From the Journals

Most practices not screening for five social needs

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Needed: Strategies for overcoming screening barriers

While momentum for social risk screening is growing nationally, the recent study by Fraze et al. illustrates that screening across multiple domains is not yet common in clinical settings, wrote Rachel Gold, PhD, of Kaiser Permanente Center for Health Research Northwest in Portland, Ore.

In an editorial accompanying the study, Dr. Gold and coauthor Laura Gottlieb, MD, an associate professor of family and community medicine at the University of California, San Francisco, wrote that a critical finding of the study is that reimbursement is associated with uptake of social risk screening (JAMA Network Open. 2019 Sep 18. doi: 10.1001/jamanetworkopen.2019.11513). Specifically, the analysis found that screening for social risks is more common in care settings that receive some form of payment to support such efforts, directly or indirectly.

“This finding aligns with other research showing that altering incentive structures may enhance the adoption of social risk screening in health care settings,” Dr. Gold and Dr. Gottlieb wrote. “But these findings are just a beginning. Disseminating and sustaining social risk screening will require a deep understanding of how best to structure financial and other incentives to optimally support social risk screening; high-quality research is needed to help design reimbursement models that reliably influence adoption.”

Further research is needed not only to explain challenges to the implementation of social risk screening, but also to reveal the best evidence-based methods for overcoming them, the authors wrote. Such methods will likely require a range of support strategies targeted to the needs of various health care settings.

“Documenting social risk data in health care settings requires identifying ways to implement such screening effectively and sustainably,” Dr. Gold and Dr. Gottlieb wrote. “These findings underscore how much we still have to learn about the types of support needed to implement and sustain these practices.”

Dr. Gold reported receiving grants from the National Institutes of Health during the conduct of the study. Dr. Gottlieb reported receiving grants from the Robert Wood Johnson Foundation, the Commonwealth Fund, Kaiser Permanente, Episcopal Health Foundation, the Agency for Healthcare Research and Quality, St. David’s Foundation, the Pritzker Family Fund, and the Harvard Research Network on Toxic Stress outside the submitted work.



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

paper medical records MarkLevant/iStock/Getty Images Plus

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.

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