Clinical Edge

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Most practices not screening for five social needs

Key clinical point: Few physician practices and hospitals are screening patients for five key social needs associated with health outcomes.

Major finding: Only 16% of physician practices and 24% of hospitals screened for all five key social needs, while 33% of physician practices and 8% of hospitals screened for no social needs.

Study details: 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.

Disclosures: 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 also reported receiving grants from the National Institute on Aging/National Institutes of Health during the conduct of the study.

Citation:

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

Commentary:

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.