Implementing Health Related Social Needs Screening in an Outpatient Clinic

Area of Science:

• Health Services Research
• Public Health
• Health Equity

Background:

• Health-related social needs (HRSN) screening is increasingly implemented in healthcare settings.
• Federally-qualified health centers (FQHCs) serve vulnerable populations and face resource constraints.
• Little is known about the representativeness of HRSN screening in FQHCs.

Purpose of the Study:

• To determine if HRSN screening in resource-constrained FQHCs captures a representative patient population.
• To identify patient characteristics associated with being screened for HRSN.

Main Methods:

• Cross-sectional study using electronic medical record (EMR) data from 2016-2020.
• Included 4731 screened patients and a random sample of unscreened patients from 7 FQHC clinics.
• Multivariable logistic regression analyzed associations between sociodemographic traits, chronic disease burden, visit frequency, and HRSN screening.

Main Results:

• Screened patients represented less than 1% of the total FQHC population.
• Medicaid patients had higher odds of being screened compared to Medicare patients.
• Increased provider visits and higher comorbid disease burden (>2 conditions) were significantly associated with higher odds of screening.

Conclusions:

• Patients with more frequent outpatient visits and a higher burden of comorbid conditions are more likely to be screened for HRSN.
• FQHCs implementing clinic-wide HRSN screening should develop strategies to ensure equitable and representative screening.
• Addressing potential screening disparities is crucial for meeting state-level Medicaid requirements and serving the entire patient population.