Most Hospitals and Physicians Fail To Screen for Social Factors That May Impact Patient Health

Most hospitals and physician practices don’t screen patients for social determinants of health such as food insecurity, housing instability, utility and transportation needs and interpersonal violence, according to an AHRQ-funded study in JAMA Network Open. Surveys administered from June 2017 to August 2018 to 2,190 physician practices and 739 hospitals found that about 16 percent of practices and 24 percent of hospitals reported screening for all five factors, while 8 percent of hospitals and 33 percent of practices screened for none. The most commonly screened-for factor was interpersonal violence, occurring at 75 percent of hospitals and 56 percent of practices. Almost 50 percent of academic hospitals reported screening, compared with 23 percent of hospitals overall. Facilities that serve economically disadvantaged patients were more likely to screen. Access the abstract.

2019 Sep 4;2(9):e1911514. doi: 10.1001/jamanetworkopen.2019.11514.

Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals.

Fraze TK1, Brewster AL2, Lewis VA3, Beidler LB1, Murray GF1, Colla CH1.

Author information

1: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.
2: School of Public Health, Division of Health Policy and Management, University of California, Berkeley.
3: Gilling School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill.

Abstract

IMPORTANCE:

Social needs, including food, housing, utilities, transportation, and experience with interpersonal violence, are linked to health outcomes. Identifying patients with unmet social needs is a necessary first step to addressing these needs, yet little is known about the prevalence of screening.

OBJECTIVE:

To characterize screening for social needs by physician practices and hospitals.

DESIGN, SETTING, AND PARTICIPANTS:

Cross-sectional survey analyses of responses by physician practices and hospitals to the 2017-2018 National Survey of Healthcare Organizations and Systems. Responses were collected from survey participants from June 16, 2017, to August 17, 2018.

EXPOSURES:

Organizational characteristics, including participation in delivery and payment reform.

MAIN OUTCOMES AND MEASURES:

Self-report of screening patients for food insecurity, housing instability, utility needs, transportation needs, and experience with interpersonal violence.

RESULTS:

Among 4976 physician practices, 2333 responded, a response rate of 46.9%. Among hospitals, 757 of 1628 (46.5%) responded. After eliminating responses because of ineligibility, 2190 physician practices and 739 hospitals remained. Screening for all 5 social needs was reported by 24.4% (95% CI, 20.0%-28.7%) of hospitals and 15.6% (95% CI, 13.4%-17.9%) of practices, whereas 33.3% (95% CI, 30.5%-36.2%) of practices and 8.0% (95% CI, 5.8%-11.0%) of hospitals reported no screening. Screening for interpersonal violence was most common (practices: 56.4%; 95% CI, 53.3%-2 59.4%; hospitals: 75.0%; 95% CI, 70.1%-79.3%), and screening for utility needs was least common (practices: 23.1%; 95% CI, 20.6%-26.0%; hospitals: 35.5%; 95% CI, 30.0%-41.0%) among both hospitals and practices. Among practices, federally qualified health centers (yes: 29.7%; 95% CI, 21.5%-37.8% vs no: 9.4%; 95% CI, 7.2%-11.6%; P < .001), bundled payment participants (yes: 21.4%; 95% CI, 17.1%-25.8% vs no: 10.7%; 95% CI, 7.9%-13.4%; P < .001), primary care improvement models (yes: 19.6%; 95% CI, 16.5%-22.6% vs no: 9.6%; 95% CI, 6.0%-13.1%; P < .001), and Medicaid accountable care organizations (yes: 21.8%; 95% CI, 17.4%-26.2% vs no: 11.2%; 95% CI, 8.6%-13.7%; P < .001) had higher rates of screening for all needs. Practices in Medicaid expansion states (yes: 17.7%; 95% CI, 14.8%-20.7% vs no: 11.4%; 95% CI, 8.1%-14.6%; P = .007) and those with more Medicaid revenue (highest tertile: 17.1%; 95% CI, 11.4%-22.7% vs lowest tertile: 9.0%; 95% CI, 6.1%-11.8%; P = .02) were more likely to screen. Academic medical centers were more likely than other hospitals to screen (49.5%; 95% CI, 34.6%-64.4% vs 23.0%; 95% CI, 18.5%-27.5%; P < .001).

CONCLUSIONS AND RELEVANCE:

This study's findings suggest that few US physician practices and hospitals screen patients for all 5 key social needs associated with health outcomes. Practices that serve disadvantaged patients report higher screening rates. The role of physicians and hospitals in meeting patients' social needs is likely to increase as more take on accountability for cost under payment reform. Physicians and hospitals may need additional resources to screen for or address patients' social needs.