Facing the Need: Screening Practices for the Social Determinants of Health

Abstract

Despite evidence that social factors can result in poor health outcomes, and the emergence of payment models that encourage the use non-medical interventions to improve health, many health care providers do not identify the social determinants of health within patient populations through routine screening. This Article explores the possible reasons for this inconsistency by considering screening practices in medical-legal partnerships (MLPs), the health care approach most concerned with identifying and treating the social determinants of health. Through an analysis of the results of a national survey and qualitative interviews with MLPs, we discovered that screening is not operationalized or consistent within many MLPs. We conclude that although health care providers may recognize the value of screening, they are not yet embracing the practice, perhaps because of an unspoken fear that fulsome screening identifies so many unmet social and legal needs that community-based resources cannot satisfy demand. This fear is unfounded. Approaches such as MLP demonstrate that social and legal needs can be efficiently treated through collaboration with other professionals, often within the health care setting. Nevertheless, providers must first operationalize screening to truly understand the scope of the need in their patient populations and collaborate to address those needs.

Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework

“…Due to how these social needs are major drivers of health outcomes [2,3], disparities [4,5], and health care utilization [6][7][8][9], health care systems are increasingly identifying and implementing strategies to address these modifiable unmet needs. Through embracing financial incentives to deliver value-based care [10,11] and improving management of population health [12], health care systems have increased their uptake of screening and response (S/R) approaches [13,14] to further enhance how social care is integrated into routine clinical encounters [15].…”

Evaluating the association of social needs assessment data with cardiometabolic health status in a federally qualified community health center patient population

“…Assessing and responding to social needs is a major priority for health care systems seeking to deliver high-value care and improve population health. Efforts to better integrate these activities into routine clinical encounters and standard of care [ 6 ] include social needs EHR documentation strategies [ 33 ], innovative care models [ 34 , 35 ], and cross-sector collaboration [ 36 ]. This study builds on the existing literature by evaluating the relationship between responses to a standardized social needs assessment and accepted measures of cardiometabolic health outcomes.…”

Sensitivity and Specificity of Real-World Social Factor Screening Approaches

“…First, screening questionnaires, as in this study, typically draw single or pairs of items from existing tools [8]. This practice results in strongly worded and consistent screening questions, whereas interpretation of ICD-10 Z codes could result from very different and inconsistently worded questioning by providers [44]. Hence, a possible reason for better performance.…”