Social Needs Screening and Subsequent Acute Care Utilization in a Large Safety-Net Health System: A Retrospective Cohort Study

Abstract Background Health systems increasingly screen for patients’ social needs, but evidence is limited on which specific needs are most associated with subsequent acute care use. Objective To examine associations between patient-reported social needs and subsequent acute care utilization in a large safety-net population. Design Retrospective cohort study linking 2023 social needs screening data from a large safety-net health system to longitudinal electronic health records from a multi-health system clinical research network. Participants 20,337 adults with a primary care visit who completed social needs screening in 2023. Main Measures Exposures were positive screening for nine social needs domains (e.g., transportation-related delayed care). Outcomes were any hospitalization, any ED visit, preventable hospitalization, and preventable ED visit. Multivariable logistic regression adjusted for demographics, comorbidities, and neighborhood social conditions. Key Results Overall, 15.9% screened positive for ≥ 1 social need. The most prevalent needs were food insecurity (5.9%) and problems with residence (5.6%), followed by housing stability concerns (4.6%) and transportation barriers (4.1%). After covariate adjustment, transportation-related delayed care was associated with a 6.8-percentage-point increase in the probability of having ≥ 1 hospitalization (95% CI, 4.1 to 9.5; p < 0.001), an 8.4-percentage-point increase in the probability of having ≥ 1 ED visit (95% CI, 4.8 to 12.0; p < 0.001), a 1.2-percentage-point increase in the probability of having ≥ 1 preventable hospitalization (95% CI, 0.1 to 2.3; p = 0.04), and a 4.2-percentage-point increase in the probability of having ≥ 1 preventable ED visit (95% CI, 1.6 to 6.7; p = 0.002). A positive screening for housing-related problems was associated with increased probability of having ≥ 1 ED visit. Other domains were not significantly associated with outcomes. Conclusions In a safety-net setting, transportation barriers showed the strongest and most consistent associations with subsequent acute care use. Targeted transportation and care-navigation strategies may be critical components of social care interventions.