Measuring patients’ basic resource needs: The role of a small survey to guide operational decisions

Introduction: Increasingly, health care systems use systematic surveys of their patients to identify basic resource needs such as food insecurity. Surveys of small patient samples can help these systems improve existing instruments and explore new measures.
Methods: In response to operational concerns with an existing food insecurity measure, we surveyed 110 older adult members (60% response rate) from Kaiser Permanente Colorado (KPCO); 96 (87%) of these individuals completed a 3-month follow-up survey. The survey compared measures of food insecurity, assessed coexisting basic resource needs, explored trade-offs between those needs, assessed changes over time, and described the use of community food resources.
Results: A well-validated, 2-item food insecurity measure had fewer false-positive responses than a previously used single-item measure. Individuals with food insecurity commonly reported concurrent difficulties paying for housing, transportation, utilities, and cost-related medication nonadherence. These basic resource needs persisted during a 3-month period. Participants commonly reported reciprocal trade-offs in paying for basic resource needs; 47.4% had delayed paying for food to pay for housing, and 22.0% had delayed paying for housing to pay for food (p 0.001). Although 51.8% of participants reported receiving assistance from KPCO in obtaining food and 25.5% reported assistance with medical costs, fewer than 5% received assistance with other basic resource needs.
Conclusion: This survey informed operational decisions about measure selection and survey timing, and helped leaders and researchers understand the relationships among basic resource needs. Such surveys can help learning health systems improve their capacity to assess these fundamental human needs.