It’s Time to Get Back to the Basics on Social Determinants

Some hospitals and health systems are taking steps to address social determinants of health (SDOH) in their communities by funding affordable housing, partnering with rideshare companies and food pantries to meet local needs. A recent study published in the Journal of the American Medical Association, however, may indicate a greater need for a more fundamental task — screening all patients for food insecurity, housing instability, utility needs, transportation needs and interpersonal violence.

The survey found that only 24% of responding hospitals and 16% of physician practices are screening for all five social determinants. The survey, conducted among nearly 5,000 hospitals and physician practices, also found that one-third of physician practices and 8% of hospitals reported no screening. The survey generated a 47% response rate.

Practices that serve economically disadvantaged patients, those that take part in payment reform models and academic medical centers were most likely to screen for all five factors. The survey results found wide disparities in screening rates among hospitals and physician practices for each of the five factors, including:

• Hospitals were more than twice as likely as physician practices to screen for interpersonal violence and transportation needs.
• 40% of hospitals screen for housing instability vs. 30% of physician practices.
• 36% of hospitals screen for utility needs vs. 23% of physician practices.

Meanwhile, a Kaiser Permanente study published in June showed that nearly 93% of respondents said they wanted their doctors to ask them about access to meals; 83% said they wanted to be asked about safe and stable housing.

A crucial step to addressing patients’ social needs is having a conversation to fully understand what patients experience beyond the walls of the care setting. AHA's The Value Initiative recently launched a new report and tools to help in this effort. “Screening for Social Needs: Guiding Care Teams to Engage Patients” covers strategic considerations for implementing a screening program. The resources also provide tips for tailoring screenings to hospitals’ unique communities and a list of national organizations that can help connect patients with local resources.