Algorithm for Identifying Positive Social Determinant of Health Screens
| Questions* | Response Options (from Hard-Copy Version or Flowsheet) | Responses That Flags a Positive Screen |
|---|---|---|
| 1. How do you learn best? | Reading Listening Looking at pictures | None |
| 2. What is the highest level of school that you have finished? | Less than a high school diploma High school diploma/GED More than high school | None |
| 3. How hard is it for you to pay for the very basics like food, housing, heating, medical care, and medications? | Not hard at all Somewhat hard Very hard | Somewhat hard or very hard |
| If you answered “Somewhat hard” or “Very hard,” what is it hard to pay for? | Yes to any of these | |
| Food, utilities, transportation, medicine or medical care, health insurance, clothing, rent/mortgage, child care, phone | ||
| 4a. In the past month, have you slept outside, in a shelter, or in a place not meant for sleeping? | Yes No | Yes |
| 4b. In the past month, have you had concerns about the conditions and quality of your housing? | Yes No | Yes |
| 5. In the past 12 months, how many times have you moved from one home to another? | (Patient to indicate number of times) | ≥2 moves flagged for follow-up |
| 6a. In the past 12 months, (I/we) worried whether (my/our) food would run out before (I/we) got money to buy more. | Often true Sometimes true Never true | Often true or sometimes true |
| 6b. In the past 12 months, the food that (I/we) bought just didn't last, and (I/we) didn't have money to get more. | Often true Sometimes true Never true | Often true or sometimes true |
| 6c. In the past 12 months, (I/we) couldn't afford to eat balanced meals. | Often true Sometimes true Never true | Often true or sometimes true |
| 7. In the past 12 months, have you ever been physically or emotionally hurt or threatened by a spouse/partner or someone else you know? | Yes No | Yes |
| 8a. On average, how many: Days per week do you engage in moderate to strenuous exercise (like walking fast, running, jogging, dancing, swimming, biking, or other activities that cause a light or heavy sweat)? | (Patient to choose a number between 0 and 7) | Multiply days per week (8a) by number of minutes (8b); <150 flagged for follow-up |
| 8b. On average, how many minutes do you exercise at this level? | (Patient to indicate number of minutes) | |
| 9. Are you married or living together with someone in a partnership? | Married or domestic partner Living with partner in committed relationship In a serious or committed relationship, but not living together Single Separated Divorced Widowed | Questions 9–11: Composite score based on the Berkman-Syme Social Network Index |
| Question 9: 1 point for “married or domestic partner,” “living with partner in committed relations,” or “in a serious or committed relationship, but not living together” | ||
| 10a. In a typical week, how often do you: Talk with family, friends, or neighbors by phone or video chat (e.g. Skype, Facetime)? | Never Once a week 2 Days a week 3–5 Days a week Nearly every day | Question 10a-c: 1 point if they have a total of ≥3 contacts per week. |
| 10b. In a typical week, how often do you get together with family, friends, or neighbors? | Never Once a week 2 Days a week 3–5 Days a week Nearly every day | |
| 10c. In a typical week, how often do you use email, text messaging, or internet (eg, Facebook) to communicate with family, friends, or neighbors? | Never Once a week 2 Days a week 3–5 Days a week Nearly every day | |
| 11a. How often do you attend church or religious services? | Never Once a year 2–3 Times a year ≥4 Times a year At least once a month At least once a week | Question 11a: 1 point for attending church or attending church or religious services “≥4 times a year,” “at least once a month,” or “at least once a week” |
| 11b. Attend meetings of the clubs or organizations you belong to? | Never Once a year 2–3 Times a year ≥4 Times a year At least once a month At least once a week | Question 11b: 1 point if attends meetings “2–3 times a year,” “≥4 times a year,” “at least once a month,” or “at least once a week”) |
| Maximum points = 4 | ||
| High risk (flagged for follow-up) = 0–2 | ||
| 12. How often do you feel lonely or isolated from those around you? | Never Rarely Sometimes Often Always | Often or always |
| 13. Do you have someone you could call if you needed help? | Yes No | No |
| 14. During the past month, how much stress would you say you experienced? | A lot of stress A moderate amount of stress Relatively little stress Almost no stress at all | A lot of stress or a moderate amount of stress |
↵* Question sources: (1) Developed by OCHIN's Clinical Operations Review Committee. (2) Adapted from standard education questions to align with patient population of OCHIN membership. (3) Slight modification of Institute of Medicine–recommended financial hardship item (medications added to list of examples), Puterman et al,61 and Hall et al.62 The follow-up question, “What is hard to pay for?” was added to get more granularity and enable the care team to identify needed interventions; the question was adapted from a Kaiser Permanente social determinants of health (SDH) questionnaire, with permission. (4) and (5) Housing questions were from the Health Begins Upstream Risk Screening Tool (http://www.healthbegins.org/).63 (6) US Department of Agriculture 18-item Household Food Security Survey. (7) Adapted from a Kaiser Permanente SDH questionnaire, with permission. (8) Exercise Vital Sign, questions 1 and 2 and Sallis RE. Developing health care systems to support exercise: exercise as the fifth vital sign. Br J Sports Med 2011;45:473–4. Epic already has copyright permission. (9–11) Third National Health and Nutrition Examination Survey. Epic already has permission to use this question. Scoring is based on the Berkman-Syme Social Network Index (SNI); Pantell et al. Social isolation: a predictor of mortality comparable to traditional clinical risk factors. Am J Public Health 2013;103:2056–62. Item 10c was created as a parallel to items 10a and 10b to capture social connection via newer electronic modes that were not available when the Berkman-Syme SNI was created. Frequency categories for questions 10 and 11 were slightly modified from original. Kaiser is also using this approach in their screening tool. Epic already has permission to use this question. (12) Modified from item in PROMIS Item Bank version 1.0, Emotional Distress - Anger - Short Form 1 - and AARP overall loneliness item from AARP survey about loneliness in older adults. The original PROMIS item was written in first person. Loneliness was added to reduce literacy level. (13) Your Current Life Situation Questionnaire from Kaiser Permanente. (14) 1998 Adult Prevention Module of the National Health Interview Survey.