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2023 HSR&D/QUERI National Conference Abstract

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1208 — Developing a Brief Assessment of Social Risks for the Veterans Health Administration Survey of Healthcare Experiences of Patients

Lead/Presenter: Leslie Hausmann,  COIN - Pittsburgh/Philadelphia
All Authors: Hausmann LR (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System; Department of Medicine, University of Pittsburgh School of Medicine), Cohen AJ (Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI) Eliacin J (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN; Department of Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN) Gurewich DA (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA; Section of General Internal Medicine, Boston University School of Medicine, Boston, MA) Lee RE (Veterans Rural Health Resource Center, White River Junction, VT) McCoy JL (StatCore, VA Pittsburgh Healthcare System, Pittsburgh, PA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA) Meterko M (Analytics and Performance Integration, Office of Quality and Patient Safety, Bedford, MA; Department of Health Law, Policy and Management, Boston University School of Public Health) Michaels Z (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA) Procario GT (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA) Russell L (Office of Health Equity, Veterans Health Administration, Washington, DC) Moy EM (Office of Health Equity, Veterans Health Administration, Washington, DC)

Healthcare systems are being called to assess and address patient risk factors related to social determinants of health (SDoH). The Veterans Health Administration (VHA) Offices of Health Equity, Rural Health, and Performance Management partnered with VHA researchers to develop a brief SDoH Module to assess social risks among Veterans as part of the Survey of HealthCare Experiences of Patients (SHEP). A key consideration was whether to use a 6 or 12-month look-back period (LBP) in the module, as the SHEP uses a 6-month LBP, but several existing point-of-care social risk screening tools use a 12-month LBP. Our aims were to: 1) develop a SHEP SDoH Module to assess Veterans’ social risks; 2) determine whether the LBPs used in the module affected rates of reported social risks; and assess 3) correlations among social risks and 4) their associations with overall health.

Social risk items were proposed by subject matter experts and refined through Veteran focus groups. The final module assessed eleven social risk domains: financial strain, adult caregiving, childcare, food, housing, transportation, internet access, social isolation/loneliness, stress, discrimination, and legal issues. Self-reported overall health was the primary outcome. Veteran volunteers from the Veteran Insight Panel were randomly assigned to complete an online survey with a 6-month or 12-month LBP between June 28 and July 19, 2021. Chi-squared tests compared the prevalence of reported social risks between LBPs. Spearman correlations assessed associations among social risks. Univariate logistic regression models estimated associations between social risks and fair/poor health.

Of 3,418 Veterans contacted, 1,063 (31.1%) responded (86.9% male; 85.6% non-Hispanic white; median age = 70, interquartile range [IQR] = 61-74). The 6-month and 12-month LBPs had no significant effect on prevalence of reported social risks (all p>0.05); therefore, LBP groups were combined for subsequent analyses. The most prevalent social risks included stress (32.5%), social isolation/loneliness (18.7%), racial/ethnic discrimination (7.3%), transportation (7.2%), and financial strain (7.0%). Most social risks were only weakly inter-correlated (median r = 0.19, IQR = 0.07-0.29). Except for childcare and legal issues, all social risks were associated with higher odds of fair/poor overall health. For example, compared to those who never experienced stress, social isolation/loneliness, or racial/ethnic discrimination, those who often or always experienced these social risks had 5.42 [95% Confidence Interval (CI) = 3.42,8.90], 5.03 [95% CI = 3.45,7.38], and 2.92 [95% CI = 1.82,4.70] odds of reporting fair/poor overall health, respectively (all p < 0.001).

Six and 12-month LBPs yielded similar rates of reported social risks. The low correlations between social risks and their strong associations with fair/poor health suggest that social risks are not interchangeable and most of them can have implications for Veteran health. Social risk screening tools such as this one should therefore include a broad range of social risks as VHA’s strategy of assessing and addressing SDoH among Veterans continues to evolve.

Assessing social risks at a population level through surveys such as the SDoH SHEP Module developed in this study can help inform VHA resource allocation, programming, and development of interventions, infrastructure, and partnerships to address Veterans’ needs.