Screen Patients for Social Determinants of Health With This 4-Part Tool

By Christopher Cheney

The American Hospital Association has developed a 4-part tool to help healthcare providers screen patients for social determinants of health (SDOH).

Social needs such as housing and food security can have a crucial effect on patient health. By making direct investments in initiatives designed to address SDOHs and working with community partners, healthcare organizations can help patients achieve positive health outcomes in ways beyond the traditional provision of medical services.

The American Hospital Association’s screening tool for SDOHs has four elements:

1. Collaborative approach to designing the screening process

A collaborative approach to designing social needs screening features healthcare providers, patients, and community stakeholders.

Including clinicians in the design process boosts their commitment to the questions and the screening process. Patients can play an essential role in the design process because they can provide insights into developing screening questions and guidance for how questions should be asked. Community stakeholders can play a pivotal role in the design process because they have intimate knowledge about their communities.

2. Conditions and settings for screening

When conducting SDOH screening during a patient encounter, location, mode of communication, and point of contact are significant considerations.

For hospital patients, screening can be conducted in office space, an exam room, or electronically from patients’ homes with follow-up during an office visit. Modes of communication include paper questionnaires, electronic surveys, and in-depth conversations. Point of contact can be before, during, or after a patient encounter.

Determining the best location, mode of communication, and point of contact for SDOH screening varies depending on the healthcare organization and the community it serves, Priya Bathija, JD, MHSA, vice president of The Value Initiative at the American Hospital Association, told HealthLeaders.

“It really takes partnering with providers, patients, and community stakeholders, within and outside of hospital walls, to identify the logistics behind a social needs screen, whether it’s the location, mode of communication or the point person conducting the screen. Additionally, partnering with patients allows hospitals and health systems to understand how well they respond to the screening. Some may feel uncomfortable in hospital settings and some in physician practices. These partnerships will help inform what will work best for a specific hospital and community,” she said.

3. Identifying care team members to conduct screening

Although physicians are well-suited to conduct SDOH screening because they can identify social needs as well as clinical needs linked to SDOHs, other care team members can be qualified to play the screener role. Possible non-physician screeners include community health workers, medical assistants, nurses, patient navigators, and social workers.

“Equipping care teams with proper tools, training, and resources will build capacity within an individual to understand a person’s social needs and increase opportunity for better engagement with patients,” Bathija said.

For example, she said the Women-Inspired Neighborhood Network at the Henry Ford Health System in Detroit utilizes community health workers to build relationships with pregnant women and to be the point of contact throughout a mother’s pregnancy. “By building this relationship, community health workers are able to assess the needs of mothers at every stage,” Bathija said.

4. Documenting social needs

The results of SDOH screening should be routinely documented in medical records so the results can be included in a patient’s treatment plan. The screening results also should be accessible to the patient’s entire care team.

Hospitals can use ICD-10-CM Z codes to document factors influencing health status, Bathija said. “Some examples of existing Z codes for social determinants of health are codes to identify problems related to education and literacy, employment, housing such as homelessness, lack of adequate food or water, and occupational exposure to risk factors such as dust, radiation, or toxic agents.”

Using Z codes has several benefits, she said. “For example, by documenting this information, hospitals can track the social determinants most impacting their patients. At the individual level, once someone has shared their information and the care team has determined there is a social need, they can address that need for specific patients. They can make the right referrals to address an individual patient’s needs.”

Bathija said other benefits of using Z codes include aggregating social needs data across patients to determine where hospitals should focus their efforts, using the data to align services and programs with the needs of hospital patients, and examining the data to help identify the best care team members to address social needs.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.