Modeling of standardization technique for population-based social determinants of health screening tools

Authors: Courtney Duckworth, Jean Nuñez, Tiana Walker, Dr. Cameron Webb




University of Virginia


IMPORTANCE: Social determinants of health (SDH) strongly affect patients’ health outcomes and healthcare costs, yet SDH screening tools are underutilized as no consensus exists on best practices and standardization of screening. Multiple screening tools exist, with additional lack of standardization as institutions adapt screening tools to fit the needs of their populations.


OBJECTIVE: Compare validated questionnaires to widely used national SDH screening tools to assess sensitivity and accuracy specific to our patient population at the University of Medical Associates (UMA) clinic, therefore providing a model for standardization in tailoring SDH screening tools to a given population.


DESIGN: One validated questionnaire and one randomly selected SDH screening tool comprised each survey distributed to study participants (n =1024) at the UMA. For each SDH category, validated questionnaires were compared to responses from randomly selected SDH screening tools to calculate sensitivity and accuracy. At the conclusion of each survey, participants were granted the option to receive future assistance from researchers via phone or email, connecting them to community resources.


RESULTS: Highest levels of sensitivity were found in the PRAPARE and Kaiser Permanente tools for education, the AHC tool for housing, the Health Begins tool for finance, the Kaiser Permanete tool for transportation, and the Health Leads tool for interpersonal violence. Highest levels of accuracy were the PRAPARE tool for education, the AHC tool for housing, the Kaiser Permanente tool for finance, the Well Rx tool for transportation, and the Health Leads screening tool for interpersonal violence.


RELEVANCE: Systematically identifying a population’s most sensitive and accurate social determinants of health screening tools can inform social and community services as well as strategies for disease management. As free clinics serve an especially vulnerable population, accurately assessing SDH needs has the potential to improve preventive health care, health outcomes, and cost for patients.