324EMF Prevalence of Health-Related Social Needs in the Emergency Department

Abstract

The emergency department (ED) cares for vulnerable populations whose members often have unmet health-related social needs (HRSN). Recent recommendations for standardized screening focus on five domains: housing instability, food insecurity, transportation needs, utility needs, and. Our objective in this study was to evaluate the extent of HRSN among patients in a large urban ED. We designed a screening tool for HRSN using publicly available questions in the five domains outlined by the National Academy of Medicine. We then conducted a cross-sectional study with 48 hours of time-shift sampling (24 hours of weekday and 24 hours of weekend) in each of the five areas of a large urban ED. Bilingual (English-Spanish) research assistants screened patients for eligibility, consenting patients or parents of pediatric patients completed a brief demographic questionnaire and the HRSN assessment. We used standard descriptive statistics to describe the prevalence of HRSN. Of the 614 participants who were screened, 483 (79%) were eligible and 276 (57%) consented to and completed the survey. The primary reasons for ineligibility included intoxication and medical acuity. Eligible patients who declined participation cited disinterest, pain, or were pulled away for a diagnostic procedure. Of the 276 participants, 81 (29%) had completed only elementary/high school education, and 120 (49%) had public or no health insurance. Twenty-six participants (9%) chose to complete the survey in Spanish. Overall, 103 patients (37%) screened positive for an HRSN. By domain, 61 (23%) were positive for housing insecurity; 45 (17%) were positive for food insecurity; 24 (9%) reported transportation needs; 11 (4%) reported utility needs, and 45 (17%) reported safety concerns. Results for the individual questions are shown in the Table. These data demonstrate that HRSN screening is feasible in ED patients, and revealed that more than one in three screened patients (37%) have at least one HRSN. These needs are unlikely to be identified during routine clinical care yet may significantly affect a patient’s health care needs and utilization. Further work is needed to determine optimal screening and linkage strategies to successfully connect patients to community organizations.Tabled 1Prevalence of health-related social needs by question and by groupn%1a. In the last month, have you slept outside, in a shelter or in a place not meant for sleeping?1871b. In the last month, have you had concerns about the condition or quality of your housing?35131c. In the last 12 months, how many times have you or your family moved from one home to another?1661d. Are you worried that in the next 2 months, you may not have stable housing?38142a. Within the past 12 months, have you worried whether your food would run out before you got money to buy more?35132b. Within the past 12 months, the food you bought just didn't last and you didn't have money to get more.34133a. How often is it difficult to get transportation to or from your medical or follow-up appointments?2073b. How often is it difficult to get transportation to or from your other non-medical activities (work, school, etc.)?1974. In the past 12 months, have you had any utility (electric, gas, water or oil) shut off for not paying your bills?1145a. Do you have any concerns about safety in your neighborhood?40155b. Are you afraid you might be hurt in your apartment building or house?135 Open table in a new tab