Background: The social determinants of health (SDOH) are variable factors, including living conditions, employment environments, and social circumstances that influence peoples’ health and can cause health disparities in communities (WHO, 2019). Physicians recognize the importance of SDOH and understand that social factors impact the health outcomes of their patients; however, they may be hesitant to tackle SDOH due to concerns about how social determinants should be addressed in the health care setting and which interventions would be feasible and effective for their patients (Magnan, 2019). To develop plans of action for assessing and addressing SDOH in the health care setting, providers must collect data on patients’ socioeconomic needs and on what kinds of interventions and resources might be useful to patients.
Methods: The objective of this study was to assess the SDOH of patients at an urban academic medical center, comparing the needs of hospitalized patients to those of clinic patients. This study also sought to obtain information about what types of resources patients feel would be the most beneficial to them. Hospitalized patients were surveyed using questions from the CMS 27 item questionnaire from June 20th through July 30th, 2018. Clinic patients were surveyed using the same questionnaire from June 5th through July 30th, 2019. Over half of the clinic patients answered ten additional questions about social needs resources that they might like to utilize. The electronic health record (EHR) of all surveyed patients was reviewed to obtain demographic and health history information.
Results: At least one socioeconomic need was identified in 64% of hospitalized patients and 70% of clinic patients. The top three needs that patients experienced were difficulty paying for housing, food, and other basic necessities (45.9% of hospitalized patients, 50% of clinic patients), feelings of loneliness or isolation (35.4% of hospitalized patients, 36.4% of clinic patients), and food insecurity (27% of hospitalized patients, 37% of clinic patients). Socioeconomic needs were found to be significantly more prevalent among patients who had specific characteristics listed in their EHR, including a history of mental illness, a history of diabetes, or no spouse or partner (p<0.05). Over 70% of patients who answered the additional resource questions felt that they would benefit from receiving a printed or online list of available community resources.
Conclusions: Both the clinic and hospital settings may be viable places to screen patients for socioeconomic needs. The rates of socioeconomic needs were found to be similar between patients admitted to the hospital and those visiting the clinic. This finding indicates that solutions to address these problems could be applied to both settings. Certain items in the EHR could be flagged to alert providers as to which patients might need in-depth screening. Giving patients access to a printable brochure of community resources- including shelters, food pantries, transportation options, and counselors- would be a low-cost, effective way to support those who have needs.