Perceptions and Experience of Patients, Staff, and Clinicians with Social Needs Assessment

Abstract

The impacts of unmet health-related social needs, such as homelessness, inconsistent access to food, and exposure to violence on health and health care utilization, are well-established. Growing evidence indicates that addressing these and other needs can help reverse their damaging health effects, but screening for social needs is not yet standard clinical practice. In many communities, the absence of established pathways and infrastructure and perceptions of inadequate time to make community referrals are barriers that seem to often keep clinicians and their staff from broaching the topic. The Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities Model, tested by the Center for Medicare and Medicaid Innovation, addresses this critical gap between clinical care and community services in the current health care delivery system by testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries impacts their total health care costs and improves health. DISCUSSION PAPER Perspectives | Expert Voices in Health & Health Care With input from a panel of national experts and after review of existing screening instruments, CMS developed a 10-item screening tool to identify patient needs in 5 different domains that can be addressed through community services (housing instability, food insecurity, transportation difficulties, utility assistance needs, and interpersonal safety). Clinicians and their staff can use this short tool across a spectrum of ages, backgrounds, and settings, and it is streamlined enough to be incorporated into busy clinical workflows. Just like with clinical assessment tools, results from this screening tool can be used to inform a patient's treatment plan as well as make referrals to community services.

Part I: A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers

“…The finding that more patients were comfortable with social screening itself than with its documentation in the EHR is consistent with a recent study on social risk screening where participants reported concern with privacy and utilization of social risk data 33 and findings from other work describing patients' unease around sharing health data. 56,57 There are already calls for developing standards to protect social risk data in EHRs, 58 which is increasingly relevant in the context of new efforts to share data across sectors.…”

“…The survey also included the following participant characteristics based on their potential to impact screening acceptability: age, sex, race/ethnicity, educational attainment, income, preferred language (English or Spanish), self-or caregiver-reported child health, social risks, 41 interest in assistance with social risk factors, trust in clinicians, 29,33,42,43 prior healthcare-based social risk screening, prior healthcare-based receipt of social assistance, and prior discrimination within health care. 44,45 Previously validated survey items were utilized or adapted when available.…”

“…25 Successful screening implementation in select settings may suggest that patients do not object to screening, 26−37 though some clinicians have expressed concerns about time constraints 38 and the potential for increasing patient stigma. 36,39,40 Prior studies on feasibility and acceptability of social screening are limited by small samples, 32,33 a focus on site-specific screening tools, 26 or inclusion of only academic pediatric primary care settings. 28,29,31,41 This study evaluated the acceptability of the AHC social risk screening tool by adult patients and adult caregivers of pediatric patients in diverse healthcare settings.…”

“…Acceptability was assessed in terms of perceived appropriateness of screening as well as comfort with electronic health record (EHR) documentation of screening results. The study measured overall acceptability and the extent to which acceptability varied by patient and caregiver characteristics, including social risk burden, 41 trust in clinicians, 29,33,42,43 prior exposure to social risk screening, 29 and prior experience of healthcare discrimination. 44,45…”

Patients’ Attitudes and Perceptions Regarding Social Needs Screening and Navigation: Multi-site Survey in a Large Integrated Health System

“…The survey domains and question language were based on content from facilitator guides developed for and themes that emerged from qualitative focus groups and key informant interviews with 46 patients and 40 clinician leaders in KPSC. 16 Themes from the focus groups and key informant interviews fell into domains of patient experiences with social needs, patient attitudes toward social needs screening and intervention, and patient support for health system investment in social needs programs. These became the main constructs for our survey, and language from the focus group prompts were adapted to examine these domains of inquiry in the survey.…”