Addressing Health-Related Social Needs in Diabetes Care: Increasing Our Stride Toward Health Equity?

Patient-reported health-related social needs obtained at the bedside and outcomes after elective major surgery.

This study explores the relationship between health-related social needs and cervical cancer screening among community health center patients. The authors analyzed data from March 2020 to March 2023 for women aged 24-64 years seeking care at a community health center across 19 states that share an electronic data repository. Health-related social needs were assessed through (1) health-related social needs questionnaire, (2) health-related social needs questionnaire + keyword search for health-related social needs (expanded health-related social needs capture), and (3) a homelessness flag. The authors examined the completion of cervical cancer screening before and after health-related social need screenings in unadjusted and adjusted analyses. Most women identified as Hispanic/Latino, were aged between 31 and 64 years, were single, had Medicaid, and had an income <100% federal poverty level. Food insecurity was the most common health-related social need, with a 13% prevalence. Before health-related social need screenings, 64% of the population completed cervical cancer screening. Women with health-related social needs had no significant differences in cervical cancer screening from those without; however, when stratified by age, women aged 24-30 years with health-related social needs reported higher cervical cancer screening rates than those without (71% vs 68%, p<0.01), and women aged 31-64 years with health-related social needs had lower cervical cancer screening rates than those without (60% vs 62%, p<0.01). After health-related social need screenings, the rates of cervical cancer screening were similar by health-related social need, regardless of age. Our findings showed that health-related social needs were associated with cervical cancer screening, with differences varying by age group and type of social need. Women aged 24-30 years with food insecurity had significantly higher cervical cancer screening rates than those without health-related social needs, and women of any age with housing insecurity had significantly lower cervical cancer screening rates than those without health-related social needs. After health-related social need screenings, disparities persisted among women who had experiences of homelessness.

In recent years, hospitals and health systems have reported increasing rates of screening for patients' individual and community social needs, but few studies have explored the national landscape of screening and interventions directed at addressing health-related social needs (HRSNs) and social determinants of health (SDOH). To evaluate the associations of hospital characteristics and area-level socioeconomic indicators to quantify the presence and intensity of hospitals' screening practices, interventions, and collaborative external partnerships that seek to measure and ameliorate patients' HRSNs and SDOH. This cross-sectional study used national data from the American Hospital Association Annual Survey Database for fiscal year 2020. General-service, acute-care, nonfederal hospitals were included in the study's final sample, representing nationally diverse hospital settings. Data were analyzed from July 2022 to February 2023. Organizational characteristics and area-level socioeconomic indicators. The outcomes of interest were hospital-reported patient screening of and strategies to address 8 HRSNs and 14 external partnership types to address SDOH. Composite scores for screening practices and external partnership types were calculated, and ordinary least-square regression analyses tested associations of organizational characteristics with outcome measures. Of 2858 US hospital respondents (response rate, 67.0%), most hospitals (79.2%; 95% CI, 77.7%-80.7%) reported screening patients for at least 1 HRSN, with food insecurity or hunger needs (66.1%; 95% CI, 64.3%-67.8%) and interpersonal violence (66.4%; 95% CI, 64.7%-68.1%) being the most commonly screened social needs. Most hospitals (79.4%; 95% CI, 66.3%-69.7%) reported having strategies and programs to address patients' HRSNs; notably, most hospitals (52.8%; 95% CI, 51.0%-54.5%) had interventions for transportation barriers. Hospitals reported a mean of 4.03 (95% CI, 3.85-4.20) external partnership types to address SDOH and 5.69 (5.50-5.88) partnership types to address HRSNs, with local or state public health departments and health care practitioners outside of the health system being the most common. Hospitals with accountable care contracts (ACCs) and bundled payment programs (BPPs) reported higher screening practices (ACC: β = 1.03; SE = 0.13; BPP: β = 0.72; SE = 0.14), interventions (ACC: β = 1.45; SE = 0.12; BPP: β = 0.61; SE = 0.13), and external partnership types to address HRSNs (ACC: β = 2.07; SE = 0.23; BPP: β = 1.47; SE = 0.24) and SDOH (ACC: β = 2.64; SE = 0.20; BPP: β = 1.57; SE = 0.21). Compared with nonteaching, government-owned, and for-profit hospitals, teaching and nonprofit hospitals were also more likely to report more HRSN-directed activities. Patterns based on geographic and area-level socioeconomic indicators did not emerge. This cross-sectional study found that most US hospitals were screening patients for multiple HRSNs. Active participation in value-based care, teaching hospital status, and nonprofit status were the characteristics most consistently associated with greater overall screening activities and number of related partnership types. These results support previously posited associations about which types of hospitals were leading screening uptake and reinforce understanding of the role of hospital incentives in supporting health equity efforts.

The purpose of this clinical focus article is to describe the use of the Accountable Health Communities health-related social needs screening tool for speech-language pathologists (SLPs) while highlighting two case studies of children with traumatic brain injury. This article provides an overview of social determinants of health (SDOH) and health-related social needs with a primary focus on children with traumatic brain injury. It aims to inform and prepare clinicians to use a health-related social needs screening tool, as they can be directly addressed and mitigated with adequate community resources. SLPs are in the unique position to consider and understand their clients' SDOH, providing support or referral as needed if there are areas of social need or social risk factors. SLPs could screen for health-related social needs by using the Accountable Health Communities health-related social needs screening tool subsequently advocating for patient-centered, holistic care. SLPs could individualize best care practice for their patients by engaging in interprofessional practice, making appropriate assessment and treatment modifications, and referring to related professionals.

Background:Addressing social determinants of health in patient care helps hospitals better understand the non-medical factors influencing patients’ health outcomes.Objectives:The objective of this study was to evaluate the correlation between hospital characteristics, county determinants, and the systematic recording of health-related social needs among general and surgical acute care hospitals in the United States. It focused on the hospital’s routine collection of data on patients’ health-related social needs, such as transportation, housing, and food insecurity.Design:A cross-sectional retrospective study design was utilized.Methods:All hospitals that completed the American Hospital Association Annual survey (n = 2254) were included in the study. A series of multinomial logistic analyses were conducted.Results:The relative risk of hospitals routinely collecting health-related social needs data is 67% lower in for-profit hospitals and 90% higher in not-for-profit hospitals compared to government hospitals. Hospitals that are part of a system are 1.5 times more likely to routinely collect data on social needs. In addition, counties with higher household income have a statistically significant higher relative risk of hospitals collecting data on social needs, though the magnitude of the difference is small. The relative risk of hospitals collecting social needs data, but not routinely, is 2 times higher in teaching hospitals and 3 times higher among system hospitals.Conclusion:Our research strongly indicates that understanding and addressing these inherent hospital-related factors are essential for effectively integrating social determinants of health into routine healthcare data collection practices. Establishing more robust guidelines and standardization in these practices may enhance hospitals’ ability to document and utilize health-related social needs information, ultimately driving improved patient outcomes and supporting more equitable care.

ICD-10 Z-Code Health-Related Social Needs and Increased Healthcare Utilization

Health-related social needs (HRSNs) are linked to worse health outcomes and increased low-value acute care use. HRSN impact on hospital length of stay (LOS) and other inpatient metrics remain underexplored. We aimed to evaluate the association between HRSNs and adverse health care utilization outcomes. Our primary outcome was LOS. Secondary outcomes included pediatric intensive care unit (PICU) admission, 30-day readmission, and 30-day emergency department (ED) revisit. This is a retrospective cohort study of hospitalized pediatric patients screened for HRSNs between November 1, 2023, and October 31, 2024. Multivariable mixed-effects regression was used to assess the association between outcomes and having 1 or more HRSNs. Models were adjusted for sociodemographic characteristics, presence of medical complexity, admission month, and exposure to community health workers. An exploratory analysis assessed interactions between medical complexity and HRSNs on LOS. Among 3645 encounters, 1049 (28.8%) reported at least 1 HRSN. In adjusted models, having 1 or more HRSNs was associated with a 0.45-days-longer LOS (95% CI, 0.23-0.67) and 38% higher odds of PICU admission (adjusted odds ratio, 1.38; 95% CI, 1.02-1.86). There were no significant associations with 30-day readmission or ED revisit. Patients with both 1 or more HRSNs and medical complexity had an estimated 3.13-days-longer LOS (95% CI, 2.48-3.78) than those with neither. Unmet HRSNs are associated with longer LOS and greater likelihood of PICU admission. Children with medical complexity who have unmet social needs may particularly benefit from targeted social care interventions. Future work should assess the impact of such interventions on key hospitalization measures.

With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6.0 trillion per year by 2027, policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to heath, there is growing recognition that social determinants of health are important influences on population health. Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health. Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs. To explore the potential effect of addressing non-medical health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the National Academies of Science, Engineering, and Medicine held a full-day public workshop titled Investing in Interventions that Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, healthy systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical health-related social needs. This publication summarizes the presentations and discussions from the workshop.

Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients.Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening.Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions.Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.

Objective: There are known disparities in access to and utilization of pediatric health care and mental health care. Unmet health-related social needs, particularly food insecurity and housing instability, have previously been associated with poorer health and mental health outcomes as well as reduced utilization of preventive care. The relation between health-related social needs and pediatric mental health care utilization, however, has been largely unexplored. Method: Using a cross-sectional design with retrospective data extraction through a large, urban medical center’s clinical data warehouse, this study investigated whether parent-reported unmet health-related social needs were associated with differences in the relationship between parent-reported child psychiatric symptoms and pediatric mental health care utilization. Additionally, the association between pediatric mental health care utilization and visiting an on-site food pantry, offered to address food insecurity, was assessed. Results: Consistent with the hypotheses, parent report of higher child psychiatric symptoms was associated with more pediatric mental health care utilization (rate ratio [ RR] = 1.17, p &lt; .001), and as parents reported more unmet health-related social needs, this relationship weakened ( B = −.015, p &lt; .001). Although the use of the on-site food pantry had no effect on the relationship between reported child symptoms and pediatric mental health care utilization, the use of the food pantry did independently correspond to an increased rate of mental health care visits ( RR = 2.25, p = .002). Conclusions: These findings suggest that screening for and addressing unmet health-related social needs may be an important part of the effort to reduce pediatric mental health service disparities. Implications for Impact Statement This study found that as families’ health-related social needs, such as food insecurity and unstable housing, increased in number, children and adolescents with more psychiatric symptoms accessed less mental health care. Furthermore, the findings indicated that pediatric mental health care utilization at an urban medical center rose along with visits to an on-site food pantry. Identifying and addressing families’ health-related social needs may help to reduce disparities in who receives needed mental health care services. Within clinical practice, this can be achieved through universal health-related social needs screening and the provision of relevant referrals and resources.

Associations between Health-Related Social Needs and Postpartum Linkage to Care.

Screening for Health-Related Social Needs: American College of Preventive Medicine's Practice Statement.

From Screening to Support: Exploring Patient Engagement With Health-Related Social Needs Services

Background: Screening for health-related social needs (HRSNs) is recommended as part of standard diabetes care given the strong impact of social factors on health outcomes. We implemented a HRSN screen at routine diabetes clinic visits and assessed differences between youth with positive and negative screens. Methods: A 6-item questionnaire was adapted from the Accountable Health Communities Health-related Social Needs Screening Tool to screen for HRSNs in 4 domains: 1) housing, 2) utilities 3) transportation, 4) food. A positive screen was defined as any positive response to a HRSN. Cross-sectional data was analyzed using chi-square or independent t-test. Results: There were 4,119 screens completed over 14 months with 10% (n=438) being positive. The majority of positive screens were positive for a single HRSN (73%), most commonly food insecurity (66%). Table 1 compares youth with positive vs. negative screens. A higher percentage of positive screens was found in minority youth (p&amp;lt;0.001), while a lower percentage was seen in youth with commercial insurance (p&amp;lt;0.001) and diabetes technology use (p&amp;lt;0.001). Most indicators of diabetes control were less optimal in the positive screen group. Summary: Youth with HRSNs are at risk for adverse health outcomes. Screening for HRSNs can be incorporated into routine pediatric diabetes care and may help enhance health equity in delivery of care. Disclosure K.Halpin: None. J.D.Colvin: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. E.L.Dewit: None. S.Relan: None. J.Roghair: None. R.Pomerantz: None. K.Evans: None. M.S.Barnes: None. H.Feingold: None. S.N.Jacob: None. C.Winterer: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.