Emilia H De Marchis1, Stephanie A Ettinger de Cuba2, Lawrence Chang3, Richard S Sheward4, Kelly M Doran5, Laura M Gottlieb1, Alicia J Cohen6, Eric W Fleegler7, Megan T Sandel8. 1. Department of Family and Community Medicine, University of California San Francisco, San Francisco, California. 2. Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts. Electronic address: sedc@bu.edu. 3. Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. 4. Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. 5. Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York. 6. Providence VA Medical Center, Providence, Rhode Island; Department of Family Medicine, Brown Alpert Medical School, Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island. 7. Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts. 8. Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
Abstract
INTRODUCTION: Healthcare systems are increasingly interested in identifying patients' housing-related risks, but minimal information exists to inform screening question selection. The primary study aim is to evaluate discordance among 5 housing-related screening questions used in health care. METHODS: This was a cross-sectional multisite survey of social risks used in a convenience sample of adults seeking care for themselves or their child at 7 primary care clinics and 4 emergency departments across 9 states (2018-2019). Housing-related risks were measured using 2 questions from the Accountable Health Communities screening tool (current/anticipated housing instability, current housing quality problems) and 3 from the Children's HealthWatch recommended housing instability screening measures (prior 12-month: rent/mortgage strain, number of moves, current/recent homelessness). The 2-sided Fisher's exact tests analyzed housing-related risks and participant characteristics; logistic regression explored associations with reported health (2019-2020). RESULTS: Of 835 participants, 52% screened positive for ≥1 housing-related risk (n=430). Comparing the tools, 32.8% (n=274) screened discordant: 11.9% (n=99) screened positive by Children's HealthWatch questions but negative by Accountable Health Communities, and 21.0% (n=175) screened positive by the Accountable Health Communities tool but negative by Children's HealthWatch (p<0.001). Worse health was associated with screening positive for current/anticipated housing instability (AOR=0.56, 95% CI=0.32, 0.96) or current/recent homelessness (AOR=0.57, 95% CI=0.34, 0.96). CONCLUSIONS: The 5 housing questions captured different housing-related risks, contributed to different health consequences, and were relevant to different subpopulations. Before implementing housing-related screening initiatives, health systems should understand how specific measures surface distinct housing-related barriers. Measure selection should depend on program goals and intervention resources.
INTRODUCTION: Healthcare systems are increasingly interested in identifying patients' housing-related risks, but minimal information exists to inform screening question selection. The primary study aim is to evaluate discordance among 5 housing-related screening questions used in health care. METHODS: This was a cross-sectional multisite survey of social risks used in a convenience sample of adults seeking care for themselves or their child at 7 primary care clinics and 4 emergency departments across 9 states (2018-2019). Housing-related risks were measured using 2 questions from the Accountable Health Communities screening tool (current/anticipated housing instability, current housing quality problems) and 3 from the Children's HealthWatch recommended housing instability screening measures (prior 12-month: rent/mortgage strain, number of moves, current/recent homelessness). The 2-sided Fisher's exact tests analyzed housing-related risks and participant characteristics; logistic regression explored associations with reported health (2019-2020). RESULTS: Of 835 participants, 52% screened positive for ≥1 housing-related risk (n=430). Comparing the tools, 32.8% (n=274) screened discordant: 11.9% (n=99) screened positive by Children's HealthWatch questions but negative by Accountable Health Communities, and 21.0% (n=175) screened positive by the Accountable Health Communities tool but negative by Children's HealthWatch (p<0.001). Worse health was associated with screening positive for current/anticipated housing instability (AOR=0.56, 95% CI=0.32, 0.96) or current/recent homelessness (AOR=0.57, 95% CI=0.34, 0.96). CONCLUSIONS: The 5 housing questions captured different housing-related risks, contributed to different health consequences, and were relevant to different subpopulations. Before implementing housing-related screening initiatives, health systems should understand how specific measures surface distinct housing-related barriers. Measure selection should depend on program goals and intervention resources.
Authors: Kevin Chagin; Franklin Choate; Karen Cook; Susan Fuehrer; James E Misak; Ashwini R Sehgal Journal: J Prim Care Community Health Date: 2021 Jan-Dec
Authors: Thomas Byrne; Mindy Hoang; Ann Elizabeth Montgomery; Eileen Johns; Marybeth Shinn; Tod Mijanovich; Dennis Culhane; Kelly M Doran Journal: JAMA Netw Open Date: 2022-08-01