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Hospitals are screening for social determinants of health, but programs, community partnerships lag


Study examines hospital strategies for social needs during COVID-19 pandemic.

Hospitals are screening for social determinants of health, but programs, community partnerships lag

Hospitals are integrating screenings to assess patients’ social determinants of health (SDOH), but programs and community partnerships to address SDOH have been slower to develop.

The pandemic sparked public interest in addressing social needs and health systems have made substantial investments to do so, said the study, “Assessment of Strategies Used in US Hospitals to Address Social Needs During the COVID-19 Pandemic,” published Oct. 21, 2022, in JAMA Health Forum. Researchers used 2020 survey data from the American Hospital Association to assess what strategies were used by rural hospitals, critical access hospitals (CAHs), and safety net hospitals (SNHs).

Three areas to examine

Among 4,295 hospitals, 2,734, or 64%, reported strategies for three areas:

  • Screening for nine SDOH types: Housing, food insecurity or hunger, utility needs, interpersonal violence, transportation, employment or income, education, social isolation, and health behaviors.
  • Creating programs or interventions to address those.
  • Working with external community partners to address SDOH, participate in community health needs assessments, or implement SDOH initiatives. There were 14 partnerships, including joint efforts with other health care providers, health insurers, local or state departments or organizations dealing with public health or social services, faith-based groups, food pantries, and organizations offering help with housing insecurity, transportation, or legal assistance.


In the findings, rural hospitals screened for a similar number of social needs compared with urban hospitals, but implemented fewer programs or interventions and had fewer community partnerships to address SDOH.

CAHs screened for a similar number of SDOH compared to non-CAHs, but also addressed fewer social needs and formed fewer community partnerships. There were no significant differences between SNHs and non-SNHs for screening, but SNHs had fewer community partnerships.

The results “suggest that rural hospitals, CAHs, and SNHs are not doing more and, in some cases, are engaging in fewer strategies to address the SDOH of their vulnerable populations, especially regarding community partnerships,” the study said. “This finding may be attributable to limited financial resources, workforce constraints, limited community resources and institutional partnerships, and lack of incentives.”

Additional research

The researchers cited another study, “Quantifying Health Systems’ Investment In Social Determinants Of Health, By Sector, 2017-19,” published in February 2020 by Health Affairs.

That analysis found 57 health systems with 917 hospitals had invested at least $2.5 billion of health system money to create 78 unique programs focusing on employment, education, food security, social and community context, and transportation.

“Health systems are making sizable investments in social determinants of health,” the study said. But it noted U.S. health systems’ overall community benefit spending is estimated to be more than $60 billion a year.

“Historically, hospitals have tended to provide community benefit through uncompensated or subsidized care rather than through investment in activities not directly related to health,” the study said.

While some SDOH programs and interventions have benefited patients’ health outcomes, generally the evidence of health outcome improvements “is thin.” Because of that, health systems are much more likely to develop screening and referral programs than directly investing in SDOH programs, the study said.

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Michael J. Barry, MD