A minority of physician practices and hospitals are screening patients for five key social needs that are associated with health outcomes, a study found.

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Lead author Taressa K. Fraze, PhD, of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., and colleagues conducted a cross-sectional survey analysis of responses by physician practices and hospitals that participated in the 2017-2018 National Survey of Healthcare Organizations and Systems. The investigators evaluated how many practices and hospitals reported screening of patients for five social needs: food insecurity, housing instability, utility needs, transportation needs, and experience with interpersonal violence. The final analysis included 2,190 physician practices and 739 hospitals.

Of physician practices, 56% reported screening for interpersonal violence, 35% screened for transportation needs, 30% for food insecurity, 28% for housing instability, and 23% for utility needs, according to the study published in JAMA Network Open.

Among hospitals, 75% reported screening for interpersonal violence, 74% for transportation needs, 60% for housing instability, 40% for food insecurity, and 36% for utility needs. Only 16% of physician practices and 24% of hospitals screened for all five social needs, the study found, while 33% of physician practices and 8% of hospitals reported screening for no social needs. The majority of the overall screening activity was driven by interpersonal violence screenings.

Physician practices that served more disadvantaged patients, including federally qualified health centers and those with more Medicaid revenue were more likely to screen for all five social needs. Practices in Medicaid accountable care organization contracts and those in Medicaid expansion states also had higher screening rates. Regionally, practices in the West had the highest screening rates, while practices in the Midwest had the lowest rates.

Among hospitals, the investigators found few significant screening differences based on hospital characteristics. Ownership, critical access status, delivery reform participation, rural status, region, and Medicaid expansion had no significant effects on screening rates, although academic medical centers were more likely to screen patients for all needs compared with nonacademic medical centers.

The study authors wrote that doctors and hospitals may need more resources and additional processes to screen for and/or to address the social needs of patients. They noted that practices and hospitals that did not screen for social needs were more likely to report a lack of financial resources, time, and incentives as major barriers.

To implement better screening protocols and address patients’ needs, the investigators wrote that doctors and hospitals will need financial support. For example, the Centers for Medicare & Medicaid Services should consider expanding care management billing to include managing care for patients who are both at risk or have clinically complex conditions in addition to social needs.

Dr. Fraze and three coauthors reported receiving grants from the Agency for Healthcare Research and Quality during the conduct of the study. Dr. Fraze also reported receiving grants from the Robert Wood Johnson Foundation during the conduct of the study and receiving grants as an investigator from the 6 Foundation Collaborative, Commonwealth Fund, and Centers for Disease Control and Prevention. One coauthor reported receiving grants from the National Institute on Aging/National Institutes of Health during the conduct of the study.

SOURCE: Fraze TK et al. JAMA Netw Open. 2019 Sep 18. doi: 10.1001/jamanetworkopen.2019.11514.