Effectiveness of Social Needs Screening and Interventions in Clinical Settings on Utilization, Cost, and Clinical Outcomes: A Systematic Review

Abstract

Objective: This systematic review examined and synthesized peer-reviewed research studies that reported the process of integrating social determinants of health (SDOH) or social needs screening into electronic health records (EHRs) and the intervention effects in the United States. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, a systematic search of Scopus, Web of Science Core Collection, MEDLINE, and Cochrane Central Register of Clinical Trials was performed. English language peer-reviewed studies that reported the process of integrating SDOH or social needs screening into EHRs within the U.S. health systems and published between January 2015 and December 2021 were included. The review focused on process measures, social needs changes, health outcomes, and health care cost and utilization. Results: In total, 28 studies were included, and half were randomized controlled trials. The majority of the studies targeted multiple SDOH domains. The interventions vary by the levels of intensity of their approaches and heterogeneities in outcome measures. Most studies (82%, n =23) reported the findings related to the process measures, and nearly half (43%, n =12) reported outcomes related to social needs. By contrast, only 39% ( n =11) and 32% ( n =9) of the studies reported health outcomes and impact on health care cost and utilization, respectively. Findings on patients' social needs change demonstrated improved access to resources. However, findings were mixed on intervention effects on health and health care cost and utilization. We also identified gaps in implementation challenges to be overcome. Conclusion: Our review supports the current policy efforts to increase U.S. health systems' investment toward directly addressing SDOH. While effective interventions can be more complex or resource intensive than an online referral, health care organizations hoping to achieve health equity and improve population health must commit the effort and investment required to achieve this goal.

“We are the sun for our community:” Partnering with community health workers/promotores to adapt, deliver and evaluate a home-based collaborative care model to improve equity in access to quality depression care for older U.S. Latino adults who are underserved

“…Some of this significant improvement may stem from PEARLS participants having on average 2.6 referrals for social needs which drive both access and outcomes. While PEARLS is not a social needs intervention per se ( 75 ), both the chronic care model and collaborative care model call for linking participants to additional services and supports to improve their depression outcomes. Our findings about the importance of addressing unmet health and social needs (e.g., caregiving to support activities of daily living, and linking to better quality primary care or augmenting current primary care through chronic disease management) to enhance depression outcomes aligns with findings from a recent related study that suggested the collaborative care model integrated with clinical and community care can strengthen depression care for older adults ( 76 ).…”

Addressing population health inequities: investing in the social determinants of health for children and families to advance child health equity

“…A recent systematic review of social needs screening research studies among the general population found that most studies reported process measure findings, nearly half reported outcomes related to SDOH, and only about one-third of studies reported health outcomes or findings related to healthcare cost and utilization. Findings were overall positive for process measures and mixed for health outcome as well as healthcare cost/utilization measures [ 15 ▪▪ ].…”

Addressing non-medical health-related social needs through a community-based lifestyle intervention during the COVID-19 pandemic: The Black Impact program

“…identification of social needs, referrals, and enrollment in community resources); and 2) lower cost and improve utilization (e.g. improved preventive care utilization, decreased length of stay and hospital readmissions) [7][8][9][10]. Evidence of health improvements after addressing social needs is mixed, with some studies showing an improvement in blood pressure, lipids, and fruit/vegetable consumption, while other studies did not show improvement in glycemic measures [7][8][9][10].…”

“…improved preventive care utilization, decreased length of stay and hospital readmissions) [7][8][9][10]. Evidence of health improvements after addressing social needs is mixed, with some studies showing an improvement in blood pressure, lipids, and fruit/vegetable consumption, while other studies did not show improvement in glycemic measures [7][8][9][10]. Emerging data shows that higher intervention dosage (number of contacts between the navigator and patient/participant) may be related to greater success of resource connections, with in-person contact being associated with the highest likelihood of success [11].…”