Predictive Value of a Financial Strain Question to Pre-screen Individuals for Social Risks

Area of Science:

• Public Health
• Health Services Research
• Social Determinants of Health

Background:

• Social risks significantly impact health outcomes and healthcare costs.
• Health systems are increasingly implementing social risk screening but face challenges like clinician burnout and financial trade-offs.
• A two-step screening approach, using financial strain as an initial screen, is proposed to reduce implementation burden.

Purpose of the Study:

• To evaluate the predictive value of a financial strain screener as a preliminary tool for identifying other social risks.
• To assess the effectiveness of financial strain screening in detecting food insecurity, housing instability, and transportation barriers.

Main Methods:

• A longitudinal study analyzed data from OCHIN, Humana, and Kaiser Permanente (n=252,845 adults).
• The study assessed the predictive performance (sensitivity, specificity, PPV, NPV, AUC) of financial strain as a pre-screener.
• Data on financial strain, food insecurity, housing instability, and transportation barriers were collected via surveys and encounter data.

Main Results:

• Prevalence of financial strain varied across datasets (28% to 41%).
• Using financial strain as a sole pre-screener could miss 12.3%–24.2% of individuals with food insecurity.
• This approach could also miss 13.2%–24.7% with housing instability, 17.0%–32.6% with transportation barriers, and 4.1%–5.7% with all three.

Conclusions:

• A financial strain pre-screener alone is insufficient for comprehensive social risk identification in healthcare settings.
• Relying solely on financial strain may lead to a significant underestimation of individuals experiencing other critical social risks.
• Health systems should consider more robust screening strategies to avoid missing vulnerable populations.