Convergence and differences across social needs identified through structured screeners and clinical assessments

Area of Science:

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

Background:

• Social determinants of health (SDOH) significantly impact patient health outcomes.
• Standardized SDOH screeners are increasingly used in clinical settings.
• The effectiveness of screeners versus conversational assessments by Community Health Workers (CHWs) is not well understood.

Purpose of the Study:

• To compare the ability of standardized SDOH screeners and CHW-led semi-structured assessments to identify patient social needs.
• To determine the concordance between these two methods of assessing social needs.

Main Methods:

• An observational study was conducted using deidentified electronic health record data.
• Adult primary care patients completed both a standardized SDOH screener and a CHW-led assessment.
• Data from 2,077 patients were analyzed to compare identified needs across 10 domains.

Main Results:

• 51.4% of patients reported at least one social need on both instruments.
• A substantial proportion (43.3%) reported needs only to CHWs, while only 1.8% reported needs only on the screener.
• CHWs identified higher rates of food insecurity, transportation needs, and legal assistance compared to the screener.

Conclusions:

• Conversational assessments by CHWs identify unmet social needs more effectively than standardized screeners.
• Relying solely on structured SDOH screening may lead to underestimation of patient needs.
• Integrating or substituting clinical assessments for screeners could improve resource linkage.