The recent surge in research on screening for social risks has been largely determined by the National Academy of Engineering, Medicine, and Science’s emphasis on screening as a central recommendation for enhancing the combination of health care and social care. However, the most recent nationally representative data on the extent to which physician practices consistently screen patients for social risks comes from the 2017 National Survey of Healthcare Organizations and Systems (NSHOS).
This 2017 NSHOS discovered that slightly more than half of US physician practices providing primary care were screening for 56.4% interpersonal violence, whereas few practices were screened for 4 other remaining social risks such as 27.8% of housing instability, 23.1% of utility needs, 29.6% of food insecurity, and 35.4% of transportation needs.
The modifications in screening processes among US physician practices since 2017 remain uncertain. However, according to 2022 data indicate that 53% to 72% of hospitals screened for 5 main social risks such as housing, utilities, interpersonal violence, transportation, and food. This data is mostly used for discharge planning. Amanda L. Brewster et al evaluated the trends in systematic screening of patients for social needs between 2017 and 2022, as well as the practice characteristics associated with the adoption of social risk screening. This cross-sectional study was published in JAMA Network Open, on January 3, 2025.
This cross-sectional design was approved by the University of California, Committee for the Protection of Human Subjects. The authors collected data on social risk screening from the 2017 and 2022 NSHOS surveys, which included physician practice sites with three or more adult primary care physicians. A total of 3442 practical survey responses were included, with 2190 physicians responding in 2017 and 1252 in 2022 with response rates of 46.9% and 35.8%, respectively.
Most surveys in the 81% (2773/3442) sample were from practices with ≤12 or fewer physicians. In adjusted analysis, the majority of the physician practices are from healthcare networks compared to self-owned hospitals. It was stated that 30% (95% confidence interval [CI]: 27%-32%) and 39% (95% CI: 33%-45%) practices were part of healthcare networks in 2017 and 2022, respectively. While 29% (95% CI: 26%-32%) and 20% (95% CI: 17%-23%) practices were part of self-owned hospitals in 2017 and 2022, respectively. Moreover, 28% (966 responses) of physicians received ≥20% of revenue from Medicaid. Between 2017 and 2022, the weighted results of practices showed slight changes including practice size, US Census region of practices, medicaid revenue, and practice ownership.
An extensive increase in social risk screening was found in an unadjusted analysis from 2017 to 2022. However, statistical significance (P < 0.001) was observed from 2017 to 2022 in 4 social risk factors like housing (28% [95% CI: 25%-30%] to 44% [95% CI: 39%-49%]), utilities (23% [95% CI: 20%-26%] to 34% [95% CI: 29%-39%]), transportation (35% [95% CI: 32%-38%] to 47% [95% CI: 42%-53%] and food (29% [95% CI: 27%-32%] to 47% [95% CI: 42%-52%]) whereas non-statistical significance (P = 0.11) was observed in interpersonal violence (56% [95% CI: 53%-59%] to 61% [95% CI: 56%-66%]).
Finally screening for all 5 social risks among US physician practices significantly enhanced from 15% (95% CI: 13%-18%) in 2017 to 27% (95% CI: 23%-32%) in 2022 with P < 0.001. While the proportion of practices screening for at least one of these five risks rose from 67% (95% CI: 64%-69%) to 74% (95% CI: 69%-79%; P = 0.007).
Social risk screening was increased by various factors such as federally qualified health center (FQHC) (incidence rate ratio [IRR], 1.550 [95% CI: 1.336-1.799]; P < 0.001), higher innovation culture scores (IRR, 1.012 [95% CI: 1.010-1.015]; P < 0.001), advanced information systems capabilities (IRR, 1.003 [95% CI: 1.001-1.005]; P = 0.005), and exposure to payment reform (IRR, 1.002 [95% CI: 1.000-1.003]; P = 0.01).
“Our conclusion specifies that screening for social risks among physician practice has increased significantly in recent years. Ongoing research is needed to monitor screening activities. Healthcare policies and programs should be developed and implemented along with social care. This will assess the impact of referrals, service delivery, and social risk screening on patient outcomes,” says Amanda L. Brewster, PhD, Division of Health Policy and Management, School of Public Health, University of California, Berkeley.
Reference: Brewster AL, Rodriguez HP, Murray GF, Lewis VA, Schifferdecker KE, Fisher ES. Trends in Screening for Social Risk in US Physician Practices. JAMA Netw Open. 2025;8(1):e2453117. doi:10.1001/jamanetworkopen.2024.53117
