Using Factor Analysis to Streamline Social Screening for the Emergency Department

Area of Science:

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

Background:

• Emergency departments (EDs) face challenges with lengthy social risk/need screening tools, leading to incomplete patient surveys.
• Streamlining these screening tools is crucial for effective clinical implementation.

Purpose of the Study:

• To guide the development of a more efficient ED-based social risk/need screener.
• To analyze patient populations by questionnaire completeness and response patterns.
• To assess the impact of age on social risk/need measurement.

Main Methods:

• Cross-sectional study of 330,109 patients responding to a 10-item social risk/need questionnaire (Feb 2019-Mar 2023).
• Descriptive analyses stratified patients by response rate (<60% vs. ≥60%).
• Factor analysis identified social risk/need constructs within the higher response group.

Main Results:

• 75% of patients completed the survey; 9% had lower response rates.
• Lower response group had more caregivers of young children and commercially insured patients.
• Factor analysis identified three constructs: core resources, housing, and ability to work.
• Key indicators included paying utilities, housing instability, and unemployment.

Conclusions:

• Incomplete social risk/need questionnaires are prevalent in this health system.
• A three-factor framework (core resources, housing, ability to work) emerged from the data.
• This framework will inform a consolidated questionnaire for EDs to improve response rates.