Social risk screening in physician practices improved, yet only 27% screen comprehensively. Explore implications for health equity and patient outcomes.
Social risk screening allows clinicians to identify non-medical risk factors that can strongly influence a patient’s overall health, chronic disease burden, and ability to follow treatment plans. From 2017 to 2022, social risk screening increased among U.S. physician practices, but only 27 percent of practices screened for all five social risks in 2022, according to a study published in JAMA Network Open.
Amanda L. Brewster, Ph.D., from the School of Public Health at the University of California in Berkeley, and colleagues examined trends in screening for five common social risks (food, housing, utilities, interpersonal violence, and transportation) among U.S. physician practices in an analysis using a nationally representative survey of physician practices, conducted in 2017 and 2022. The researchers assessed 3,442 practice survey responses.
The researchers found that 27 percent of practices reported screening for all five social risks in 2022, up from 15 percent in 2017. Unadjusted results showed a significant increase in the mean number of social risks screened per practice, from 1.71 to 2.34 in 2017 and 2022, respectively. Between 2017 and 2022, practice characteristics associated with screening for more social risks remained consistent and included being a federally qualified health center, having higher innovation culture scores, having higher advanced information system scores, and having higher payment reform exposure scores (incidence rate ratios, 1.550, 1.012, 1.003, and 1.002, respectively).
“As policies and programs that support social care integration into health care continue to be tested and disseminated, it will be important to examine how social risk screening, referral, and service delivery processes are associated with patient outcomes,” the authors write.
Social risk screening involves systematically asking patients about their social circumstances that could impact their health. These circumstances, often referred to as social determinants of health (SDOH), encompass a wide range of non-medical factors such as housing stability, food security, transportation access, financial strain, and social support. By identifying these risks, providers can better understand the challenges patients face and connect them with appropriate resources to improve their overall well-being.
Traditionally, healthcare has focused primarily on biological and medical factors. However, it’s increasingly recognized that social factors play a crucial role in health outcomes. For example, a patient with diabetes may struggle to manage their blood sugar if they lack access to healthy food or safe housing. Similarly, a patient with a chronic respiratory condition may experience more frequent exacerbations if they live in a home with mold or poor ventilation. Social risk screening aims to bridge this gap by incorporating social context into patient care.
The screening process typically involves a brief questionnaire or a series of questions asked during a patient’s visit.
These questions might cover areas such as:
Once the healthcare team identifies a patient’s social risks, it can take several steps to address them.
This might include:
Social risk screening offers several benefits for patients:
Social risks often contribute to disparities in hypertension, diabetes, chronic kidney disease, maternal health, cancer screening, and cardiovascular disease. Black patients, in particular, are more likely to encounter structural barriers that influence health outcomes, such as high out-of-pocket costs, transportation challenges, provider shortages, or caregiving responsibilities.
Social risk screening can help clinicians and organizations identify population-level needs and direct resources more effectively. By collecting social risk data, health systems can better measure inequities and develop more targeted interventions.
Below are some tools clinicians can use to screen patients’ social risks:
While social risk screening is a valuable tool, it’s essential to implement it thoughtfully. Healthcare providers need to be trained on how to conduct screenings sensitively and respectfully. They also need to have access to updated information on local resources and be prepared to follow up with patients to ensure they are connected with the support they need. In conclusion, social risk screening is a crucial step towards a more equitable and effective healthcare system that addresses the whole person, not just their medical conditions.
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