Document Type
DNP Project
Publication Date
2026
Degree Name
Doctor of Nursing Practice
Abstract
Background: Social determinants of health (SDOH) significantly influence health outcomes, particularly among underserved populations receiving care in federally qualified health centers (FQHCs). At a Federally Qualified Health Center (FQHC) in an urban community in the Northeast, the PRAPARE screening tool was implemented to assess patients’ social needs; however, internal evidence revealed that although screening was completed for many patients, providers frequently did not review the results or document interventions in the electronic health record (EHR). Additionally, documentation of SDOH-related ICD-10 Z-codes and PRAPARE screenings were inconsistent. External evidence indicates that integrating provider education, structured workflows, and EHR prompts can improve the use of SDOH screening tools.
Objective: The purpose of this quality improvement project was to enhance provider engagement with PRAPARE screening results and improve documentation and processes for SDOH-related needs among adult patients receiving primary care services at a community health center.
Methods: Guided by the Iowa Model for Evidence-Based Practice and Lewin’s Change Theory, a 12-week quality improvement intervention was implemented at a Federally Qualified Health Center (FQHC) in the Northeast. The intervention included staff education sessions, and EHR prompts to alert providers to completed PRAPARE screenings. Medical assistants administered the PRAPARE screening during patient intake, and providers were prompted to review results, document appropriate ICD-10 Z-codes. Data were collected through pre- and post-training staff surveys, and EHR audits. Process measures included staff participation and provider review of PRAPARE results, while outcome measures included Z-code documentation and screening completion. Data were collected through pre- and post-training staff surveys (9 staff completed both surveys due to technical issues with QR code access) and EHR audits. Process measures included staff participation and provider review of PRAPARE results, while outcome measures included Z-code documentation and screening completion.
Results: Staff awareness and confidence in using the PRAPARE tool improved following the educational intervention. Provider review of PRAPARE screening results increased from less than 30% at baseline to approximately 45% by week 12. Documentation of SDOH-related ICD-10 Z-codes increased from less than 10% to approximately 22%. Additionally, EHR data showed SDOH screening completion rates increased from approximately 7% pre-intervention to 15% post-intervention, more than doubling following the educational training. Monthly Z-code submission data showed stabilization following the intervention, with submissions averaging 19 per month post-training compared to a low of 2 in the month immediately prior to training.
Conclusion: Integrating provider education, EHR prompts, screenings improved engagement with SDOH screening and documentation processes. Although the project did not fully achieve all targeted goals, the intervention demonstrated meaningful improvements in provider engagement and care coordination. Continued workflow integration, staff education, and ongoing quality monitoring may further strengthen the sustainability and effectiveness of SDOH screening initiatives in primary care settings.
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Recommended Citation
D'Souza, A. (2026). Enhancing social determinants of health screening using the PRAPARE tool in a community health center: A quality improvement project [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.