Evaluating Redundancy and Biases in EHR Social Determinants of Health Data Screening

Healthcare organizations have begun incorporating screening procedures for social determinants of health (SDOH) into care, recognizing the impact these factors can have on health outcomes. We aimed to present methods for evaluating redundancy in the risk information gained across SDOH questions and for evaluating whether demographic biases are present in whether patients were asked SDOH questions and whether they declined to answer them.

SDOH question data were analyzed for 1.8 million UNC Health patients. To evaluate risk information redundancy, response agreement was analyzed for pairs of questions. Demographic biases were evaluated using logistic regression models.

Risk information redundancy was identified, particularly across food and financial insecurity questions. Furthermore, female and White patients were more likely to be asked some questions than other groups, and American Indian or Alaska Native and Hispanic or Latino patients were less likely to decline to answer questions.

We demonstrated methods healthcare organizations can use to evaluate their SDOH screening procedures. These methods yielded insights for (1) reducing burden in clinical workflows by identifying where redundancy could be eliminated and (2) reducing bias in SDOH data collection through more systematic screening protocols.