Trends in Screening for Social Risk in US Physician Practices Report

Academic Background

In recent years, the importance of social risk screening in healthcare has become increasingly prominent, with more research focusing on identifying patients’ social risk factors such as food insecurity, housing instability, utility needs, interpersonal violence, and transportation needs. These social risk factors are closely related to patients’ health status, and identifying and addressing these risks can help improve overall health outcomes. However, despite the growing body of research on the implementation of social risk screening, there is still limited research on how US physician practices have changed in this regard over time.

In 2017, the National Survey of Healthcare Organizations and Systems (NSHOS) showed that more than half of primary care physician practices systematically screened for interpersonal violence (56.4%), but the screening rates for other social risks were lower (food insecurity 29.6%, housing instability 27.8%, utility needs 23.1%, and transportation needs 35.4%). Since 2017, it remains unclear how the implementation of social risk screening has evolved, particularly whether physician practices have increased their screening for these social risks.

Research Source

This report was co-authored by Amanda L. Brewster, Hector P. Rodriguez, Genevra F. Murray, Valerie A. Lewis, Karen E. Schifferdecker, and Elliott S. Fisher, affiliated with the University of California, Berkeley, New York University, the University of North Carolina at Chapel Hill, and Dartmouth College, respectively. The study was published on January 3, 2025, in JAMA Network Open, titled Trends in Screening for Social Risk in US Physician Practices.

Research Design and Methods

Research Design

This study employed a repeated cross-sectional design, analyzing data from the 2017 and 2022 NSHOS surveys. NSHOS is a nationally representative survey of physician practice sites that include at least three adult primary care physicians. In 2017, a total of 2,333 practices completed the survey (response rate: 46.9%), while in 2022, 1,252 practices completed the survey (response rate: 35.8%). To ensure data comparability, the study only used questions that were included in both survey waves.

Research Variables

Dependent Variable

The primary dependent variable was whether physician practices systematically screened for five common social risks: food insecurity, housing instability, utility needs, interpersonal violence, and transportation needs. The study also calculated the number of social risks screened by each practice (ranging from 0 to 5).

Independent Variables

Independent variables included the survey year (2017 or 2022) and practice characteristics, such as the proportion of practice revenue from Medicaid, innovation culture scores, advanced information system scores, and payment reform exposure scores.

Covariates

Covariates included practice ownership, size, and geographic location.

Data Analysis

The study used multivariable Poisson regression models to analyze the association between survey year, practice characteristics, and the number of social risks screened. To test the robustness of the results, sensitivity analyses were conducted, including fixed-effects models for practices that responded in both 2017 and 2022, as well as testing interactions between year and practice characteristics.

Research Findings

Trends in Social Risk Screening

The results showed a significant increase in social risk screening by physician practices from 2017 to 2022. In 2022, 27% of practices reported systematically screening for all five social risks, a significant increase from 15% in 2017 (p < 0.001). Unadjusted results showed that the average number of social risks screened per practice increased from 1.71 in 2017 to 2.34 in 2022.

Association Between Practice Characteristics and Social Risk Screening

The study found that certain types of practices were more likely to screen for more social risks, including Federally Qualified Health Centers (FQHCs), practices with higher innovation culture scores, practices with advanced information systems, and practices exposed to more payment reforms. Specifically, FQHCs screened significantly more social risks than other practices (IRR = 1.550, p < 0.001), and for every one-point increase in innovation culture scores, the number of social risks screened increased by 1.2% (IRR = 1.012, p < 0.001).

Sensitivity Analysis

Sensitivity analysis results were consistent with the main analysis, indicating the robustness of the findings. In particular, fixed-effects models showed that the relationship between time-varying characteristics and social risk screening was similar to the main analysis results.

Discussion and Conclusion

Discussion

The study suggests that although the prevalence of social risk screening has increased among physician practices, less than one-third of practices systematically screen for all five social risks. This growth indicates that practices nationwide are changing their care processes to more systematically consider patients’ social circumstances. However, screening alone does not necessarily mean that practices will use this information to adjust care or provide referrals for social needs.

The study also found that despite a decline in innovation culture scores, innovation culture remained strongly associated with higher rates of social risk screening. This may be related to the negative impact of the COVID-19 pandemic on healthcare worker morale and innovation. Moving forward, how to further promote social risk screening in resource-constrained settings remains a challenge.

Conclusion

This study provides evidence of a significant increase in social risk screening in recent years. However, whether practices can use this screening data to improve patient health outcomes remains to be seen. As policies and programs supporting the integration of social care into healthcare continue to expand, future research should focus on the relationship between social risk screening, referrals, and service delivery processes and patient outcomes.

Research Highlights

1. Significant Increase in Social Risk Screening: From 2017 to 2022, physician practices significantly increased their screening rates for social risks, particularly for food insecurity, housing instability, and transportation needs.
2. Impact of Practice Characteristics: FQHCs, practices with higher innovation culture scores, practices with advanced information systems, and practices exposed to payment reforms were more likely to screen for more social risks.
3. Importance of Innovation Culture: Despite a decline in innovation culture scores, innovation culture remains a key driver of social risk screening.

Research Significance

This study not only reveals trends in social risk screening among US physician practices but also provides important insights for future policy-making. As social risk screening becomes more widespread, how to effectively use this screening data to improve patient health outcomes will be a key focus of future research. Additionally, the study highlights the critical role of innovation culture and information system capabilities in driving healthcare innovation.