Most U.S. providers don’t screen for social determinants of health


Five social determinants of health prioritized by the CMS are food insecurity, housing instability, transportation needs, interpersonal violence and utility needs. Nearly a quarter of hospitals and 15.6% of physician practices screened patients for all these five social determinants of health, according to the study published in JAMA.

Most U.S. physician practices and hospitals screen patients for at least one social need. But only a small percentage are screening for all five social needs as recommended by the federal government, according to the study.

Screening for interpersonal violence was found to be the most common. Checking patients for utility needs was the least common.

Federally qualified health centers, primary care improvement programs, bundled payment participants, academic health centers, Medicaid accountable care organizations and physician practices in Medicaid expansion states are the providers with higher screening rates.

The study by Dartmouth University researchers is one of the first to examine the adoption of social risk screening in U.S. healthcare settings. It has been recognized that social risks are linked to poorer treatment adherence, worse health outcomes and higher costs of care, as mentioned in an accompanying JAMA commentary.

Physician practices may lack the financial or staffing resource to screen for social determinants routinely. But hospitals are more likely to screen due to greater resources and federal patient safety requirements.

Organizations like National Association of Community Health Centers, the American Academy of Family Physicians and the American Academy of Pediatrics have developed tools that assist physicians and hospitals to identify patients with social needs to offer them community-based support.

NACHC has a protocol called Prapare, now used by health centers, physician practices and hospitals. It is embedded in electronic health records offering questions that staff ask patients to know social conditions that may be harming their health. NACHC makes this tool available for free to all types of providers.