TY - JOUR
T1 - Social Risk Screening and Response Equity
T2 - Assessment by Race, Ethnicity, and Language in Community Health Centers
AU - Torres, Cristina I.Huebner
AU - Gold, Rachel
AU - Kaufmann, Jorge
AU - Marino, Miguel
AU - Hoopes, Megan J.
AU - Totman, Molly S.
AU - Aceves, Benjamín
AU - Gottlieb, Laura M.
N1 - Publisher Copyright:
© 2023 American Journal of Preventive Medicine
PY - 2023/8
Y1 - 2023/8
N2 - Introduction: Little has previously been reported about the implementation of social risk screening across racial/ethnic/language groups. To address this knowledge gap, the associations between race/ethnicity/language, social risk screening, and patient-reported social risks were examined among adult patients at community health centers. Methods: Patient- and encounter-level data from 2016 to 2020 from 651 community health centers in 21 U.S. states were used; data were extracted from a shared Epic electronic health record and analyzed between December 2020 and February 2022. In adjusted logistic regression analyses stratified by language, robust sandwich variance SE estimators were applied with clustering on patient's primary care facility. Results: Social risk screening occurred at 30% of health centers; 11% of eligible adult patients were screened. Screening and reported needs varied significantly by race/ethnicity/language. Black Hispanic and Black non-Hispanic patients were approximately twice as likely to be screened, and Hispanic White patients were 28% less likely to be screened than non-Hispanic White patients. Hispanic Black patients were 87% less likely to report social risks than non-Hispanic White patients. Among patients who preferred a language other than English or Spanish, Black Hispanic patients were 90% less likely to report social needs than non-Hispanic White patients. Conclusions: Social risk screening documentation and patient reports of social risks differed by race/ethnicity/language in community health centers. Although social care initiatives are intended to promote health equity, inequitable screening practices could inadvertently undermine this goal. Future implementation research should explore strategies for equitable screening and related interventions.
AB - Introduction: Little has previously been reported about the implementation of social risk screening across racial/ethnic/language groups. To address this knowledge gap, the associations between race/ethnicity/language, social risk screening, and patient-reported social risks were examined among adult patients at community health centers. Methods: Patient- and encounter-level data from 2016 to 2020 from 651 community health centers in 21 U.S. states were used; data were extracted from a shared Epic electronic health record and analyzed between December 2020 and February 2022. In adjusted logistic regression analyses stratified by language, robust sandwich variance SE estimators were applied with clustering on patient's primary care facility. Results: Social risk screening occurred at 30% of health centers; 11% of eligible adult patients were screened. Screening and reported needs varied significantly by race/ethnicity/language. Black Hispanic and Black non-Hispanic patients were approximately twice as likely to be screened, and Hispanic White patients were 28% less likely to be screened than non-Hispanic White patients. Hispanic Black patients were 87% less likely to report social risks than non-Hispanic White patients. Among patients who preferred a language other than English or Spanish, Black Hispanic patients were 90% less likely to report social needs than non-Hispanic White patients. Conclusions: Social risk screening documentation and patient reports of social risks differed by race/ethnicity/language in community health centers. Although social care initiatives are intended to promote health equity, inequitable screening practices could inadvertently undermine this goal. Future implementation research should explore strategies for equitable screening and related interventions.
UR - http://www.scopus.com/inward/record.url?scp=85151458949&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85151458949&partnerID=8YFLogxK
U2 - 10.1016/j.amepre.2023.02.018
DO - 10.1016/j.amepre.2023.02.018
M3 - Article
C2 - 36990938
AN - SCOPUS:85151458949
SN - 0749-3797
VL - 65
SP - 286
EP - 295
JO - American journal of preventive medicine
JF - American journal of preventive medicine
IS - 2
ER -