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Study finds lack of social needs screening at health care facilities

Valley News Staff Writer
Published: 9/23/2019 9:58:26 PM
Modified: 9/23/2019 9:58:23 PM

LEBANON — Though people’s health outcomes are often determined by social factors outside of their medical care, many physicians and hospitals do not screen for them, according to a new study led by researchers at the Dartmouth Institute for Health Policy and Clinical Practice.

The study published last week online in the JAMA Network Open examined whether physician practices and hospitals in the U.S. ask patients if they’re experiencing housing instability, food insecurity, utility needs, transportation needs or interpersonal violence, challenges that are priorities for the Centers for Medicare and Medicaid Services, among other health care groups and payers.

“Although across stakeholders there is swelling momentum for addressing social needs, our study findings suggest that most physician practices and hospitals are not screening across 5 key social needs associated with health outcomes,” wrote the authors, who were led by Dartmouth Institute research scientist Taressa Fraze.

Just 24% of hospitals and about 16% of physician practices reported screening for all five social factors, while 33% of physician practices and 8% of hospitals did not screen for any of them.

Most practices screen for at least one social factor and most often that was interpersonal violence. Screening for utility needs was least prevalent.

“Getting those basic numbers was important,” Fraze said in a phone interview on Monday.

The study, which analyzed data from self-reported surveys of 2,190 physician practices and 739 hospitals, was one of the first to describe how universally the questions are asked. It used data from the National Survey of Healthcare Organizations and Systems, OneKey database, the American Hospital Association’s annual survey and the U.S. Census to determine which providers were screening for the five factors between June 2017 and August 2018.

“One critical, albeit unsurprising, finding is that reimbursement is indeed associated with uptake of social risk screening,” according to a commentary by Rachel Gold, of Kaiser Permanente Center for Health Research Northwest, and Laura Gottlieb, of the Department of Family and Community Medicine at the University of California, San Francisco, that also was published in JAMA Network Open last week.

The study authors found that practices participating in delivery and payment reform were more likely to screen than those that did not.

This was true of payment reform efforts such as participation in accountable care organizations — which pay providers on a per patient basis rather than a fee-for-service model — and Medicaid expansion.

The Green Mountain Care Board, which is overseeing Vermont’s effort to improve care and reduce costs, encourages providers to track these needs, sometimes referred to as “social determinants of health,” said Susan Barrett, the board’s executive director.

Meeting the state’s goals related to reducing drug overdose deaths and suicide and improving the management of chronic illnesses will require that providers ask these questions, she said.

“We want them to do that; that’s how we address the highest costs,” she said. “More importantly, it’s the right thing for people to do.”

The study authors wrote that hospitals may be able to do more screening than physician practices because they have more resources, including staff, money and technology, as well as more standardization in how they provide care. In addition, hospitals also may be required to screen patients for transportation and housing needs as part of discharge planning.

Among hospitals, the survey found that academic medical centers were more likely than non-academic medical centers to screen.

The study also highlights some of the barriers to screening such as hesitancy among providers to screen for needs they themselves may not be able to address and finding time to fit screening into already busy schedules.

“If there’s one really big take-home message,” Fraze said. “This work is really hard.”

Fraze and her team now have interviewed dozens of health care leaders about how they ask the questions and respond to the needs they find. Fraze said they plan to publish what they’ve learned about “what works well” in the future.

Nora Doyle-Burr can be reached at or 603-727-3213.

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