Date of Conferral
8-7-2026
Date of Award
August 2026
Degree
Doctor of Nursing Practice (DNP)
School
Nursing
Advisor
Cara Krulewitch
Abstract
Social determinants of health (SDOH) significantly influence health outcomes, yet many primary care organizations lack a standardized, evidence-based process for identifying patients' social needs and facilitating referrals to appropriate community resources. The purpose of this Doctor of Nursing Practice executive leadership project was to develop and implement a clinical practice guideline (CPG) to standardize SDOH screening and social services referrals in a primary care setting. The practice-focused question asked whether a CPG designed to standardize social services referrals would be approved by a panel of subject matter experts using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. The project was guided by the Johns Hopkins Evidence-Based Practice Model and informed by current peer-reviewed evidence, Healthy People 2030, and Centers for Medicare & Medicaid Services guidance. The resulting evidence-based guideline provides a structured approach to SDOH screening, referral workflows, electronic health record integration, staff education, and evaluation. Anticipated outcomes include improved consistency in SDOH screening, increased referrals to community resources, enhanced care coordination, greater health equity, and reduced avoidable emergency department visits and hospital readmissions. This project supports nursing leadership by promoting evidence-based practice, interdisciplinary collaboration, and sustainable system-level improvements that enhance equitable, patient-centered care for vulnerable populations.
Recommended Citation
Pottinger, Patricia, "Development and Implementation of a Clinical Practice Guideline to Standardize Social Determinants of Health Screening and Social Services Referrals in Primary Care" (2026). Walden Dissertations and Doctoral Studies. 20597.
https://scholarworks.waldenu.edu/dissertations/20597
