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Am J Prev Med. 2019 Dec;57(6S1):S25-S37. doi: 10.1016/j.amepre.2019.07.010.

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

Author information

1
Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California. Electronic address: emilia.demarchis@ucsf.edu.
2
Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California.
3
Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, San Francisco, California.
4
Center for Health and Community, University of California, San Francisco, San Francisco, California.
5
Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
6
Providence VA Medical Center, Providence, Rhode Island; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
7
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York.
8
Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
9
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
10
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
11
Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine-Geriatrics, University of Chicago, Chicago, Illinois.
12
Section of General Internal Medicine, University of Chicago, Chicago, Illinois.
13
Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado; Center for Women's Health Research, University of Colorado School of Medicine, Aurora, Colorado.
14
Department of Psychiatry, University of San Francisco, San Francisco, California.
15
Department of Emergency Medicine, University of San Francisco, San Francisco, California.
16
Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
17
Upstream Health Innovations, Hennepin County Medical Center, Minneapolis, Minnesota.
18
La Familia Medical Center, Santa Fe, New Mexico.
19
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
20
Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
21
Children's HealthWatch, Boston, Massachusetts.

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.

PMID:
31753277
DOI:
10.1016/j.amepre.2019.07.010
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