RT Journal Article
SR Electronic
T1 A Comparison of Inpatient to Outpatient Screening for Social Drivers of Health (SDOH) in a Safety-Net Hospital
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 4668
DO 10.1370/afm.22.s1.4668
VO 21
IS Supplement 3
A1 Sweeney, Sarah
A1 Nair, Kiron
A1 Liang, Katherine
YR 2023
UL http://www.annfammed.org/content/21/Supplement_3/4668.abstract
AB Context: Health systems are working to identify and address the social drivers of health (SDOH). Little is known about screening inpatient adults for SDOH and how SDOH risks and population characteristics compare between outpatient vs inpatient settings.Objective: Compare SDOH risks between inpatient and outpatient populations in the same health system, and examine differences by age, race, ethnicity, gender, average income and insurance.Study Design and Analysis: Cross-sectional studySetting: A safety-net public hospital in Cleveland, OhioPopulation Studied: Adults admitted to two inpatients units during an SDOH screening pilot Feb– April 2023 compared to previously published data from outpatient SDOH screening done Feb–March 2021Intervention/Instrument: The SDOH screening tool included 11 (inpatient) and 9 (outpatient) domains using the same validated questionnaire items. 5 domains were directly comparable.Outcome Measures: The primary outcomes were proportion of SDOH risk from the two groups. Demographics including age, gender, race, ethnicity, insurance status and average income were extracted from the EMR (inpatients) and previously published data (outpatients). Chi-squared test was used to determine differences.Results: 796 inpatients and 5741 outpatients were eligible for screening with 28% (44% self-screen, 56% staff assist) and 60% (100% staff assist) of patients successfully screened in each setting. There were no differences in the proportion of screened patients based on age, gender and race (p=0.05). Differences existed between groups on insurance type and income level, with inpatients representing a higher proportion of Medicaid and lower income patients (p=0.001). For all 5 domains, (financial strain (34% v 6%), food insecurity (27% v 17%), intimate partner violence (6% vs 1%), transportation (17% to 5%) and lack of internet access (17% to 4%)), inpatients had a higher proportion at risk (p=0.001).Conclusions: Screening for SDOH in different settings has implications for patients and health systems. Inpatients may disproportionately represent those with higher SDOH risk and outpatient data may not adequately represent population demographics or risk. Screening in the inpatient setting has unique challenges and some screening modalities may be more successful than others. To achieve universal screening, it is important to design SDOH programs that target at-risk populations, using the most successful settings and modalities.