(Research Hub Theater) Evaluating Social Determinants of Health Screening Tools Using a Disability Equity Lens

Objective: Health-related social needs are conditions that may contribute to poor health when unmet (e.g., food insecurity, housing instability, unemployment, lack of reliable transportation) and may result from underlying social determinants of health (i.e., conditions in which people are born, grow, work, and age). In an increasing effort to improve population health across the lifespan, health systems and providers are seeking to address health inequities, which are especially important for people with disabilities. Disability intersects with health-related social needs and is important to consider in the development of screening tools.

Design: We reviewed 11 clinical screening tools for health-related social needs for information on identifying disability status and performed a pilot to improve collection on inpatient rehabilitation rounds.

Setting: Screening tools used to assess health-related social needs in U.S.-based adult and pediatric settings.

Participants: Seven reviewers, including three physiatrists, one case manager, one hospital administrator, and two health professions students performed the review. Two physiatrists performed a pilot of collecting screening on inpatient rounds.

Interventions: Two physiatrists performed a pilot of collecting screening on inpatient rehabilitation rounds in collaboration with case management.

Main Outcome Measures: Screening tools were assessed for inclusion of disability status and context. Inpatient rehabilitation screening was tracked for two weeks.

Results: Five out of 11 screening tools included disability status, and three of these were in the context of caregiver status or employment benefits. Baseline collection of screening improved from 63% to 80% with concerted workflow redesign.

Conclusions: Information on health-related social needs and social determinants of health are critical to assess for inpatient rehabilitation populations and can be collected with concerted and collaborative efforts. Many current screening tools lack questions on disability status, and those that do are not uniform. It will be important to prioritize alignment between screening tools and disability status identification in ongoing efforts to improve health equity for people with disabilities.