Screening for Health-Related Social Needs of Emergency Department Patients

Samuels‐Kalow, Margaret; Boggs, Krislyn M.; Cash, Rebecca E.; Herrington, R. N.; Mick, Nathan W.; Rutman, Maia S.; Venkatesh, Arjun K.; Zabbo, Christopher P.; Sullivan, Ashley F.; Hasegawa, Kohei; Zachrison, Kori S; Camargo, Carlos A.

doi:10.1016/j.annemergmed.2020.08.010

Cited by 36 publications

(50 citation statements)

References 37 publications

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“…16 In a recent study, 39% of a regional sample of emergency departments reported screening for housing instability, food insecurity, transportation needs, or trouble paying utilities. 28 This study builds on these estimates in important ways. It uses a census of all FQHCs to present national and between-state variation.…”

Section: Discussionmentioning

confidence: 98%

Screening for Social Risk at Federally Qualified Health Centers: A National Study

Cole

Nguyen

Byhoff

et al. 2022

American Journal of Preventive Medicine

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Introduction: Federally Qualified Health Centers serve 29.8 million low-income patients across the U. S., many of whom have unaddressed social risks. In 2019, for the first time, data on social risk screening capabilities were collected from every U.S. Federally Qualified Health Center. The objectives of this study were to describe the national rates of social risk screening capabilities across Federally Qualified Health Centers, identify organizational predictors of screening, and assess between-state heterogeneity.Methods: Using a 100% sample of U.S. Federally Qualified Health Centers (N=1,384, representing 29.8 million patients) from the 2019 Uniform Data System, the primary outcome was whether a Federally Qualified Health Center collected data on patients' social risk factors (yes/no). Summary statistics on the rates of social risk screening capabilities were generated in aggregate and by state. Linear probability models were then used to estimate the relationship between the probability of social risk screening and 7 key Federally Qualified Health Center characteristics (e.g., Federally Qualified Health Center size, Medicaid MCO contract, Medicaid accountable care organization presence). Data were analyzed in 2020-2021.Results: Most (71%) Federally Qualified Health Centers collected social risk data, with a betweenstate variation. The most common screener was the Protocol for Responding to and Assessing Patients' Assets Risks and Experiences (43% of Federally Qualified Health Centers that screened), whereas 22% collected social risk data using a nonstandardized screener. After adjusting for other characteristics, Federally Qualified Health Centers with social risk screening capabilities served more total patients, were more likely to be located in a state with a Medicaid accountable care organization, and were less likely to have an MCO contract.Conclusions: There has been widespread adoption of social risk screening tools across U.S. Federally Qualified Health Centers, but between-state disparities exist. Targeting social risk screening resources to smaller Federally Qualified Health Centers may increase the adoption of screening tools.

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Section: Discussionmentioning

confidence: 98%

Screening for Social Risk at Federally Qualified Health Centers: A National Study

Cole

Nguyen

Byhoff

et al. 2022

American Journal of Preventive Medicine

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“…emergency departments (EDs)) more than outpatient clinics. Patients who do not visit outpatient clinics as often may have different HRSN, such as mental health, substance use, and exposure to violence, (19)(20)(21) that are not as widespread in populations captured by current outpatient screening. The lack of capture of these needs may divert resources away from patients who do not visit outpatient clinics and cause further stigmatization and marginalization.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Implementing Health Related Social Needs Screening in an Outpatient Clinic: A Cross-Sectional Study

Nohria

Xiao

Guardado

et al. 2021

Preprint

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BackgroundTo date, health-related social needs (HRSN) screening implementation efforts have reported high rates of identified social needs. However, little is known about how screening processes may fail to leverage implementation strategies to optimize reach, and thereby unintentionally target non-representative groups for screening and referral programs. MethodsElectronic medical data were abstracted from 2016-2020 for 4,731 screened patients from 7 affiliated clinics of a federally-qualified health center (FQHC). Unscreened patients were pulled first as a random sample from the study period, then matched based on clinic site and clinic visit frequency. Sociodemographic traits, comorbid conditions, and outpatient encounter type and frequency were compared between the screened and unscreened patient cohorts using descriptive statistics.ResultsScreened patients (n-4731) had a median of 3.3 (+/- 2.5) unmet HRSN. Compared to a random sample of unscreened FQHC patients, screened patients had significantly more clinic visits (26.8 vs 16.3; p<0.05) and carried a higher comorbid disease burden (3+ conditions: 8% vs 2%; p<0.05). When the unscreened cohort was matched to the screened cohort for clinic site, these findings remained constant. Due to high visit frequency in the screened cohort, our analysis was matched for clinic visit frequency. Screened patients continued to demonstrate a higher comorbid disease burden (3+ conditions, 8% vs 3%; p<0.05), but only had a higher prevalence of 4 chronic conditions (diabetes, hypertension, chronic kidney disease, and anxiety/depression). ConclusionsWithout an a priori plan for implementation, we have found a predisposition to screen patients who visit outpatient services more often and have a higher comorbid disease burden. HRSN screening processes will benefit from implementation strategies to improve reach and to ensure maximal uptake of screening.

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“…[16][17][18] While social risk factors have been noted to contribute to ED use and adverse outcomes, [19][20][21] EDs also face significant challenges in identifying and intervening on social needs. 22,23 Particularly for older adults, the intersection of ED care transitions and SDOH represents a key quality focus. Their contemporary relevance is evidenced by priority within the 2014 Geriatric ED Guidelines, 24 the 2017 National Quality Forum ED Transitions of Care Report, 25 the 2018 launch of the American College of Emergency Physicians tiered geriatric ED accreditation process, 26 the growing role of social emergency medicine, [27][28][29][30] and the Social Interventions Research & Evaluation Network (SIREN).…”

Section: Introductionmentioning

confidence: 99%

Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement

Bristol

Gladney

Seidenfeld

et al. 2021

Academic Emergency Medicine

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Screening for Health-Related Social Needs of Emergency Department Patients

Cited by 36 publications

References 37 publications

Screening for Social Risk at Federally Qualified Health Centers: A National Study

Screening for Social Risk at Federally Qualified Health Centers: A National Study

WITHDRAWN: Implementing Health Related Social Needs Screening in an Outpatient Clinic: A Cross-Sectional Study

Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement

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