Psychometric and Pragmatic Properties of Social Risk Screening Tools: A Systematic Review

Henrikson, Nora B.; Blasi, Paula R.; Dorsey, Caitlin N.; Mettert, Kayne D.; Nguyen, Matthew B.; Walsh‐Bailey, Callie; Macuiba, Jennifer; Gottlieb, Laura M.; Lewis, Cara C.

doi:10.1016/j.amepre.2019.07.012

Cited by 100 publications

(105 citation statements)

References 74 publications

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“…This method is similar to that employed in other studies assessing social need. 12 Notably, others have highlighted the lack of gold standards for SDoH screening tools, 15 the limited data on psychometric properties of screening tools, 16 the large variation in prevalence of SDoH across domains, and the variable availability of community services across geographic locations that limits those SDoH that may be amenable to intervention. 15 Given that these limitations preclude a formal validation of the tool, we felt that using questions from the scientific literature was the next best option.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of Emergency Department Social Risk and Social Needs

Molina

Manchanda

et al. 2020

WestJEM

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Introduction: 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. 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. Methods: We 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. Results: Of 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]). Conclusion: Approximately 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. [

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Section: Methodsmentioning

confidence: 99%

Prevalence of Emergency Department Social Risk and Social Needs

Molina

Manchanda

et al. 2020

WestJEM

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“…[7][8][9][10][11][12][13] Screening activities often rely on standardized screening tools that can be self-administered on paper or tablet, or orally by clinic staff. 14,15 Assistance activities can include connecting patients with on-site clinic services (eg, food boxes), community-based organizations (eg, food pantries), and government benefits (eg, food stamps). 16 While there has been emerging evidence on the implementation and effectiveness of interventions to identify and address patients' unmet social needs in the healthcare setting, 17,18 a recent National Academies of Sciences, Engineering, and Medicine (NASEM) report revealed there is little evidence on the types of workers that are used most frequently and in which settings, the specific roles of individual staff in interprofessional teams, and the training components for each workforce model.…”

Section: Introductionmentioning

confidence: 99%

Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

Sandhu

Eisenson

et al. 2021

J Prim Care Community Health

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Objectives While healthcare organizations increasingly aim to address the social determinants of health (SDOH) in the clinic setting, there is little guidance on which staff are best equipped to assume this role. The present study is a scoping review of the peer-reviewed literature to characterize workforce models used to screen for and respond to patients’ unmet social needs in ambulatory settings. Methods Four online databases were used to identify papers published until February 2021. Eligible articles were original research studies or systematic reviews that described the implementation of a standardized assessment for multiple SDOH domains and resulting activities to respond to individual patient needs (eg, referral to community resources) in ambulatory care settings. Results Of the 1569 articles identified, 65 met study eligibility criteria. Majority of studies had observational study designs (11% were randomized control trials). For screening-related activities, more articles reported using traditional healthcare staff (51%), such as medical providers, medical assistants, and front-desk staff, than social care staff (32%), such as social workers and student volunteers. In contrast, for response-related activities, more articles reported using social care staff (88%) than traditional healthcare staff (60%). While we found wide variations in specific team configurations and training for the roles, social care staff generally provided more intensive forms of assistance than traditional healthcare staff. Conclusion While this review demonstrates the breadth of models for building or deploying a workforce to integrate health and social care, it also identifies the need for rigorous research on workforce development, implementation, and effectiveness.

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“…Of those, only one suggested using a standardized social risk assessment tool (22). This may re ect the fact that more evidence is needed on social risk screening, including measure validity, implementation feasibility, and relevance for informing subsequent interventions (43). Prior research not limited to hypertension suggests patients nd social risk screening acceptable (44,45) and that clinicians are unlikely to accurately gauge patients' social risks without those assessments (46).…”

Section: Resultsmentioning

confidence: 99%

Clinical Hypertension Guidelines and Social Determinants of Health: A Systematic Scoping Review

Razon¹,

Hessler-Jones²,

Bibbins‐Domingo³

et al. 2020

Preprint

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Background Social and economic factors impact hypertension risk and control. We examined the integration of social determinants of health (SDH) guidance into adult US hypertension guidelines to explore how existing hypertension guidelines reference social care activities. Objective To explore how existing hypertension management guidelines reference social care activities. Methods Systematic scoping review of clinical guidelines (guidelines, protocols, and professional organization statements) for adult hypertension management. We employed a PubMed search strategy to identify all hypertension guidelines and protocols published in the US between 1977 and 2019. We reviewed all titles to identify the most updated versions focused on non-pregnant adults with essential hypertension. We extracted instances where included guidelines referred to social determinants of health or social care. The primary outcome was how guidelines covered topics related to social care, defined using a framework adapted from the National Academies of Sciences, Engineering and Medicine (NASEM). Results Search terms yielded 126 guidelines. Thirty-six guidelines met inclusion criteria. Of those 72% (26/36) recommended social care activities as part of hypertension management; 58% recommended clinicians change clinical care practice based on social risk information. These recommendations often lacked specific guidance around how to address SDH. When guidelines referred to specific social factors, patient financial security was the most common social determinant highlighted (n = 101). Ten guidelines (28%) did not reference social care activities. Conclusion Information about social determinants of health is included in many adult hypertension management guidelines, but few guidelines provide clear guidance for clinicians on how to identify and address actionable social risk factors in the context of care delivery.

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Psychometric and Pragmatic Properties of Social Risk Screening Tools: A Systematic Review

Cited by 100 publications

References 74 publications

Prevalence of Emergency Department Social Risk and Social Needs

Prevalence of Emergency Department Social Risk and Social Needs

Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

Clinical Hypertension Guidelines and Social Determinants of Health: A Systematic Scoping Review

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