Background: The social determinants of health (SDOH) are widely recognized as having an important impact on health and mortality with up to 80% of health outcomes shaped by SDOH domains ( the conditions in which people are born, grow, work, live, and age). There is strong evidence that addressing unmet social needs can lower healthcare costs and utilization. For these reasons, SDoH screening in primary care settings has been established as important step in addressing unmet needs and clinical outcomes. Emerging evidence is now demonstrating that SDoH screening in the inpatient setting may add value prior to discharge.
Purpose: To determine the feasibility and effect of screening adult inpatients on an internal medicine unit for unmet social needs; To identify barriers to screening on an inpatient unit
Description: A questionnaire was used to identify unmet social needs for inpatients hospitalized on a single general internal medicine unit within our AMC. Patients eligible for screening were >18 years old, had capacity, and spoke English. Questionnaire domains included food and housing insecurity, transportation needs, inability to pay for medications, find work, obtain educational resources or identify support for childcare. The questionnaire was verbally administered. All responses were documented in a REDCap database. Unmet social needs were shared with the unit team via a SharePoint site. These results were then discussed and integrated into the unit multidisciplinary team meetings held daily. Questionnaire responses were tracked along with process and outcome measures including the timing of social work consultations, integration of unmet social needs within the team discharge summary, and future healthcare utilization (e.g., 30-day readmissions, ED visits, missed PCP and specialty). Results for 155 inpatients approached (8/2021- 3/2022) revealed the following unmet needs: transportation (21%), employment status (19%), food access (17%), housing (15%), and medication payment ability (14%). Fifty percent of the needs identified on survey were previously unknown to medical teams. Sixty-nine percent of needs were addressed prior to or on hospital discharge and 95% were incorporated into clinical care team planning. Analysis is underway to determine relationships between identified unmet needs and demographics (including insurance, age, race, etc), social work consult placement timing, and clinical outcomes after discharge (30-day readmissions, ED visits, missed PCP and specialty appointments). Final analysis is expected January 2023.
Conclusions: Screening for social needs is feasible in a high volume, inpatient, academic hospital setting. This pilot enabled healthcare team members to identify and respond to social needs for patients that were otherwise not previously known to the care team. Challenges include staff workflows, EHR integration, and resource response to positive screens. If addressed, the inpatient setting may be established as an underutilized setting for universal social needs screening.