Social risks: Do patients want health systems to help?


New SONNET study led by Leah Tuzzio, MPH, looks at patients’ unmet social risks and their desire for assistance

Primary care teams nationwide are increasingly called upon to assist patients who have unmet social risks, like unstable housing, food, transportation, and money for utilities. These social risks can have a significant negative impact on a person’s overall health and well-being.

A new study in Annals of Family Medicine sheds light on the prevalence of social risks faced by many Americans — and looks at whether patients want help from their health care organization to address these risks.

Led by Kaiser Permanente’s Social Needs Network for Evaluation and Translation (SONNET), the study found that nearly half of participants had at least one social risk — and that most thought that health systems should play a role in addressing patients’ social risks. But only about a quarter of people who reported having a social risk said they wanted assistance from their health system.

Lead author Leah Tuzzio, MPH, and colleagues recently shared these results in "Social Risk Factors and Desire for Assistance Among Patients Receiving Subsidized Health Care Insurance in a US-based Integrated Delivery System.” Tuzzio is a senior research associate at Kaiser Permanente Washington Health Research Institute (KPWHRI), which is the home of SONNET’s Coordinating Center.

“We hope these results inspire health care organizations and researchers to co-design patient-centered interventions to overcome issues such as stigma, especially as social health screening is elevated as a HEDIS metric,” said Tuzzio.

A closer look at study findings

To find out more about patients’ social risks and their interest in receiving help from their health care organization, Tuzzio and colleagues looked at data from a quality improvement survey led by SONNET that included questions about social risks, desire for assistance, attitudes about health care, and health outcomes. The survey was administered in English and Spanish for adult Kaiser Permanente members in Southern California who received federal health insurance subsidies through the California health care insurance exchange.

Among the study’s main findings:

  • 48% of participants reported one or more social risks. The most common was housing insecurity and quality, with 70% reporting this challenge.
  • People with social risks were twice as likely to report their health as "fair" or "poor" — even though they were similar in race, ethnicity, and other demographic features to people who did not have social risks.
  • Although 90% of participants believed that health systems should assist patients with social risk factors, 14% who reported having social risks also reported more discomfort being screened for social risks than the 5% who reported no risks.
  • Of those who reported 1 or 2 social risks, only 27% desired assistance from the health system compared with 51% of those with 3 or 4 social risks.
     

Implications for health systems and social health researchers

Based on these findings, the authors suggest that health organizations consider training  clinicians in exploring unconscious bias and consider system-level culture change as screening for social health becomes more prevalent. Among the future research they recommend are assessments of the actual uptake of assistance with social risks and more studies focused on patients' desire for help to tailor interventions.

The authors also suggest that future interventions could use a structured approach, including education for health care providers about the value of being aware of patients' social needs and having ways to provide assistance.

“Health systems should work to increase the comfort of patients in reporting risks, explore how to successfully assist them when desired, and offer resources to address these risks outside the health care sector,” said co-author Cara Lewis, PhD, SONNET co-director and KPWHRI senior investigator.

Watch our new video to learn more.

The work was supported by SONNET, which is funded by Kaiser Permanente’s National Office of Community Health. SONNET’s Coordinating Center is led by Dr. Lewis, Katie Coleman, MSPH, who directs KPWHRI’s Center for Accelerating Care Transformation, and Andrea Paolino, MA, from Kaiser Permanente Colorado’s Institute for Health Research.

The paper is "Social Risk Factors and Desire for Assistance Among Patients Receiving Subsidized Health Care Insurance in a US-based Integrated Delivery System" by KPWHRI researchers Leah Tuzzio, MPH, Robert Wellman, MS, Alphonse Derus, MS, and Cara C. Lewis, PhD, with KPWHRI Affiliate Investigator Salene M.W. Jones, PhD, MA. Coauthors are Emilia H. De Marchis, MD, MAS, and Laura M. Gottlieb, MD, MPH from UCSF, Callie Walsh-Bailey, MPH from Washington University in St. Louis, Claudia L. Nau, PhD, and Adam L. Sharp, MD, MSC from Kaiser Permanente Southern California, John F. Steiner, MD, MPH, from Kaiser Permanente Colorado, and Matthew P. Banegas, PhD MPH, from Kaiser Permanente Northwest.

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