Healthcare providers are increasingly asking patients about whether they have enough food to eat or a safe place to live as the recognize that social factors contribute to poorer health outcomes, but there are still ways patients slip through the cracks.
A 2019 survey of more than 750 hospitals and more than 700 physician practices across the U.S. from June 2017 through August 2018 found the majority of those providers screened for at least one social need.
Many experts see screening for social determinants of health as an important first step for healthcare providers to address the individual needs of a patient and gain valuable insights on managing the health of their communities.
But the strategies most healthcare providers use to screen for social determinants of health can miss significant portions of patients who might be in need of support.
"Everybody has social determinants and they all need things," said DeAnna Minus-Vincent Minus-Vincent, corporate senior vice president for social impact and community investment at RWJBarnabas Health.
The health system recently launched an initiative, "Health Beyond the Hospital", which will create a social continuum of care network that screens patients for social needs, provides referrals to support services with local partners, and follows up with those organizations and patients to make sure their needs were met.
While other providers have launched similar models in recent years to target social needs, Minus-Vincent said many of those programs have focused on identifying the social needs among specific populations like low-income patients or high utilizers. She said the RWJBarnabas program plans to screen all their patients for social determinants.
Universal screening provides RWJBarnabas with better population-level data on where the most prevalent needs are throughout its service area, which allows the health system to develop more targeted outreach services.
The plan also eliminates the risk of a clinician's implicit bias influencing which patients they screen. It can reduce the stigma that can be associated with singling out certain patients.
"As an African-American woman, I've been in situations where I've been treated in such a way or asked questions mistakenly because someone may have thought I needed help where potentially a white counterpart hasn't," Minus-Vincent said.
While only a handful of stakeholders have developed initiatives like RWJBarnabas' program, efforts to address social determinants of health have prompted more healthcare providers to develop larger-scale approaches to addressing systemic social needs.
But it's unclear why more hospitals have yet to adopt similar universal screening programs as a routine practice of care delivery.
The majority of providers who screen for social determinants target specific populations. A 2017 survey of 300 hospitals conducted by consulting firm Deloitte found while 88% reported screening for social determinants, the vast majority focused their resources on identifying and providing support to low-income inpatients and high utilizers of medical services.
"One of the most challenging things right now is that in general, institutions can't even define their high-risk patients," said Dr. Pablo Buitron de la Vega, clinician lead of Boston Medical Center's THRIVE Social Determinants of Health Program.
BMC began universally screening patients for social needs in 2016 as a pilot project that scaled up a pediatric department screening tool. The THRIVE model was developed to be included within the health system's electronic health record to document patients' social needs and provide referral information for area resources for support.
Kate Sommerfeld, president of Toledo-based ProMedica's Social Determinants of Health Institute, said the health system's universal SDOH screening program began in 2015 with pregnant mothers and then expanded to include all ambulatory patients in 2017. This year it started including inpatients.
But ProMedica's overall effort to screen for social needs began in 2013 by asking patients about food insecurity. Since then, the health system has screened more than a hundred thousand patients a year across all of its services lines for a total of more than million.
Sommerfeld said universal screening has enabled ProMedica to visualize patient and community-level risk profiles of need and facilitate programs and responses to address emerging gaps. The model connects food-insecure patients with local food pantries and also led to new interventions, such as an education program connecting at-risk mothers with community health workers to reduce infant mortality rates.
"We believe that providing universal screening and using the data points to guide our intervention strategies is important," Sommerfeld said. "Rarely does a patient screen positive in just one domain. It is multi-factorial, so broadening the screen to 14 domains allows us to have optics on the availability of community resources to address those needs."