Assessing the impact of social needs and social determinants of health on health care utilization: using patient- and community-level data

Abstract

As the US health care system moves to expand access to and quality of medical care, the importance of addressing patient-level social needs and community-level social determinants of health (SDOH) is increasingly being recognized. This study evaluates individual- and community-level needs of housing (one of the SDOH domains) across the patient population of an academic medical center and explores how the level of housing needs impacts health care utilization. The authors performed a descriptive analysis of housing issues identified in both structured and unstructured (eg, clinical notes) data extracted from the electronic health record (EHR) and compared this to community-level characteristics of patients' neighborhood as measured by the Area Deprivation Index. Multivariate analyses were performed to assess the association between these and other factors on the frequency of service encounters. Among the 1,034,683 study participants, 59,703 (5.8%) had at least 1 housing issue identified in their EHR from structured or unstructured data combined. After adjusting for other factors, patients with housing instability and homelessness had 49% and 34% more encounters with the health care system compared to patients without housing issues ( P < 0.00001). Patients living in the most disadvantaged neighborhoods had 55% more encounters with the health care system compared to those living in the most advantaged neighborhoods ( P < 0.00001). This data collection approach and findings can inform health care systems aiming to make use of their EHRs and community-level SDOH information to provide a full assessment of patients' social needs and challenges.