Improving Understanding of Screening Questions for Social Risk and Social Need Among Emergency Department Patients

Ciccolo, Gia; Curt, Alexa; Camargo, Carlos A.; Samuels‐Kalow, Margaret

doi:10.5811/westjem.2020.5.46536

Cited by 11 publications

(16 citation statements)

References 12 publications

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“…19 These findings are consistent with research on patient screening preferences for intimate partner violence (IPV) where computer-based screening has been associated with increased detection of IPV, 27,28,31 but mixed results from interviews with IPV survivors suggest differing advantages of both face-to-face and computer-based screening. [32][33][34] A prior study examining screening modalities in the pediatric setting found higher rates of disclosure in the computer-based group as compared to the face-to-face group. 18 The difference between this study and our study, in part, may be due to differences in questions asked as we did not include questions on substance use in the home or request that participants disclose their annual household income.…”

Section: Discussionmentioning

confidence: 97%

A pilot mixed‐methods randomized controlled trial of verbal versus electronic screening for adverse social determinants of health

Macias‐Konstantopoulos

Ciccolo

Muzikansky

et al. 2022

JACEP Open

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Objectives: Examining the social risks that influence the health of patients accessing emergency care can inform future efforts to improve health outcomes. The optimal modality for screening in the emergency department (ED) has not yet been identified. We conducted a mixed methods evaluation of the impact of screening modality on patient satisfaction with the screening process. Methods:Patients were enrolled at a large urban academic ED and randomized to verbal versus electronic modalities following informed consent. Participants completed a short demographic survey, a brief validated health literacy test, and a social need and risk screening tool. Participants were purposively sampled to complete qualitative interviews balanced across 4 groups defined by health literacy scores (high vs limited) and screening modality. Quantitative outcomes included screening results and satisfaction with the screening process; qualitative questions focused on experience with the screening process, barriers, and facilitators to screening. Results:Of 554 patients assessed, 236 were randomized (115 verbal, 121 electronic).Participants were 23% Hispanic, 6% non-Hispanic Black, 58% non-Hispanic White, 38% publicly insured, and 57% privately insured. Two-thirds (67%) identified social needs and risks and the majority (81%) reported satisfaction with the screening.Screening modality was not associated with satisfaction with screening process after adjustment for language, health literacy, and social risk (adjusted odds ratio, 0.74; 95% confidence interval, 0.32, 1.71). Conclusion:Screening modality was not associated with overall satisfaction with screening process. Future strategies can consider the advantage of multimodal screening options, including the use of electronic tools to streamline screening and expand scalability and sustainability.

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Section: Discussionmentioning

confidence: 97%

A pilot mixed‐methods randomized controlled trial of verbal versus electronic screening for adverse social determinants of health

Macias‐Konstantopoulos

Ciccolo

Muzikansky

et al. 2022

JACEP Open

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“…Importantly, the term “health‐related social needs,” which was often used to describe risk factors rather than needs, would be replaced by “social risk.” The Appendix (Online Supplement) shows examples of how the terminology can be applied to the core domains of housing, food, transportation, and utilities. We do not provide a figure for safety because our prior work suggested wide variation in how people defined this concept 34 …”

Section: Proposed Terminologymentioning

confidence: 99%

The terminology of social emergency medicine: Measuring social determinants of health, social risk, and social need

et al. 2020

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Emergency medicine has increasingly focused on addressing social determinants of health (SDoH) in emergency medicine. However, efforts to standardize and evaluate measurement tools and compare results across studies have been limited by the plethora of terms (eg, SDoH, health‐related social needs, social risk) and a lack of consensus regarding definitions. Specifically, the social risks of an individual may not align with the social needs of an individual, and this has ramifications for policy, research, risk stratification, and payment and for the measurement of health care quality. With the rise of social emergency medicine (SEM) as a field, there is a need for a simplified and consistent set of definitions. These definitions are important for clinicians screening in the emergency department, for health systems to understand service needs, for epidemiological tracking, and for research data sharing and harmonization. In this article, we propose a conceptual model for considering SDoH measurement and provide clear, actionable, definitions of key terms to increase consistency among clinicians, researchers, and policy makers.

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“…[7][8][9][10][11] Few studies have examined multiple HRSNs through a standardized screening tool, large-scale randomized controlled trials (RCT), diverse healthcare settings, geographies, and populations. [12][13][14] We analyzed data from a representative sample of community-dwelling Medicare and Medicaid beneficiaries through the national CMS Accountable Health Communities (AHC) Model. 15 The AHC Model, launched in May 2017, 1,15 uses the AHC screening tool to assess five HRSNs: housing instability, difficulty paying utility bills, food insecurity, transportation, and interpersonal safety.…”

Section: Introductionmentioning

confidence: 99%

Association of Social Needs and Healthcare Utilization Among Medicare and Medicaid Beneficiaries in the Accountable Health Communities Model

et al. 2022

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Background Integration of health-related social needs (HRSNs) data into clinical care is recognized as a driver for improving healthcare. However, few published studies on HRSNs and their impact are available. CMS sought to fill this gap through the Accountable Health Communities (AHC) Model, a national RCT of HRSN screening, referral, and navigation. Data from the AHC Model could significantly advance the field of HRSN screening and intervention in the USA. Objective To present data from the Greater Houston AHC (GH-AHC) Model site on HRSN frequency and the association between HRSNs, sociodemographic factors, and self-reported ED utilization using a cross-sectional design. Analyses included descriptive statistics and multinomial logistic regression. Participants (or Patients or Subjects) All community-dwelling Medicare, Medicaid, or dually covered beneficiaries at participating GH-AHC clinical delivery sites were eligible. Main Measures Self-reported ED utilization in the previous 12 months served as the outcome; demographic characteristics including race, ethnicity, age, sex, income, education level, number of people living in the household, and insurance type were treated as covariates. HRSNs included food insecurity, housing instability, transportation, difficulty paying utility bills, and interpersonal safety. Clinical delivery site type was used as the clustering variable. Key Results Food insecurity was the most common HRSN identified (38.7%) followed by housing instability (29.0%), transportation (28.0%), and difficulty paying utility bills (26.7%). Interpersonal safety was excluded due to low prevalence. More than half of the beneficiaries (56.9%) reported at least one of the four HRSNs. After controlling for covariates, having multiple co-occurring HRSNs was strongly associated with increased risk of two or more ED visits (OR 1.8–9.47 for two to four needs, respectively; p < 0.001). Beneficiaries with four needs were at almost 10 times higher risk of frequent ED utilization (p < 0.001). Conclusions To our knowledge, this is only the second published study to report screening data from the AHC Model. Future research focused on the impact of multiple co-occurring needs on health outcomes is warranted.

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Improving Understanding of Screening Questions for Social Risk and Social Need Among Emergency Department Patients

Abstract: Improving Screening Questions for Social Risk and Need Among ED Patients Ciccolo et al.

Cited by 11 publications

References 12 publications

A pilot mixed‐methods randomized controlled trial of verbal versus electronic screening for adverse social determinants of health

A pilot mixed‐methods randomized controlled trial of verbal versus electronic screening for adverse social determinants of health

The terminology of social emergency medicine: Measuring social determinants of health, social risk, and social need

Association of Social Needs and Healthcare Utilization Among Medicare and Medicaid Beneficiaries in the Accountable Health Communities Model

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