“What is your housing situation today? Are you worried about losing it?”
“In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?”
“How often do you feel lonely or isolated from those around you?”
Most people don’t think of these as medical questions. But just like doctors check a patient’s pulse, blood pressure and medical history, or take X-rays for broken bones, social needs can be vital signs. Cedars-Sinai’s Community Connect Program, which launched in August 2021, is carving a path for hospitals to implement this new type of diagnostic screening.
Living conditions such as poverty, unstable housing, violence and loneliness can determine whether a patient is able to take medications they’re prescribed, understand their care and get—and stay—well long-term. Social factors are responsible for up to 90% of a community’s health, according to a study in the American Journal of Preventive Medicine, a far greater impact than genetics and even medical care (20%). In turn, vulnerability is linked to a wide range of serious illnesses including cancer, dementia, heart disease and stroke, worse quality of life, more hospitalizations and early death.
“If someone’s worried about where their next meal is going to come from or where they’re going to sleep that night, they’re not worried about seeing their primary care doctor or refilling a prescription,” said Katie Hren, associate director of community health at Cedars-Sinai. “So, we’re only going to get so far without really talking about these things.”
A Culture Shift in Medicine
Nurses screen every adult admitted to Cedars-Sinai Medical Center, Cedars-Sinai Marina del Rey Hospital and Huntington Hospital, an affiliate of Cedars-Sinai, for five areas of health-related social needs:
- Food access
- Housing
- Transportation
- Utilities such as electricity, gas and water
- Interpersonal violence
Anyone who needs support is referred to a social worker. They try to learn more about patients’ physical, mental and emotional health by gauging independence, health literacy and if they are able to afford medical care, as well as if they use substances or are socially isolated.
“We look at every single patient who comes through our doors as a whole person,” Hren said.
Cedars-Sinai has screened almost 125,000 patients for at least one of these social drivers, connecting more than 4,700 people to care. The screening tool is now live throughout primary and outpatient care and the Emergency Department, where researchers are studying the level of need and the possibility of implementing universal screening.
“If someone’s worried about where their next meal is going to come from or where they’re going to sleep that night, they’re not worried about seeing their primary care doctor or refilling a prescription.”