Social Needs Screening and Subsequent Acute Care Utilization in a Large Safety-Net Health System: A Retrospective...

Health systems increasingly screen for patients' social needs, but evidence is limited on which specific needs are most associated with subsequent acute care use.

To examine associations between patient-reported social needs and subsequent acute care utilization in a large safety-net population.

Retrospective cohort study linking 2023 social needs screening data from a large safety-net health system to longitudinal electronic health records from a multi-health system clinical research network.

20,337 adults with a primary care visit who completed social needs screening in 2023.

Exposures were positive screening for nine social needs domains (e.g., transportation-related delayed care). Outcomes were any hospitalization, any ED visit, preventable hospitalization, and preventable ED visit. Multivariable logistic regression adjusted for demographics, comorbidities, and neighborhood social conditions.

Overall, 15.9% screened positive for ≥ 1 social need. The most prevalent needs were food insecurity (5.9%) and problems with residence (5.6%), followed by housing stability concerns (4.6%) and transportation barriers (4.1%). After covariate adjustment, transportation-related delayed care was associated with a 6.8-percentage-point increase in the probability of having ≥ 1 hospitalization (95% CI, 4.1 to 9.5; p < 0.001), an 8.4-percentage-point increase in the probability of having ≥ 1 ED visit (95% CI, 4.8 to 12.0; p < 0.001), a 1.2-percentage-point increase in the probability of having ≥ 1 preventable hospitalization (95% CI, 0.1 to 2.3; p = 0.04), and a 4.2-percentage-point increase in the probability of having ≥ 1 preventable ED visit (95% CI, 1.6 to 6.7; p = 0.002). A positive screening for housing-related problems was associated with increased probability of having ≥ 1 ED visit. Other domains were not significantly associated with outcomes.

In a safety-net setting, transportation barriers showed the strongest and most consistent associations with subsequent acute care use. Targeted transportation and care-navigation strategies may be critical components of social care interventions.