Social needs — including food, housing, utilities, transportation — and exposure to interpersonal violence are well known to be linked to health outcomes. In fact, up to 90% of health outcomes are a result of social, behavioral, and economic factors.1 However, few hospitals or practices screen patients comprehensively for the aforementioned factors that affect health outcomes, according to a study published in JAMA Network Open.2
Although most hospitals and practices are not required to screen for social needs, many federal programs and national associations are developing tools aimed at identifying patients with social needs. The current study was designed to examine whether practices and hospitals were embracing such screening practices.
“We believe systematic use of screening is a required first step to attend to social needs and improve health; addressing resource barriers such as time, information, and money, may be a key element in supporting physicians and hospitals in efforts to screen patients for social needs,” the authors said.
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The researchers used data from the 2017 to 2018 National Survey of Healthcare Organizations and Systems (NSHOS) to assess screening for food insecurity, housing instability, utility needs, transportation needs, or interpersonal violence in primary care physician practices (n=2190) and nonspecialty acute care hospitals (n=739).
Screening for all 5 social needs was reported by 24.4% of hospitals and 15.6% of practices; 8.0% of hospitals and 33.3% of practices reported no screening at all. The most common screening was for interpersonal violence (practices: 56.4%; hospitals: 75.0%); screening for utility needs, such as heat, electricity, and gas was practiced with the least frequency (practices: 23.1%; hospitals: 35.5%).
Federally qualified health centers, bundled payment participants, primary care improvement models, and Medicaid accountable care organizations were found to have the highest rates of screening. Practices located in Medicaid expansion states as well as those with more revenue from Medicaid were also more likely to screen. Academic medical centers represented the most common type of hospital that performed screening.
Practices and hospitals that did not screen for social needs were more likely to report a lack of financial resources, time, and incentives.
“Despite the spotlight on the importance of social needs, there is little consensus about responsibility for addressing social needs or the best approaches to the problem,” the authors noted.
“Anyone in the clinical setting could advocate for practice-wide or systemwide implementation of screening or, if appropriate, they could start screening patients using a validated tool,” noted Laura Binder, a co-author of the study.
References
1. Magnan S. Social determinants of health 101 for health care: five plus five. National Academy of Medicine; Washington, DC: 2017.
2. Fraze TK, Brewster AL, Lewis VA, Beidler LB, Murray GF, Colla CH. Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals. JAMA Network Open. 2019;2(9):e1911514.
