Trends in screening for social risk in us physician practices

IMPORTANCE: A wealth of research on screening for social risks in health care has emerged, but evidence is lacking on how social risk screening among physician practices has changed over time. 

OBJECTIVES: To evaluate trends in screening for social risks among US physician practices and examine practice characteristics associated with adoption of social risk screening. 

DESIGN, SETTING, AND PARTICIPANTS: The main analysis used a repeated cross-sectional design to analyze results from US physician practices that completed the National Survey of Healthcare Organizations and Systems, a nationally representative survey of physician practices, in 2017 and 2022. Sensitivity analysis tested robustness in a cohort of practices that completed surveys in both years. EXPOSURES: Survey year and characteristics of physician practices. 

MAIN OUTCOMES AND MEASURES: Whether physician practices systematically screened patients for 5 common social risks: food, housing, utilities, interpersonal violence, and transportation. 

RESULTS: In this cross-sectional study, 3442 practice survey responses were studied. Weighted results showed that in 2022, 27% (95% CI, 23%-32%) of practices reported screening for all 5 of the social risks, an increase from 15% (95% CI, 13%-18%) of practices in 2017 (P < .001). Unadjusted results showed a significant increase in the mean number of social risks screened per practice, from 1.71 (95% CI, 1.60-1.82) in 2017 to 2.34 (95% CI, 2.12-2.55) in 2022. Practice characteristics associated with screening for more social risks remained consistent between 2017 and 2022; these included being a federally qualified health center (incidence rate ratio [IRR], 1.550 [95% CI, 1.336-1.799]) and having higher innovation culture scores (IRR, 1.012 [95% CI, 1.010-1.015]), higher advanced information system scores (IRR, 1.003 [95% CI, 1.001-1.005]), and higher payment reform exposure scores (IRR, 1.002 [95% CI, 1.000-1.003]). 

CONCLUSIONS AND RELEVANCE: In this survey-based cross-sectional study of US physician practices, social risk screening increased substantially from 2017 to 2022, although still less than one-third of practices systematically screened for a set of 5 common social risks. What remains to be seen is whether practices use these data to help improve patient health by adjusting health care or referring patients for assistance with social needs. As policies and incentives increasingly emphasize social risk screening, it will be important to assess the association of screening and referrals with patient outcomes.