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Cited by 72Health disparities and outcomesPublic Health and Social InequalitiesHealthcare Policy and Management

Screening for health-related social needs and collaboration with external partners among US hospitals

Open access
Ashe, Jason J., Baker, Matthew C., Alvarado, Carla S., Alberti, Philip M.·2023·JAMA Network Open
DOI 10.1001/jamanetworkopen.2023.30228PMC PMC10448297
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Abstract

Importance: In recent years, hospitals and health systems have reported increasing rates of screening for patients’ individual and community social needs, but few studies have explored the national landscape of screening and interventions directed at addressing health-related social needs (HRSNs) and social determinants of health (SDOH). Objective: To evaluate the associations of hospital characteristics and area-level socioeconomic indicators to quantify the presence and intensity of hospitals’ screening practices, interventions, and collaborative external partnerships that seek to measure and ameliorate patients’ HRSNs and SDOH. Design, Setting, and Participants: This cross-sectional study used national data from the American Hospital Association Annual Survey Database for fiscal year 2020. General-service, acute-care, nonfederal hospitals were included in the study’s final sample, representing nationally diverse hospital settings. Data were analyzed from July 2022 to February 2023. Exposures: Organizational characteristics and area-level socioeconomic indicators. Main Outcomes and Measures: The outcomes of interest were hospital-reported patient screening of and strategies to address 8 HRSNs and 14 external partnership types to address SDOH. Composite scores for screening practices and external partnership types were calculated, and ordinary least-square regression analyses tested associations of organizational characteristics with outcome measures. Results: Of 2858 US hospital respondents (response rate, 67.0%), most hospitals (79.2%; 95% CI, 77.7%-80.7%) reported screening patients for at least 1 HRSN, with food insecurity or hunger needs (66.1%; 95% CI, 64.3%-67.8%) and interpersonal violence (66.4%; 95% CI, 64.7%-68.1%) being the most commonly screened social needs. Most hospitals (79.4%; 95% CI, 66.3%-69.7%) reported having strategies and programs to address patients’ HRSNs; notably, most hospitals (52.8%; 95% CI, 51.0%-54.5%) had interventions for transportation barriers. Hospitals reported a mean of 4.03 (95% CI, 3.85-4.20) external partnership types to address SDOH and 5.69 (5.50-5.88) partnership types to address HRSNs, with local or state public health departments and health care practitioners outside of the health system being the most common. Hospitals with accountable care contracts (ACCs) and bundled payment programs (BPPs) reported higher screening practices (ACC: β = 1.03; SE = 0.13; BPP: β = 0.72; SE = 0.14), interventions (ACC: β = 1.45; SE = 0.12; BPP: β = 0.61; SE = 0.13), and external partnership types to address HRSNs (ACC: β = 2.07; SE = 0.23; BPP: β = 1.47; SE = 0.24) and SDOH (ACC: β = 2.64; SE = 0.20; BPP: β = 1.57; SE = 0.21). Compared with nonteaching, government-owned, and for-profit hospitals, teaching and nonprofit hospitals were also more likely to report more HRSN-directed activities. Patterns based on geographic and area-level socioeconomic indicators did not emerge. Conclusions and Relevance: This cross-sectional study found that most US hospitals were screening patients for multiple HRSNs. Active participation in value-based care, teaching hospital status, and nonprofit status were the characteristics most consistently associated with greater overall screening activities and number of related partnership types. These results support previously posited associations about which types of hospitals were leading screening uptake and reinforce understanding of the role of hospital incentives in supporting health equity efforts.

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  • Individual-level SDoH data collection remains evolving and is not yet consistently available across large populations.

    “individual-level SDoH data collection remains evolving and not yet consistently available across large populations [95–98]”

    From Machine learning-driven risk prediction for post-hospitalization diabetes case management: Integrating clinical and social determinants of health (2026) · cites this paper as [95]

    The Discussion’s Limitations section (page unavailable) says the national hospital survey identifies which hospitals screen for social needs but cannot show whether screening reaches all patients; it calls for more granular data. That supports a gap in patient-level screening data, but the paper does not establish that individual-level SDoH data are inconsistently available across large populations generally. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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2 of the 40 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [6]Mechanic R, Fitch A. Working with ACOs to address social determinants of health. Health Affairs Forefront. January 10, 2023. Accessed January 11, 2023. https://www.healthaffairs.org/content/forefront/working-acos-address-social-determinants-health
  2. [19]Senathirajah M, Dankwa-Mullan I, Pickens G, Benevent R, Spurlock B. A hospital social needs index would help hospitals collaborate to address social needs and health equity. Health Affairs Forefront. August 2, 2022. Accessed July 20, 2023. https://www.healthaffairs.org/content/forefront/hospital-social-needs-index-would-help-hospitals-collaborate-address-social-needs-and

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Authors
Ashe, J. J., Baker, M. C., Alvarado, C. S., & Alberti, P. M.
Affiliations
Association of American Medical Colleges (US)
Corresponding author
Ashe, Jason J.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2023-08-23
Volume
6
Issue
8
Pages
e2330228
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2023.30228
PMC
PMC10448297
OpenAlex
W4386083661
Cited by
71
References
40
Citations by year
2026: 23 · 2025: 24 · 2024: 21 · 2023: 3
FWCI
19.19
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Health › Public Health and Social Inequalities
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
social determinants of health, hospital collaboration, community health needs assessment, food insecurity, hunger, interpersonal violence, transportation barriers, hospital-community collaboration, United States hospitals, health equity
MeSH terms
Critical Care, Cross-Sectional Studies, Health Facilities, Hospitals, Teaching, Humans, United States, Databases, Factual

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