Screening for Social Determinants of Health Limited at Healthcare Organizations

Most hospitals and physician practices do not screen for all five of the social determinants of health featured in the federal Accountable Health Communities model.

Most healthcare organizations are not screening for the primary social determinants of health, recent research shows.

Social determinants of health (SDOH) such as housing, food security, and transportation can have a pivotal impact on the physical and mental health of patients. By making direct investments in initiatives designed to address SDOHs and working with community partners, healthcare organizations can improve patient health in profound ways beyond the traditional provision of medical services.

"The association of patients' social needs, such as food insecurity, housing instability, utility needs, transportation needs, and experience with interpersonal violence, with health outcomes and costs is increasingly recognized by the medical community, and an increasing amount of evidence documents that physician- and hospital-led interventions addressing patients' social needs can produce improved health outcomes and less costly medical care," wrote the co-authors of the recent research, which was published in the Journal of the American Medical Association.

Prevalence of SDOH screening
 

The researchers examined data from more than 2,000 physician practices and more than 700 hospitals.

The primary focus of the research was the prevalence of screening for the five social needs highlighted in the Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities model: food insecurity, housing instability, utility needs, transportation needs, and experience of interpersonal violence.

The research generated several key data points:

• 24.4% of hospitals and 15.6% of physician practices reported screening for all five SDOHs
   
• 8.0% of hospitals and 33.3% of physician practices reported no screening for SDOHs
   
• The most commonly screened SDOH was interpersonal violence, at 75.0% of hospitals and 56.4% of physician practices
   
• The least commonly screened SDOH was utility needs, at 35.5% of hospitals and 23.1% of physician practices
   
• At physician practices, the highest rates of screening for all five SDOHs were at federally qualified health centers (29.7%), Medicaid accountable care organizations (21.8%), bundled payment participants (21.4%), and primary care improvement model participants (19.6%)
   
• Among hospitals, the highest rate of screening for all five SDOHs was conducted at academic medical centers (49.5%)

"This study’s findings suggest that most U.S. physician practices and hospitals do not report screening patients for key social needs, and it appears that practices serving more economically disadvantaged populations report screening at higher rates," the researchers wrote.

Interpreting the data
 

Availability of resources is the most likely explanation for why hospitals are more likely to screen for SDOHs than physician practices, the researchers speculated. "Hospitals may have more resources, including staffing, financial, and technological, as well as more processes, protocols, and standardization in care delivery."

Regulatory considerations are another likely factor driving higher screening rates at hospitals, the researchers wrote. "Hospitals may also be more likely to screen patients for transportation and housing needs as part of their discharge processes because they are subject to federal regulations on patient safety as part of their certification from CMS."

Lack of financial resources was reported as a major barrier to screening at both physician practices and hospitals. At physician practices that conducted no SDOH screening, 51% reported lack of financial resources as a major barrier. At hospitals that conducted no screening, 60% reported lack of financial resources as a major barrier.

Increased financial support will likely be needed to increase screening for SDOHs at hospitals and physician practices, the researchers wrote.

"Payers could allow physicians and hospitals to bill for evidence-based programs, such as FoodRx, that have been shown effective at addressing needs and improving outcomes. The CMS could consider expanding care management billing to include managing care for patients who are both at risk or have clinically complex conditions in addition to social needs."