Factors associated with patients desiring assistance from the health care system: Evidence from a national integrated health system
本研究基于三个大型医疗网络的数据，评估了用财务压力问题作为预筛查工具识别其他社会风险（食品不安全、住房不稳定、交通障碍）的准确性，发现单一财务压力问题会漏掉超过10%有其他社会风险的患者。
Methods: Longitudinal cohort study evaluating the proportion of participants that endorsed financial strain and food insecurity, housing instability, and transportation barriers.The analytic sample was from survey and encounter data for patients with information available from all four social domains.Data were obtained from the OCHIN network (2019-2023), Humana (2019-2020), and Kaiser Permanente (KP) (2020).We assessed the predictive value (e.g., sensitivity, specificity, positive and negative predictive value, area under the receiver operating characteristic curve, and false negative rate) of using financial strain as a pre-screener for the other three social risks. Results:The final sample included 252,845 adults with complete social risk data (63.7% from OCHIN, 32.2% from Humana, 4.1% from KP). 38% of the OCHIN sample, 41% of the Humana sample, and 28% of the KP sample experienced financial strain.Across samples, using the financial strain item in an initial prescreening would fail to identify 12.3% to 24.2% of individuals who reported food insecurity, 13.2% to 24.7% who reported housing instability, 17.0% to 32.6% who reported transportation barriers, and 4.1% to 5.7% who reported all three risks.Conclusion: A single financial strain question would cause the health system to miss >10% of people who report other social risks.