Fewer than one-quarter of U.S. hospitals and physician practices screen patients for all five of what CMS considers five key social determinants of health, according to a study published Wednesday in JAMA Network Open.
For the study, Dartmouth University researchers looked at survey responses from 2,333 physician practices and 757 hospitals from June 2017 to August 2018 to determine whether they had a system in place to screen patients for the five social determinants of health as outlined by CMS' Accountable Health Communities model:
- Food insecurity;
- Housing instability;
- Interpersonal violence;
- Transportation needs; and
- Utility needs.
The researchers noted that social risks are linked to poor treatment adherence, higher care costs, and overall worse health outcomes. In some cases, up to 90% of a patient's health outcomes can be a result of social, behavioral, and economic factors.
As such, the researchers sought to examine the state of social risk screening among U.S. providers, and according to Modern Healthcare this is one of the first studies on the topic.
The study revealed that only 24.4% of hospitals and 15.6% of physician practices screened patients for all five social determinants of health as outlined by CMS. Most providers reported screening for at least one social need, but 33.3% of physician practices and 8% of hospitals reported screening for no social needs.
- 75% screened for interpersonal violence;
- 74% screened for transportation needs;
- 60.1% screened for housing insecurity;
- 39.8% screened for food insecurity; and
- 35.5% screened for utility needs.
Among physician practices:
- 56.4% screened for interpersonal violence;
- 35.4% screened for transportation needs;
- 29.6% screened for food insecurity;
- 27.8% screened for housing instability; and
- 23.1% screened for utility needs.
The researchers observed differences in screening practices based on the patient populations providers served. For instance, practices that served more disadvantaged patients, bundled payment participants, and Medicaid accountable care organizations were more likely to screen for all five social needs. Academic medical centers were also more likely to screen for all five needs than non-academic medical centers, the study found.
In a commentary on the study, Rachel Gold of the Kaiser Permanente Center for Health Research Northwest and Laura Gottlieb of the Department of Family and Community Medicine at the University of California San Francisco said health care providers may hesitate to adopt the screening practices out of concern that it would be difficult to address the social issues a patient is experiencing.
As a result, Gold and Gottlieb explained, "Future research should not only elucidate barriers to the implementation of social risk screening but also surface evidence-based methods for overcoming them" (Meyer, Modern Healthcare, 9/18; Owens, "Vitals," Axios, 9/19; Lewis, Medscape, 9/18; Fraze et al., JAMA Open Network, 9/18).