Physician screening for social risks experienced ‘marked’ increase since 2017
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Key takeaways:
- In 2022, 27% of practices reported screening for a set of five social risks, up from 15% in 2017.
- The mean number of social risks screened per practice during the study period rose from 1.71 to 2.34.
Screening for social risks in physician practices significantly increased over the last several years, according to a cross-sectional study published in JAMA Network Open.
Still, less than one-third of practices screen for a set of five common social risks, but study results show that practices “have become better positioned to recognize and potentially address unmet social needs in vulnerable patient populations,” the researchers wrote.
Social risks and social needs can have substantial negative impacts on mental and physical health. Previous studies have tied them to increased risks for ED use and suicide, making them important for primary care physicians and practices to understand and address.
According to Amanda L. Brewster, PhD, an associate professor of health policy and management at the University of California, Berkely School of Public Health, and colleagues, the 2017 National Survey of Healthcare Organizations and Systems (NSHOS) showed that over half of physician practices systematically screened for interpersonal violence, whereas less than half screened for transportation needs, housing instability, utility needs or food insecurity.
However, “it is unknown how screening processes have changed among physician practices since 2017,” they wrote.
The researchers assessed 2017 and 2022 NSHOS data to determine changes in screening for all five social risks, including 3,442 practice survey responses in their analysis.
They also looked at additional practice factors that may influence screening likelihood, like culture of innovation — such as whether it is common for a practice to try a new approach or idea — the capacity of information systems and exposure to value-based payment models.
Brewster and colleagues found that 27% (95% CI, 23%-32%) of practices reported screening for all five social risks in 2022, an increase from 15% (95% CI, 13%-18%) of practices in 2017.
Meanwhile, the percentage of practices screening for any of the five social risks rose from 67% (95% CI, 64%-69%) to 74% (95% CI, 69%-79%) from 2017 to 2022.
The mean number of social risks screened per practice increased from 1.71 (95% CI, 1.6-1.82) in 2017 to 2.34 (95% CI, 2.12-2.55) in 2022.
Some practice characteristics tied to screening for more social risks emerged from the analysis, including:
- having higher innovation culture scores (incidence rate ratio [IRR] = 1.012; 95% CI, 1.01-1.015);
- having higher advanced information system scores (IRR = 1.003; 95% CI, 1.001-1.005);
- having higher payment reform exposure scores (IRR = 1.002; 95% CI, 1-1.003); and
- being a federally qualified health center (IRR = 1.55; 95% CI, 1.336-1.799).
The researchers explained that screening for social risk “does not necessarily imply that practices are using the information to either adjust care or provide referrals to address social needs, but it is normally the first step toward doing so.”
“This marked increase suggests that practices nationwide are changing processes of care to more systematically consider patients’ social circumstances, as has been recommended by many leading health care institutions over the past 5 years,” they wrote.
Brewster and colleagues pointed out that the analysis did not allow for a look into how practices are implementing social risk screening, while the lower NSHOS response rates may hurt the findings’ generalizability to all U.S. physician practices.
“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,” they concluded. “Fostering innovative primary care practice cultures, which provide time and resources to test and disseminate innovative care processes, could further encourage social risk screening.”
Perspective
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In recent years, the term social determinants of health has become something of a buzzword — and for good reason. As a family physician, I witness firsthand how socioeconomic limitations profoundly impact patients' health outcomes. These negative impacts have driven a surge in health policies aimed at identifying social risk factors through screening tools. However, much of this policy shift appears to be driven by quality metrics tied to reimbursement rates, which I believe is the primary reason for the increased screening rates observed in this study.
The study’s authors raised a critical concern that resonates with my own experience: What are the actual outcomes of these screenings? We can screen every patient who walks through the door, but unless we have the resources to address the identified risks, these efforts will do little to improve health outcomes. In my experience, I’ve seen how larger health care organizations can implement protocols that boost screening rates to meet metrics and maximize reimbursements. However, these same organizations often fall short in allocating the necessary funding and manpower to develop meaningful interventions and provide tangible resources to patients.
To drive real, lasting change in addressing social determinants of health, policymakers must shift their focus beyond identifying risks. The emphasis should be on developing and implementing practical resources that patients can access. Without this crucial step, screening remains an exercise in data collection rather than a tool for improving lives.
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