What unmet social needs do patients have - a 60-second survey reveals the answers
A link has now been established between adverse social determinants of health and high utilization of health care, and patients with adverse social determinants of health tend to have higher 30-day readmission rates. The researchers used a 60-second survey to better understand patients' unmet social needs to prioritize assistance strategies.
The current link between adverse social determinants of health and high utilization of health care has been established, treatment of manageable diseases in the community through emergency departments is very common, and 30-day readmissions for patients with adverse social determinants of health rates tend to be higher. Inspired by the WellRx toolkit developed by Arthur Kaufman, the researchers used a 60-second survey to better understand patients' unmet social needs to prioritize assistance strategies.
The study, conducted by the Virginia Commonwealth University Department of Family Medicine and Population Health in collaboration with the Office of Health System Innovation, Internal Medicine, Inpatient Departments, and Emergency Departments, conducted a 60-second survey of patients during their visit.
In the emergency department, a member of the research team conducted a 60-second survey in the waiting room. On a 4 x 6 inch card, the patient identified age, gender, and whether they needed help with any of the following in the past 30 days: food, housing, utilities, transportation, day care, legal, employment, education, substance abuse Treatment, safety, or domestic violence assistance. The card also provides the option to fill in "Other Needs" or select "No Help Required". All patients presenting to the emergency department during the data collection period were admitted to the study, and 93% (n = 508) of patients participated in the study. The researchers also provided the same survey for medical patients, with an additional question about whether the patient had been admitted to the hospital in the past 30 days. Nurses were given discretion when asking patients if they were interested in participating in the survey. Among medical patients presenting within 4 weeks, 75% (n = 223) participated in the study. Surveys are conducted in English and Spanish and are accompanied by study descriptions and a list of local resources to help patients discover their unmet social needs.
Outpatients were receptive to brief surveys about unmet social needs, and little guidance was required to complete the surveys. Internal medicine nurses demonstrated low staff burden through a survey that could easily be used in primary care settings. Over 60% of patients reported at least one unmet social need in the past 30 days. In all cases, the rate of patients with identified unmet social needs was higher among hospitalized patients. Across both internal medicine and emergency departments, the investigators found a large number of patients reporting 2 (8.1% internal medicine; 7.8% emergency department) and three or more needs (18.4% internal medicine; 15.5% emergency department). The 3 most common unmet social needs were transportation (26.8% MD; 18.4% ED), food (23.1% MD; 16.9% ED), and housing (14.2% MD; 12.7% ED). When these 3 needs were considered clusters, transportation and food (33.6% MD; 29.2% ED), housing and food (24.3% MD; 26.4% ED) were generally associated. This data is shared with VCU's Office of Health Innovation and is used to target relevant community partnerships. Likewise, once unmet social need rates are identified, time and resource-constrained primary care practices can prioritize and target community partnerships that are most valuable to patients.