Introduction
Federally Qualified Health Centers serve 29.8 million low-income patients across the
U.S., many of whom have unaddressed social risks. In 2019, for the first time, data
on social risk screening capabilities were collected from every U.S. Federally Qualified
Health Center. The objectives of this study were to describe the national rates of
social risk screening capabilities across Federally Qualified Health Centers, identify
organizational predictors of screening, and assess between-state heterogeneity.
Methods
Using a 100% sample of U.S. Federally Qualified Health Centers (N=1,384, representing
29.8 million patients) from the 2019 Uniform Data System, the primary outcome was
whether a Federally Qualified Health Center collected data on patients’ social risk
factors (yes/no). Summary statistics on the rates of social risk screening capabilities
were generated in aggregate and by state. Linear probability models were then used
to estimate the relationship between the probability of social risk screening and
7 key Federally Qualified Health Center characteristics (e.g., Federally Qualified
Health Center size, Medicaid MCO contract, Medicaid accountable care organization
presence). Data were analyzed in 2020‒2021.
Results
Most (71%) Federally Qualified Health Centers collected social risk data, with a between-state
variation. The most common screener was the Protocol for Responding to and Assessing
Patients’ Assets Risks and Experiences (43% of Federally Qualified Health Centers
that screened), whereas 22% collected social risk data using a nonstandardized screener.
After adjusting for other characteristics, Federally Qualified Health Centers with
social risk screening capabilities served more total patients, were more likely to
be located in a state with a Medicaid accountable care organization, and were less
likely to have an MCO contract.
Conclusions
There has been widespread adoption of social risk screening tools across U.S. Federally
Qualified Health Centers, but between-state disparities exist. Targeting social risk
screening resources to smaller Federally Qualified Health Centers may increase the
adoption of screening tools.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Unmet social needs among low-income adults in the United States: associations with health care access and quality.Health Serv Res. 2020; 55: 873-882https://doi.org/10.1111/1475-6773.13555
- Housing instability and food insecurity as barriers to health care among low-income Americans.J Gen Intern Med. 2006; 21: 71-77https://doi.org/10.1111/j.1525-1497.2005.00278.x
- Addressing basic resource needs to improve primary care quality: a community collaboration programme.BMJ Qual Saf. 2016; 25: 164-172https://doi.org/10.1136/bmjqs-2015-004521
Health Center Program: impact and growth. Health Resources & Service Administration. https://bphc.hrsa.gov/about/healthcenterprogram/index.html. Updated 2020. Accessed September 24, 2020.
- Prevalence of patient-reported social risk factors and receipt of assistance in federally funded health centers.J Gen Intern Med. 2020; 35: 360-364https://doi.org/10.1007/s11606-019-05393-w
- Prevalence of housing problems among community health center patients.JAMA. 2018; 319: 717-719https://doi.org/10.1001/jama.2017.19869
42 USC 254b: Health Centers. http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim. Accessed July 21, 2021.
- Enabling services improve access to care, preventive services, and satisfaction among health center patients.Health Aff (Millwood). 2019; 38: 1468-1474https://doi.org/10.1377/hlthaff.2018.05228
- Receipt of social needs assistance and health center patient experience of care.Am J Prev Med. 2021; 60: e139-e147https://doi.org/10.1016/j.amepre.2020.08.030
- Provision of social services and health care quality in U.S. community health centers, 2017.Am J Public Health. 2020; 110: 567-573https://doi.org/10.2105/AJPH.2019.305519
- Collecting and applying data on social determinants of health in health care settings.JAMA Intern Med. 2013; 173: 1017-1020https://doi.org/10.1001/jamainternmed.2013.560
- Screening for social determinants of health in clinical care: moving from the margins to the mainstream.Public Health Rev. 2018; 39: 19https://doi.org/10.1186/s40985-018-0094-7
- Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by us physician practices and hospitals.JAMA Netw Open. 2019; 2e1911514https://doi.org/10.1001/jamanetworkopen.2019.11514
- Integrating social needs care into the delivery of health care to improve the Nation's health.The National Academies of Sciences Engineering Medicine, Washington, DC2019 (https://www.nationalacademies.org/our-work/integrating-social-needs-care-into-the-delivery-of-health-care-to-improve-the-nations-health. Published 2019. Accessed July 29, 2021)
- The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by U.S. physicians.Milbank Q. 2020; 98: 1114-1133https://doi.org/10.1111/1468-0009.12480
- FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.J Gen Intern Med. 2021; 36: 2922-2928https://doi.org/10.1007/s11606-021-06746-0
- Adoption of social determinants of health EHR tools by community health centers.Ann Fam Med. 2018; 16: 399-407https://doi.org/10.1370/afm.2275
- How 6 organizations developed tools and processes for social determinants of health screening in primary care: an overview.J Ambul Care Manage. 2018; 41: 2-14https://doi.org/10.1097/JAC.0000000000000221
- Moving electronic medical records upstream: incorporating social determinants of health.Am J Prev Med. 2015; 48: 215-218https://doi.org/10.1016/j.amepre.2014.07.009
- Integrating data on social determinants of health into electronic health records.Health Aff (Millwood). 2018; 37: 585-590https://doi.org/10.1377/hlthaff.2017.1252
- Initiating and implementing social determinants of health data collection in community health centers.Popul Health Manag. 2021; 24: 52-58https://doi.org/10.1089/pop.2019.0205
- Screening for social determinants of health in Michigan health centers.J Am Board Fam Med. 2017; 30: 418-427https://doi.org/10.3122/jabfm.2017.04.170079
- Screening for social determinants of health in free and charitable clinics in North Carolina.J Health Care Poor Underserved. 2020; 31: 382-397https://doi.org/10.1353/hpu.2020.0029
- Collecting social determinants of health data in the clinical setting: findings from national PRAPARE implementation.J Health Care Poor Underserved. 2020; 31: 1018-1035https://doi.org/10.1353/hpu.2020.0075
PRAPARE. National Association of Community Health Centers. https://www.nachc.org/research-and-data/prapare/. Updated 2020. Accessed July 21, 2021.
Uniform Data System (UDS) resources. Health Resources and Services Administration, Bureau of Primary Health Care. https://bphc.hrsa.gov/datareporting/reporting/index.html. Updated 2021. Accessed July 21, 2021.
- A View from the states: key Medicaid policy changes: results from a 50-state Medicaid budget survey for state fiscal years 2019 and 2020.Kaiser Family Foundation, San Francisco, CA2019 (https://www.kff.org/medicaid/report/a-view-from-the-states-key-medicaid-policy-changes-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2019-and-2020/. Published October 18, 2019. Accessed July 21, 2021)
- Screening for health-related social needs of emergency department patients.Ann Emerg Med. 2021; 77: 62-68https://doi.org/10.1016/j.annemergmed.2020.08.010
- Screening for social determinants of health in populations with complex needs: implementation considerations.Center for Health Care Strategies, Hamilton, NJ2017 (https://www.chcs.org/resource/screening-social-determinants-health-populations-complex-needs-implementation-considerations/. Published October 26, 2017. Accessed July 21, 2021)
- Screening for social determinants of health: the known and unknown.JAMA. 2019; 322: 1037-1038https://doi.org/10.1001/jama.2019.10915
- Addressing social determinants of health identified by systematic screening in a Medicaid accountable care organization: a qualitative study.J Prim Care Community Health. 2021; 122150132721993651https://doi.org/10.1177/2150132721993651
- Variation in health outcomes: the role of spending on social services, public health, and health care, 2000–09.Health Aff (Millwood). 2016; 35: 760-768https://doi.org/10.1377/hlthaff.2015.0814
- CMS issues new road map for states to address the social determinants of health to improve outcomes, lower costs, support state value-based care strategies.Centers of Medicare and Medicaid Services, Baltimore, MD2021 (https://www.cms.gov/newsroom/press-releases/cms-issues-new-roadmap-states-address-social-determinants-health-improve-outcomes-lower-costs. Published January 7, 2021. Accessed July 21, 2021)
- Marrying value-based payment and the social determinants of health through Medicaid ACOs: implications for policy and practice.Milbank Memorial Fund, 2020 (May 2020. https://www.milbank.org/publications/marrying-value-based-payment-and-the-social-determinants-of-health-through-medicaid-acos-implications-for-policy-and-practice/. Accessed July 21, 2012)
- Accelerating the implementation of social determinants of health interventions in internal medicine.J Gen Intern Med. 2018; 33: 223-225https://doi.org/10.1007/s11606-017-4230-8
- National data on social risk screening underscore the need for implementation research.JAMA Netw Open. 2019; 2e1911513https://doi.org/10.1001/jamanetworkopen.2019.11513
- Upstream with a small paddle: how ACOs are working against the current to meet patients’ social needs.Health Aff (Millwood). 2020; 39: 199-206https://doi.org/10.1377/hlthaff.2019.01266
- The prevalence of social care in US health care settings depends on how and whom you ask.BMC Health Serv Res. 2020; 20: 481https://doi.org/10.1186/s12913-020-05338-8
- What evidence do we need before recommending routine screening for social determinants of health?.Am Fam Physician. 2019; 99: 602-605https://pubmed.ncbi.nlm.nih.gov/31083876Date accessed: July 22, 2021
- Social determinants matter, but who is responsible?.Cottonwood Heights, UT, 2018 (Leavitt Partners. https://leavittpartners.com/whitepaper/social-determinants-matter-but-who-is-responsible/. Published May 9, 2018. Accessed July 22, 2021)
- Why more evidence is needed on the effectiveness of screening for social needs among high-use patients in acute care settings.Health Affairs Blog. 2019; (May 23, 2019)https://doi.org/10.1377/hblog20190520.243444
- Unemployment insurance, health-related social needs, health care access, and mental health during the COVID-19 pandemic.JAMA Intern Med. 2021; 181: 699-702https://doi.org/10.1001/jamainternmed.2020.7048
- The early food insecurity impacts of COVID-19.Nutrients. 2020; 12: 2096https://doi.org/10.3390/nu12072096
- Addressing the social determinants of health during the COVID-19 pandemic: ensuring equity, quality, and sustainability.Fam Community Health. 2021; 44: 78-80https://doi.org/10.1097/FCH.0000000000000290
Article Info
Publication History
Published online: February 07, 2022
Identification
Copyright
© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
