Screening for Social Risk at Federally Qualified Health Centers: A National Study

Abstract

Introduction: Federally Qualified Health Centers serve 29.8 million low-income patients across the U.S., many of whom have unaddressed social risks. In 2019, for the first time, data on social risk screening capabilities were collected from every U.S. Federally Qualified Health Center. The objectives of this study were to describe the national rates of social risk screening capabilities across Federally Qualified Health Centers, identify organizational predictors of screening, and assess between-state heterogeneity.

Methods: Using a 100% sample of U.S. Federally Qualified Health Centers (N=1,384, representing 29.8 million patients) from the 2019 Uniform Data System, the primary outcome was whether a Federally Qualified Health Center collected data on patients' social risk factors (yes/no). Summary statistics on the rates of social risk screening capabilities were generated in aggregate and by state. Linear probability models were then used to estimate the relationship between the probability of social risk screening and 7 key Federally Qualified Health Center characteristics (e.g., Federally Qualified Health Center size, Medicaid MCO contract, Medicaid accountable care organization presence). Data were analyzed in 2020‒2021.

Results: Most (71%) Federally Qualified Health Centers collected social risk data, with a between-state variation. The most common screener was the Protocol for Responding to and Assessing Patients' Assets Risks and Experiences (43% of Federally Qualified Health Centers that screened), whereas 22% collected social risk data using a nonstandardized screener. After adjusting for other characteristics, Federally Qualified Health Centers with social risk screening capabilities served more total patients, were more likely to be located in a state with a Medicaid accountable care organization, and were less likely to have an MCO contract.

Conclusions: There has been widespread adoption of social risk screening tools across U.S. Federally Qualified Health Centers, but between-state disparities exist. Targeting social risk screening resources to smaller Federally Qualified Health Centers may increase the adoption of screening tools.

Figure 1.

Rates of social risk screening capabilities across all U.S. FQHCs (2019). ^aFQHCs may report using more than one screener and therefore, distributions of “which screener(s) used” do not add up to 100%. ^b”Other standardized screener” is inclusive of modified versions of the other listed screeners. ^c “Capabilities” indicates any social risk data collection (yes/no) and not the extent of data collection. FQHC, Federally Qualified Health Center; PRAPARE, Protocol for Responding to and Assessing Patients’ Assets Risks and Experiences; AHC, Accountable Health Communities; WECARE, Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education; iHELP, Income, Housing, Education, Legal Status, Literacy, Personal Safety.

Figure 2.

Percent of FQHCs with social risk capabilities by state, unadjusted (2019). Notes: States with fewer than 5 FQHCs have wider CIs around screening adoption rates. This includes the states of Delaware, North Dakota, and South Dakota, plus all territories except for Puerto Rico. However, because the data include the universe of FQHCs in the U.S., rather than a sample, data are reported for each state regardless of number of FQHCs. FQHC, Federally Qualified Health Center.