A one-minute survey in an emergency department waiting room or in general inpatient setting can offer big insights into what a patient's unmet social needs are, according to a study published in the Annals of Family Medicine.
The link between poor social determinants of health and the higher utilization of emergency departments (ED) and hospitalizations, as well as readmission rates, is well established.
So the Virginia Commonwealth University’s (VCU) Department of Family Medicine and Population Health set out to create a tool to better measure the biggest social priorities for patients in the ED and the hospital. That tool was a survey that could be filled out 60 seconds or less.
“The goal of the health system was to determine which social needs were impacting patients’ health most frequently,” author Sara Reves of VCU told FierceHealthcare. “With limited resources, helping all patients with all social needs is impossible. So aiming to provide resources that would have the most impactful was their goal."
The idea, she said, is that reducing the highest priority needs could also ultimately decrease overall cost and burden to the system as a whole by decreasing complications and readmission rates.
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In the ED, a research team member passed out a 4 x 6 card with 15 questions to waiting patients. Questions on the survey broached the topics of education, substance abuse, safety or and domestic violence. Patients could also write in other needs or assistance searched out in the past 30 days. And in GIM services, intake nurses were supplied the same survey to determine which social needs were serviced in the last 30 days.
The collected data revealed more than 60% of patients reported at least one unmet social need within the past 30 days. Almost 8% of inpatients and ED patients reported two needs and 18.4% of inpatients and 15.5% of ED patients reported three or more unmet needs.
Beyond that, the authors also concluded patients were receptive to that type of survey after 100% of those approached in the ED filled out the 15-item checklist. They also required a relatively low burden on staff and workflow in the inpatient setting.
Those results indicated that the survey could be transferable to a primary care office setting as part of a step for room staff or front desk paperwork, Reves said.
“The survey was anonymous, but you were ultimately still handing it back directly to a person who had seen who you were," Reves said. "I think we were all expecting more reluctance and lower percentage of participation as a result of embarrassment."
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Participants listed transportation, food and housing at the most common social services they had received in the past 30 days. When looking which social needs were most often paired together, transportation and food were commonly linked, as were housing and food. The triad of transportation, food and housing were also closely linked, given as a response by 17.8% of GIM patients and 17.4% of ED patients.
The data was shared with the VCU Office of Health Innovation and has since been used to target relevant community partnerships, the authors of the study wrote.
Reves noted that the study left the authors with one big question: “How does a healthcare system stretch a tight budget even when they know that a dollar spent now may ultimately save tens of thousands later.”
She knows this question permeates all healthcare in the U.S. “They all come down to the cost of the initial investment is a significant hit to the budget, but if you can financially survive the strain, the payoff, in the end, is huge."