Clinically screening hospital patients for social risk factors across multiple hospitals: Results and implications for intervention development

Background: Hospitals are increasingly screening patients for social risk factors to help improve patient and population health. Intelligence gained from such screening can be used to inform social need interventions, the development of hospital-community collaborations, and community investment decisions.

Objective: We evaluated the frequency of admitted patients' social risk factors and examined whether these factors differed between hospitals within a health system. A central goal was to determine if community-level social need interventions can be similar across hospitals.

Design and participants: We described the development, implementation, and results from Northwell Health's social risk factor screening module. The statistical sample included patients admitted to 12 New York City/Long Island hospitals (except for maternity/pediatrics) who were clinically screened for social risk factors at admission from June 25, 2019, to January 24, 2020.

Main measures: We calculated frequencies of patients' social needs across all hospitals and for each hospital. We used chi-square and Friedman tests to evaluate whether the hospital-level frequency and rank order of social risk factors differed across hospitals.

Results: Patients who screened positive for any social need (n = 5196; 6.6% of unique patients) had, on average, 2.3 of 13 evaluated social risk factors. Among these patients, the most documented social risk factor was challenges paying bills (29.4%). The frequency of 12 of the 13 social risk factors statistically differed across hospitals. Furthermore, a statistically significant variance in rank orders between the hospitals was identified (Friedman test statistic 30.8 > 19.6: χ2 critical, p = 0.05). However, the hospitals' social need rank orders within their respective New York City/Long Island regions were similar in two of the three regions.

Conclusions: Hospital patients' social needs differed between hospitals within a metropolitan area. Patients at different hospitals have different needs. Local considerations are essential in formulating social need interventions and in developing hospital-community partnerships to address these needs.