Performance of 2-stage health-related social needs screening using area-level measures

Screening for health-related social needs (HRSNs) has increased in importance, but screening large patient populations comes with a cost and potential burden for care delivery organizations. This study evaluated the performance of 2-stage HRSN screening that used residence in a high-poverty area to determine which patients were administered screening questions.

Screening evaluation.

Adult primary care patients in Indiana and Florida completed HRSN screening questions included in an electronic health record (EHR) system and a set of additional questionnaires that served as the gold standard for assessing HRSN presence. Responses were linked to patients' residential zip code (n = 1351). The first stage of screening applied residence in a high-poverty zip code, and the second stage was the EHR-based HRSN screening questions. Using the response to the gold-standard questions, we calculated sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) for each HRSN.

The highest AUC value was for food insecurity (80%), which was largely driven by the strong performance of the EHR-based HRSN screening questions. The remaining HRSNs had lower AUC values, which were driven by the overall low sensitivities of the screening questions and the overall low performance of the first-stage area-level screen. Positive predictive values were high.

Two-stage HRSN screening based on geography is suboptimal. Although a 2-stage approach based on area-level socioeconomic measures can reduce the number of patients requiring individual-level HRSN screening, large percentages of patients in need would go unidentified.