TY - JOUR
T1 - Screening Discordance and Characteristics of Patients With Housing-Related Social Risks
AU - De Marchis, Emilia H.
AU - Ettinger de Cuba, Stephanie A.
AU - Chang, Lawrence
AU - Sheward, Richard S.
AU - Doran, Kelly M.
AU - Gottlieb, Laura M.
AU - Cohen, Alicia J.
AU - Fleegler, Eric W.
AU - Sandel, Megan T.
N1 - Funding Information:
The authors thank the research staff and site principal investigators at each of our 11 study sites for their assistance with data collection, and the study participants for sharing their information and time with us. The authors thank José Parra and Catherine Arevalo of University of California San Francisco (UCSF) for their assistance with study launch and organization of study sites. The authors thank Remi Frazier and Glenda Sharp of the UCSF Academic Research Systems for their assistance with inputting the study survey into REDCap. The authors thank Cambridge Creative Group for their assistance creating Figure 1. EHDM and SAEDC served as cofirst authors, each with equal contribution to the manuscript. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund (CWF), its directors, officers, or staff. CWF and National Research Service Award (NRSA) had no role in study design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The manuscript's contents are solely the responsibility of the authors and do not represent the official views of the CWF, NRSA, or Department of Veterans Affairs. This work was supported by CWF, a national, private foundation based in New York City that supports independent research on healthcare issues and makes grants to improve healthcare practice and policy. EHDM was additionally supported by a fellowship training grant NRSA T32HP19025. AJC was supported by an Advanced Health Services Research and Development postdoctoral fellowship through the Department of Veterans Affairs Office of Academic Affiliations, and subsequently by Grant CDA 20-037 from the Department of Veterans Affairs Health Services Research and Development. The study was approved by the UCSF IRB (17-23110); per their own institutional requirements, 8 of the study sites also obtained site-specific IRB approvals (University of Arkansas, 217767; Boston Medical Center, H-37489; University of Chicago, 18-0139; University of Colorado, 17-2434; Dartmouth College, STUDY00031049; Hennepin Health, 18-4482; New York University, i18-00004; Brigham and Women's Hospital, 2018P000990). Author contributions are as follows: Study concept and design (EHDM, SAEDC, AJC, LMG, EWF, MS); acquisition of data (EHDM, SAEDC, KMD, LMG, MS); analysis and interpretation of data (all authors); drafting of the manuscript (EHDM, SAEDC, LC, MS); critical revision of the manuscript for important intellectual content (all authors); statistical analysis (EHDM); obtaining funding (LMG); administrative, technical, or material support and supervision (LMG, MS); final approval of the version to be published (all authors). EHDM had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. EWFM was a consultant for Veta Health, a company that develops software for chronic disease management. The research published in this paper is not related to any of the above consulting work and was conducted before EWFM was working with Veta Health. MS holds an unpaid position on the board of Enterprise Community Partners, a national housing organization. No other financial disclosures were reported.
Funding Information:
This work was supported by CWF , a national, private foundation based in New York City that supports independent research on healthcare issues and makes grants to improve healthcare practice and policy. EHDM was additionally supported by a fellowship training grant NRSA T32HP19025 . AJC was supported by an Advanced Health Services Research and Development postdoctoral fellowship through the Department of Veterans Affairs Office of Academic Affiliations , and subsequently by Grant CDA 20-037 from the Department of Veterans Affairs Health Services Research and Development . The study was approved by the UCSF IRB (17-23110); per their own institutional requirements, 8 of the study sites also obtained site-specific IRB approvals (University of Arkansas, 217767; Boston Medical Center, H-37489; University of Chicago, 18-0139; University of Colorado, 17-2434; Dartmouth College, STUDY00031049; Hennepin Health, 18-4482; New York University, i18-00004; Brigham and Women's Hospital, 2018P000990).
Publisher Copyright:
© 2021 American Journal of Preventive Medicine
PY - 2021/7
Y1 - 2021/7
N2 - Introduction: Healthcare systems are increasingly interested in identifying patients’ housing-related risks, but minimal information exists to inform screening question selection. The primary study aim is to evaluate discordance among 5 housing-related screening questions used in health care. Methods: This was a cross-sectional multisite survey of social risks used in a convenience sample of adults seeking care for themselves or their child at 7 primary care clinics and 4 emergency departments across 9 states (2018–2019). Housing-related risks were measured using 2 questions from the Accountable Health Communities screening tool (current/anticipated housing instability, current housing quality problems) and 3 from the Children's HealthWatch recommended housing instability screening measures (prior 12-month: rent/mortgage strain, number of moves, current/recent homelessness). The 2-sided Fisher's exact tests analyzed housing-related risks and participant characteristics; logistic regression explored associations with reported health (2019–2020). Results: Of 835 participants, 52% screened positive for ≥1 housing-related risk (n=430). Comparing the tools, 32.8% (n=274) screened discordant: 11.9% (n=99) screened positive by Children's HealthWatch questions but negative by Accountable Health Communities, and 21.0% (n=175) screened positive by the Accountable Health Communities tool but negative by Children's HealthWatch (p<0.001). Worse health was associated with screening positive for current/anticipated housing instability (AOR=0.56, 95% CI=0.32, 0.96) or current/recent homelessness (AOR=0.57, 95% CI=0.34, 0.96). Conclusions: The 5 housing questions captured different housing-related risks, contributed to different health consequences, and were relevant to different subpopulations. Before implementing housing-related screening initiatives, health systems should understand how specific measures surface distinct housing-related barriers. Measure selection should depend on program goals and intervention resources.
AB - Introduction: Healthcare systems are increasingly interested in identifying patients’ housing-related risks, but minimal information exists to inform screening question selection. The primary study aim is to evaluate discordance among 5 housing-related screening questions used in health care. Methods: This was a cross-sectional multisite survey of social risks used in a convenience sample of adults seeking care for themselves or their child at 7 primary care clinics and 4 emergency departments across 9 states (2018–2019). Housing-related risks were measured using 2 questions from the Accountable Health Communities screening tool (current/anticipated housing instability, current housing quality problems) and 3 from the Children's HealthWatch recommended housing instability screening measures (prior 12-month: rent/mortgage strain, number of moves, current/recent homelessness). The 2-sided Fisher's exact tests analyzed housing-related risks and participant characteristics; logistic regression explored associations with reported health (2019–2020). Results: Of 835 participants, 52% screened positive for ≥1 housing-related risk (n=430). Comparing the tools, 32.8% (n=274) screened discordant: 11.9% (n=99) screened positive by Children's HealthWatch questions but negative by Accountable Health Communities, and 21.0% (n=175) screened positive by the Accountable Health Communities tool but negative by Children's HealthWatch (p<0.001). Worse health was associated with screening positive for current/anticipated housing instability (AOR=0.56, 95% CI=0.32, 0.96) or current/recent homelessness (AOR=0.57, 95% CI=0.34, 0.96). Conclusions: The 5 housing questions captured different housing-related risks, contributed to different health consequences, and were relevant to different subpopulations. Before implementing housing-related screening initiatives, health systems should understand how specific measures surface distinct housing-related barriers. Measure selection should depend on program goals and intervention resources.
KW - Adult
KW - Child
KW - Cross-Sectional Studies
KW - Emergency Service, Hospital
KW - Homeless Persons
KW - Housing
KW - Humans
KW - Mass Screening
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U2 - 10.1016/j.amepre.2021.01.027
DO - 10.1016/j.amepre.2021.01.027
M3 - Article
C2 - 33785274
AN - SCOPUS:85106255188
SN - 0749-3797
VL - 61
SP - e1-e12
JO - American journal of preventive medicine
JF - American journal of preventive medicine
IS - 1
ER -