Abstract
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. To characterize screening for social needs by physician practices and hospitals. 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. Organizational characteristics, including participation in delivery and payment reform. Self-report of screening patients for food insecurity, housing instability, utility needs, transportation needs, and experience with interpersonal violence. 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). 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.
Highlights
High-quality, coordinated medical care alone cannot ensure that patients achieve optimal health outcomes.[1]
The Centers for Medicare & Medicaid Services (CMS) created the Accountable Health Community model, and multiple states have recently established waivers that allow Medicaid dollars to pay for services that support patients’ social needs.[13,14,15]. As part of their campaigns to encourage physicians and hospitals to screen patients for social needs, the American Academy of Family Physicians,[7] National Association of Community Health Centers,[9] and the American Academy of Pediatrics[8] have each developed tools aimed at helping physicians and hospitals identify patients with social needs and offer them support to avail themselves of community resources
Screening rates varied by social need: 56.4% of physician practices reported screening for interpersonal violence, 35.4% for transportation needs, 29.6% for food insecurity, 27.8% for housing instability, and 23.1% for utility needs
Summary
High-quality, coordinated medical care alone cannot ensure that patients achieve optimal health outcomes.[1]. Systematically identifying and addressing patients’ social needs has not been part of medical practice.[1] physicians and hospitals may recognize the association of social needs with patient outcomes, they may be reluctant to assume responsibility for social needs given the complexity of addressing these needs coupled with increasing clinical demands.[10,11] Despite these challenges, the movement toward value-based care has accelerated the focus of physicians and hospitals on population and whole-person health by incentivizing physicians and hospitals to address needs that may be outside of traditional clinical care yet associated with health spending.[3,12] state and federal policymakers as well as private payers are designing programs aimed at integrating social services into clinical care. Despite support by physician and hospital groups coupled with delivery reform from payers, little is known about the extent to which these initiatives have diffused into care delivery
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