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Health-Related Social Needs: Which Patients Respond to Screening and Who Receives Resources?

Journal of General Internal Medicine (2023)Cite this article

Abstract

Background

Health systems are screening patients for health-related social needs (HRSN) but the optimal approach is unknown.

Objective

To describe the variation in responding to an HRSN questionnaire delivered via patient portal, and whether referral to and resources provided by social workers differed by response status.

Design

Retrospective observational study.

Participants

Primary care patients with a visit between June 2020 and January 2022.

Intervention

HRSN questionnaire

Main Measures

We identified each patient’s index visit (e.g., date of their first questionnaire response for responders or their first visit within the study period for non-responders). Through the EHR, we identified patients’ demographic characteristics. We linked the area deprivation index (ADI) to each patient and grouped patients into quintiles. We used multilevel logistic regressions to identify characteristics associated with responding to the questionnaire and, for responders, reporting a need. We also determined if responder status was associated with receiving a social worker referral or receiving a resource. We included patient demographics and ADI quintile as fixed variables and practice site as a random variable.

Key Results

Our study included 386,997 patients, of which 51% completed at least one HRSN questionnaire question. Patients with Medicaid insurance (AOR: 0.62, 95%CI: 0.61, 0.64) and those who lived in higher ADI neighborhoods had lower adjusted odds of responding (AOR: 0.76, 95% CI: 0.75, 0.78 comparing quintile 5 to quintile 1). Of responders, having Medicaid insurance (versus private) increased the adjusted odds of reporting each of the HRSN needs by two- to eightfold (p < 0.01). Patients who completed a questionnaire (versus non-responders) had similar adjusted odds of receiving a referral (AOR: 0.91, 95% CI: 0.80, 1.02) and receiving a resource from a SW (AOR: AOR: 1.18, 95%CI: 0.79, 1.77).

Conclusion

HRSN questionnaire responses may not accurately represent the needs of patients, especially when delivered solely via patient portal.

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Funding

Dr. Pfoh’s time is supported by a KL2 grant from NCATS to Dr. Dweik (2KL2TR002547).

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Authors and Affiliations

  1. Community Health & Partnerships, Cleveland Clinic Community Care, Community Health, Cleveland, OH, USA

    Nazleen Bharmal MD, PhD

  2. Department of Internal Medicine, Cleveland Clinic Lerner College of Medicine at CWRU, Cleveland, OH, USA

    Nazleen Bharmal MD, PhD & Robert Jones MD

  3. Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA

    Nazleen Bharmal MD, PhD, Alex Rennick BS, Amy Shideler MSW, Robert Jones MD, Chi’ Wilson MBA & Elizabeth R. Pfoh PhD, MPH

  4. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Madeleine Blazel BS

  5. Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA

    Elizabeth R. Pfoh PhD, MPH

Authors
  1. Nazleen Bharmal MD, PhD
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Correspondence to Nazleen Bharmal MD, PhD.

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Bharmal, N., Rennick, A., Shideler, A. et al. Health-Related Social Needs: Which Patients Respond to Screening and Who Receives Resources?. J GEN INTERN MED (2023). https://doi.org/10.1007/s11606-023-08135-1

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