University of San Francisco California
The importance of role and setting in health system social determinants of health screening results
Presentations from 2025 SIREN National Research Meeting: Advancing the Science of Social Care
Background
With recent regulations requiring health systems to conduct social determinants of health (SDOH) screening among patients, more information is needed on best practices to conduct screening.
Objective
Analyze differences in SDOH screening rates by screener role and setting at Henry Ford Health based in Detroit, Michigan.
Methods
A report of 2023 SDOH screening data was generated and analyzed. Informational interviews and participant observation were also conducted with Medical Assistants (MAs) and Community Health Workers (CHWs).
Results
In 2023, 1,066,651 SDOH screenings were conducted by a total of 240 unique job titles. MAs conducted the majority (50.7%) of screenings; however, they identified a low percentage of needs (4.3%). Patient self-reported screens via MyChart comprised 34.8% of screens with 15.6% identifying a need. Conversely, Ambulatory Case Managers (ACM), CHWs, and Mobile Integrated Health (MIH) paramedics conducted far fewer screens, but identified needs in over 70% of screens. Shadowing revealed CHWs used a more conversational approach than MAs.
Table 1. Top SDoH Screenings by Screening Type
Screening Completed By | # SDOH Screenings Conducted | % of Total Screenings | % with Identified Need | % Wants Assistance with Need |
ALL | 1,066,651 | 100% | 11.6% | 20.5% |
Medical Assistant | 540,625 | 50.7% | 4.3% | 18.5% |
MyChart (Self-Reported Online) | 370,916 | 34.8% | 15.6% | 17.7% |
Ambulatory Case Manager | 41,885 | 3.9% | 74.3% | 67.1% |
Community Health Worker | 1,284 | 0.1% | 78.7% | 40.9% |
Mobile Integrated Health Paramedic | 712 | 0.1% | 70.6% | 22.9% |
Conclusion
Roles and setting clearly impact SDOH screening. Roles that traditionally better establish trust with patients (i.e. CHW, ACM) are well placed to obtain honest answers regarding needs; however, staffing resources are limited. Empathic inquiry training would benefit MAs to obtain more accurate screens. Patients are also more likely to reveal needs when they are in a comfortable setting (MIH screens occur in patients’ homes) or they self-report via MyChart; however, inequities in digital access and technology literacy must be addressed.