Social drivers of health screening development and implementation at an urban Native American community clinic

Methods: Longitudinal cohort study evaluating the proportion of participants that endorsed financial strain and food insecurity, housing instability, and transportation barriers.The analytic sample was from survey and encounter data for patients with information available from all four social domains.Data were obtained from the OCHIN network (2019-2023), Humana (2019-2020), and Kaiser Permanente (KP) (2020).We assessed the predictive value (e.g., sensitivity, specificity, positive and negative predictive value, area under the receiver operating characteristic curve, and false negative rate) of using financial strain as a pre-screener for the other three social risks. Results:The final sample included 252,845 adults with complete social risk data (63.7% from OCHIN, 32.2% from Humana, 4.1% from KP). 38% of the OCHIN sample, 41% of the Humana sample, and 28% of the KP sample experienced financial strain.Across samples, using the financial strain item in an initial prescreening would fail to identify 12.3% to 24.2% of individuals who reported food insecurity, 13.2% to 24.7% who reported housing instability, 17.0% to 32.6% who reported transportation barriers, and 4.1% to 5.7% who reported all three risks.Conclusion: A single financial strain question would cause the health system to miss >10% of people who report other social risks.