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Majority of hospitals, physician practices screen patients for at least one SDOH, Dartmouth study finds

The pressure on physicians and hospitals to address social determinants will likely increase, as they've been a focus of payers and providers.

Jeff Lagasse, Associate Editor

Most U.S. physician practices and hospitals report screening patients for at least one social determinant of health, according to a new study from The Dartmouth Institute for Health Policy and Clinical Practice, published this week in JAMA Network Open

It's a trend that is expected to increase in the future, as practices that care for disadvantaged patients report higher screening rates.

Researchers conducted a cross-sectional study using national survey data to assess the prevalence of screening among physician practices and hospitals for five social needs prioritized by the Centers for Medicare and Medicaid Services: food insecurity, housing instability, utility and transportation needs, and experience with interpersonal violence.

Responses from 2,190 physician practices and 739 hospitals were collected between June 2017 to August 2018. As part of the study, the researchers examined how screening efforts varied by organizational characteristics, including participation in reform efforts. They also identified major barriers to linking medical and social care that were reported by physicians and hospitals.


The results suggest that most U.S. physician practices and hospitals do not report screening patients for key social needs, and it appears that practices serving more economically disadvantaged populations report screening at higher rates.

In recent years, the link between patients' social needs, health outcomes, and costs -- the crux of SDOH -- has become increasingly recognized and advocated for by stakeholders across the nation's medical communities. But little has been known about the extent to which these screenings have been incorporated into patient care.

The new data showed that the majority of U.S. physician practices and hospitals were screening patients for at least one social need, with about 24 percent of hospitals and 16 percent of physician practices reporting screening for all five social needs. Among both hospitals and practices, screening for interpersonal violence was most common, while screening for utility needs was least common.

Federally qualified health centers and physician practices that participated in bundled payments, primary care improvement models, and Medicaid accountable care organizations were more likely to report screening than other practices. Academic medical centers were significantly more likely than nonacademic medical centers to report screening patients for all social needs.

In general, the majority of physician practices and hospitals identified the lack of financial or staffing resources, time, and incentives as the main barriers to adopting initiatives that address social needs.

The authors consider it likely that the pressure on physicians and hospitals to address social determinants will only increase considering they've been a focus of payers, providers, and federal and state policymakers. The systematic use of screening was considered a necessary first step.


An estimated 70 percent of the variation in healthcare outcomes is attributable to social determinants -- but it is only in recent years that healthcare settings have begun formally looking at these factors to better understand and treat patients.

A May study co-authored by Boston University School of Public Health researchers and published in the Journal of the American Board of Family Medicine finds that these social determinant screening systems need to be tailored to individual clinics.

In April, UnitedHealthcare and the American Medical Association announced they had entered into a collaboration that will better identify and address social determinants of health with the goal of improving access to care and patient outcomes.

Building on work initiated by UnitedHealthcare, the two organizations are working together to standardize how data is collected, processed and integrated regarding critical social and environmental factors that contribute to patient well-being.

Twitter: @JELagasse

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Focus on Social Determinants of Health

In September, Healthcare Finance News, Healthcare IT News and MobiHealthNews will take a look at the SDOH and how varied health systems, IT companies, Congress and others are addressing it.