Part I: A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers

Emilia H De Marchis, Danielle Hessler, Caroline Fichtenberg, Nancy Adler, Elena Byhoff, Alicia J Cohen, Kelly M Doran, Stephanie Ettinger de Cuba, Eric W Fleegler, Cara C Lewis, Stacy Tessler Lindau, Elizabeth L Tung, Amy G Huebschmann, Aric A Prather, Maria Raven, Nicholas Gavin, Susan Jepson, Wendy Johnson, Eduardo Ochoa Jr, Ardis L Olson, Megan Sandel, Richard S Sheward, Laura M Gottlieb, Emilia H De Marchis, Danielle Hessler, Caroline Fichtenberg, Nancy Adler, Elena Byhoff, Alicia J Cohen, Kelly M Doran, Stephanie Ettinger de Cuba, Eric W Fleegler, Cara C Lewis, Stacy Tessler Lindau, Elizabeth L Tung, Amy G Huebschmann, Aric A Prather, Maria Raven, Nicholas Gavin, Susan Jepson, Wendy Johnson, Eduardo Ochoa Jr, Ardis L Olson, Megan Sandel, Richard S Sheward, Laura M Gottlieb

Abstract

Introduction: Despite recent growth in healthcare delivery-based social risk screening, little is known about patient perspectives on these activities. This study evaluates patient and caregiver acceptability of social risk screening.

Methods: This was a cross-sectional survey of 969 adult patients and adult caregivers of pediatric patients recruited from 6 primary care clinics and 4 emergency departments across 9 states. Survey items included the Center for Medicare and Medicaid Innovation Accountable Health Communities' social risk screening tool and questions about appropriateness of screening and comfort with including social risk data in electronic health records. Logistic regressions evaluated covariate associations with acceptability measures. Data collection occurred from July 2018 to February 2019; data analyses were conducted in February‒March 2019.

Results: Screening was reported as appropriate by 79% of participants; 65% reported comfort including social risks in electronic health records. In adjusted models, higher perceived screening appropriateness was associated with previous exposure to healthcare-based social risk screening (AOR=1.82, 95% CI=1.16, 2.88), trust in clinicians (AOR=1.55, 95% CI=1.00, 2.40), and recruitment from a primary care setting (AOR=1.70, 95% CI=1.23, 2.38). Lower appropriateness was associated with previous experience of healthcare discrimination (AOR=0.66, 95% CI=0.45, 0.95). Higher comfort with electronic health record documentation was associated with previously receiving assistance with social risks in a healthcare setting (AOR=1.47, 95% CI=1.04, 2.07).

Conclusions: A strong majority of adult patients and caregivers of pediatric patients reported that social risk screening was appropriate. Most also felt comfortable including social risk data in electronic health records. Although multiple factors influenced acceptability, the effects were moderate to small. These findings suggest that lack of patient acceptability is unlikely to be a major implementation barrier.

Supplement information: This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.

Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.
Figure 1.
CONSORT flow diagram. aVersion 1= AHC 10-item social risk questions first; no additional response option. bVersion 2= Question on interest in assistance with social risks first; no additional response option. cVersion 3= Question on interest in assistance with social risks first; “I prefer not to answer” option. dVersion 4= AHC 10-item social risk questions first; “I prefer not to answer” option. AHC, Accountable Health Communities.

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