BRIEF REPORT
Joshua R Vest, PhD, MPH; Wei Wu, PhD; Kyaien Conner, PhD, LSW, MPH
Corresponding Author: Joshua R. Vest, PhD, MPH; Indiana University Richard M. Fairbanks School of Public Health - Indianapolis Regenstrief Institute, Center for Biomedical Informatics
Email: joshvest@iu.edu
DOI: 10.3122/jabfm.2024.240173R1
Keywords: Cluster Analysis, Health Policy, Primary Health Care, Public Health, Screening, Social Care, Social Determinants of Health, Surveys and Questionnaires
Dates: Submitted: 04-26-2024; Revised: 07-14-2024; Accepted: 07-29-2024
FINAL PUBLICATION: |HTML| |PDF|
INTRODUCTION: Patients frequently report multiple health-related social needs (HRSNs) at the same time. This study aimed to identify clusters of co-occurring HRSNs in an adult primary care population.
METHODS: We surveyed 1,252 adult (>=18) primary care patients in BLINDED, BLINDED. Subjects completed surveys in person at one of three sites operated by two different health systems. Data collection was offered in both English and Spanish. Surveys comprised previously published and validated instruments covering housing instability, financial strain, food insecurity, transportation barriers, unemployment, and legal problems.
RESULTS: We identified 4 underlying clusters of HRSNs within the patient population using Complete-Linkage Agglomerative Hierarchical Clustering: “low HRSNs” (38.6%), “high HRSNs” (29.6%), “housing dominant” (23.2%), and “food dominant” (8.6%). The high HRSN cluster had higher average comorbidity scores (p <0.001), number of inpatient admissions (p=0.004), number of ED visits (p <0.001), and number of primary care visits (p <0.001).
DISCUSSION: As healthcare organizations increasingly focus on HRSNs as an approach to reducing costs and improving health of patients, these findings indicate that organizational strategies and actions should consider the interrelated and co-occurring nature of HRSNs. To support a large number of patients, strategies should support multiple HRSNs.