Prevalence of Emergency Department Social Risk and Social Needs.

Melanie Molina,Gia Ciccolo,Carlos Camargo Jr,Caitlin Li,Emily Manchanda,Janice Espinola,Henry Ashworth,Benjamin White,Mohammad Faridi,Margaret Samuels-Kalow

doi:10.5811/westjem.2020.7.47796

Abstract

IntroductionSocial risks, or adverse social conditions associated with poor health, are prevalent in emergency department (ED) patients, but little is known about how the prevalence of social risk compares to a patient’s reported social need, which incorporates patient preference for intervention. The goal of this study was to describe the relationship between social risk and social need, and identify factors associated with differential responses to social risk and social need questions.MethodsWe conducted a cross-sectional study with 48 hours of time-shift sampling in a large urban ED. Consenting patients completed a demographic questionnaire and assessments of social risk and social need. We applied descriptive statistics to the prevalence of social risk and social need, and multivariable logistic regression to assess factors associated with social risk, social need, or both.ResultsOf the 269 participants, 100 (37%) reported social risk, 83 (31%) reported social need, and 169 (63%) reported neither social risk nor social need. Although social risk and social need were significantly associated (p < 0.01), they incompletely overlapped. Over 50% in each category screened positive in more than one domain (eg, housing instability, food insecurity). In multivariable models, those with higher education (adjusted odds ratio [aOR] 0.44 [95% confidence interval {CI}, 0.24–0.80]) and private insurance (aOR 0.50 [95% CI, 0.29–0.88]) were less likely to report social risk compared to those with lower education and state/public insurance, respectively. Spanish-speakers (aOR 4.07 [95% CI, 1.17–14.10]) and non-Hispanic Black patients (aOR 5.00 [95% CI, 1.91–13.12]) were more likely to report social need, while those with private insurance were less likely to report social need (private vs state/public: aOR 0.13 [95% CI, 0.07–0.26]).ConclusionApproximately one-third of patients in a large, urban ED screened positive for at least one social risk or social need, with over half in each category reporting risk/need across multiple domains. Different demographic variables were associated with social risk vs social need, suggesting that individuals with social risks differ from those with social needs, and that screening programs should consider including both assessments.

Highlights

Social risks, or adverse social conditions associated with poor health, are prevalent in emergency department (ED) patients, but little is known about how the prevalence of social risk compares to a patient’s reported social need, which incorporates patient preference for intervention
Different demographic variables were associated with social risk vs social need, suggesting that individuals with social risks differ from those with social needs, and that screening programs should consider including both assessments. [West J Emerg Med. 2020;21(6)152-161.]
Regarding social risk questions by domain, 23% were positive for housing insecurity, 17% for food insecurity, 9% for transportation needs, 4% for utility needs, and 17%

Summary

Introduction

Housing instability and food insecurity have been associated with increased emergency department (ED) use and hospitalizations.[4] With rising pressures to improve health outcomes, reduce healthcare costs, and the transition from fee-for-service to accountable care organizations, the US healthcare system has become increasingly focused on identifying and addressing patients’ SDoH.[5] most screening efforts have primarily focused on the outpatient clinical setting,[6,7] studies have shown an association between adverse SDoH and ED visits.[8,9] This relationship suggests that encounters in the ED may provide a unique screening opportunity, as many individuals who use the ED for healthcare may not otherwise have access to outpatient services, 8-10 and the ED may be their only opportunity for screening and intervention

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