Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization
Abstract Background Health systems are increasingly attempting to intervene on social adversity as a strategy to improve health care outcomes. To inform health system efforts to screen for social adversity, we sought to explore the stability of social risk and interest in assistance over time and to...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-11-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-08740-6 |
| _version_ | 1811190494926995456 |
|---|---|
| author | Cara C. Lewis Salene M. W. Jones Robert Wellman Adam L. Sharp Laura M. Gottlieb Matthew P. Banegas Emilia De Marchis John F. Steiner |
| author_facet | Cara C. Lewis Salene M. W. Jones Robert Wellman Adam L. Sharp Laura M. Gottlieb Matthew P. Banegas Emilia De Marchis John F. Steiner |
| author_sort | Cara C. Lewis |
| collection | DOAJ |
| description | Abstract Background Health systems are increasingly attempting to intervene on social adversity as a strategy to improve health care outcomes. To inform health system efforts to screen for social adversity, we sought to explore the stability of social risk and interest in assistance over time and to evaluate whether the social risk was associated with subsequent healthcare utilization. Methods We surveyed Kaiser Permanente members receiving subsidies from the healthcare exchange in Southern California to assess their social risk and desire for assistance using the Accountable Health Communities instrument. A subset of initial respondents was randomized to be re-surveyed at either three or six months later. Results A total of 228 participants completed the survey at both time points. Social risks were moderate to strongly stable across three and six months (Kappa range = .59-.89); however, social adversity profiles that included participants’ desire for assistance were more labile (3-month Kappa = .52; 95% CI = .41-.64 & 6-month Kappa = .48; 95% CI = .36-.6). Only housing-related social risks were associated with an increase in acute care (emergency, urgent care) six months after initial screening; no other associations between social risk and utilization were observed. Conclusions This study suggests that screening for social risk may be appropriate at intervals of six months, or perhaps longer, but that assessing desire for assistance may need to occur more frequently. Housing risks were associated with increases in acute care. Health systems may need to engage in screening and referral to resources to improve overall care and ultimately patient total health. |
| first_indexed | 2024-04-11T14:52:07Z |
| format | Article |
| id | doaj.art-c784d927003545d3bb810771c8ca3ae0 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-11T14:52:07Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-c784d927003545d3bb810771c8ca3ae02022-12-22T04:17:26ZengBMCBMC Health Services Research1472-69632022-11-0122111010.1186/s12913-022-08740-6Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilizationCara C. Lewis0Salene M. W. Jones1Robert Wellman2Adam L. Sharp3Laura M. Gottlieb4Matthew P. Banegas5Emilia De Marchis6John F. Steiner7Kaiser Permanente Washington Health Research InstitutePublic Health Sciences Division, Fred Hutchinson Cancer Research CenterKaiser Permanente Washington Health Research InstituteResearch and Evaluation Department, Kaiser Permanente Southern CaliforniaCenter for Health and Community, University of California San FranciscoKaiser Permanente Center for Health ResearchDepartment of Family and Community Medicine, University of California San FranciscoInstitute of Health Research, Kaiser PermanenteAbstract Background Health systems are increasingly attempting to intervene on social adversity as a strategy to improve health care outcomes. To inform health system efforts to screen for social adversity, we sought to explore the stability of social risk and interest in assistance over time and to evaluate whether the social risk was associated with subsequent healthcare utilization. Methods We surveyed Kaiser Permanente members receiving subsidies from the healthcare exchange in Southern California to assess their social risk and desire for assistance using the Accountable Health Communities instrument. A subset of initial respondents was randomized to be re-surveyed at either three or six months later. Results A total of 228 participants completed the survey at both time points. Social risks were moderate to strongly stable across three and six months (Kappa range = .59-.89); however, social adversity profiles that included participants’ desire for assistance were more labile (3-month Kappa = .52; 95% CI = .41-.64 & 6-month Kappa = .48; 95% CI = .36-.6). Only housing-related social risks were associated with an increase in acute care (emergency, urgent care) six months after initial screening; no other associations between social risk and utilization were observed. Conclusions This study suggests that screening for social risk may be appropriate at intervals of six months, or perhaps longer, but that assessing desire for assistance may need to occur more frequently. Housing risks were associated with increases in acute care. Health systems may need to engage in screening and referral to resources to improve overall care and ultimately patient total health.https://doi.org/10.1186/s12913-022-08740-6Social RiskSocial NeedsHealth CareUtilizationLongitudinal |
| spellingShingle | Cara C. Lewis Salene M. W. Jones Robert Wellman Adam L. Sharp Laura M. Gottlieb Matthew P. Banegas Emilia De Marchis John F. Steiner Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization BMC Health Services Research Social Risk Social Needs Health Care Utilization Longitudinal |
| title | Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization |
| title_full | Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization |
| title_fullStr | Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization |
| title_full_unstemmed | Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization |
| title_short | Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization |
| title_sort | social risks and social needs in a health insurance exchange sample a longitudinal evaluation of utilization |
| topic | Social Risk Social Needs Health Care Utilization Longitudinal |
| url | https://doi.org/10.1186/s12913-022-08740-6 |
| work_keys_str_mv | AT caraclewis socialrisksandsocialneedsinahealthinsuranceexchangesamplealongitudinalevaluationofutilization AT salenemwjones socialrisksandsocialneedsinahealthinsuranceexchangesamplealongitudinalevaluationofutilization AT robertwellman socialrisksandsocialneedsinahealthinsuranceexchangesamplealongitudinalevaluationofutilization AT adamlsharp socialrisksandsocialneedsinahealthinsuranceexchangesamplealongitudinalevaluationofutilization AT lauramgottlieb socialrisksandsocialneedsinahealthinsuranceexchangesamplealongitudinalevaluationofutilization AT matthewpbanegas socialrisksandsocialneedsinahealthinsuranceexchangesamplealongitudinalevaluationofutilization AT emiliademarchis socialrisksandsocialneedsinahealthinsuranceexchangesamplealongitudinalevaluationofutilization AT johnfsteiner socialrisksandsocialneedsinahealthinsuranceexchangesamplealongitudinalevaluationofutilization |