Most hospitals do not systematically screen for social determinants of health in pregnancy

Key takeaways:

• Overall, 73.5% of hospitals screened for social determinants of health using any method, and 39.4% used systematic screening.
• Screening frequency varied from random times to during every clinic visit.

Fewer than half of hospitals participating in a maternity care quality collaborative reported systematic screening for social determinants of health in pregnancy, researchers reported in the American Journal of Obstetrics and Gynecology.

“Leading professional health care organizations recommend assessing and addressing [social determinants of health] as part of routine pregnancy care, with the ultimate goal of alleviating unmet social needs,” Alex Friedman Peahl, MD, MSc, assistant professor in the department of obstetrics and gynecology at the University of Michigan and the University of Michigan Medical School, Ann Arbor, and colleagues wrote. “An essential first step involved identifying unmet social needs through screening. Little is known about [social determinants of health] screening in routine maternity care practice outside of research settings, including when, whether and how it is completed.”

Peahl and colleagues analyzed data from a cross-sectional online survey of 68 hospitals that participated in the Obstetrics Initiative, a Blue Cross Blue Shield of Michigan-funded statewide collaborative quality initiative. Hospital leaders who were engaged in quality improvement efforts completed the surveys responding to whether hospitals perform social determinants of health screening, the methods of data collection and frequency of assessment.

Overall, 50% of respondents were nurses and/or nurse managers, 36.8% were quality improvement team members, 27.9% were administrators and other non-clinical workers and 2.9% were maternity care professionals. Of all hospitals, 73.5% reported screening for social determinants of health using any method and 39.4% reported systematic screening.

A variety of screening methods and intervals were reported by hospitals. The most common methods were patient-completed questionnaires (44%) and provider-completed assessments (32%). The most common screening frequencies were random (19%) and at every visit (18%).

In addition, no hospital characteristics were linked to completing systematic social determinants of health screening in bivariate comparisons, unadjusted models or models adjusted for hospital-level characteristics.

“Future work is needed to identify the most effective social needs interventions for improving health care access and outcomes and the best methods for overcoming barriers to their widespread implementation,” the researchers wrote.