Screening worked, but varied by hospital

Inpatient social-needs screening was feasible at scale, but completion differed widely by hospital.
*Retrospective observational electronic-record study; Level 3 (OCEBM).

Citation

Rowland B, Gee J, Obermiller C, et al. Evaluating the Implementation of Social Determinants of Health Screening Across 18 Hospitals. Journal of General Internal Medicine. 2026. doi:10.1007/s11606-026-10662-6

Background

Hospitals are now required to screen many patients for health-related social needs, but little is known about how well large inpatient screening programs perform. This study evaluated screening quality, hospital-level variation, and links with readmission.

Patients

197,305 adult inpatient encounters at 18 Atrium Health hospitals in the Southeastern United States. Pediatric and non-inpatient encounters were not included.

Intervention

Nurse-administered Accountable Health Communities screening for housing, food, transportation, utilities, and safety needs during admission.

Control

Patients with negative screening results; hospital sites were also compared.

Outcome

Screen completion, positive screens, data quality, and 30-day hospital readmission.

Follow-up Period

May to December 2024; 30-day readmission assessed after discharge.

Results

Finding Result
Screening completed 172,519 of 197,305 encounters, 87.4%; by market: 92.1% vs 73.4%
Positive for at least one need 21,900 screened encounters, 12.7%
Medicaid vs commercial insurance Adjusted OR 2.18 (95% CI 2.07 to 2.29) for positive screen
Black vs White patients Adjusted OR 1.41 (95% CI 1.36 to 1.46) for positive screen
Highest vs lowest neighborhood vulnerability Adjusted OR 1.31 (95% CI 1.24 to 1.39) for positive screen

Positive screens had higher unadjusted 30-day readmission, 14.2% vs 11.0%, but this was not significant after adjustment. Screening data generally met internal quality checks.

Limitations

Single health system, nurse-led workflow, and limited racial diversity outside Black and White groups reduce generalizability. Readmission findings were exploratory and confounded by patient complexity.

Funding

Carolinas Consortium; no declared conflicts.

Clinical Application

Use inpatient social-needs screening, but monitor site completion rates and plan local workflow fixes before relying on results for care coordination.