Table 2.

Literature Synthesis and Main Findings

Article no.	Refs.	Main findings	Research method
1	Bleacher et al17	Screening program undersampled African Americans, oversampled Caucasians. 91% of staff and 92% of clinicians agreed that screening benefitted patients. 96% of clinicians agreed to continue screening for HRSN despite the additional work. Clinicians were already involved with screening intervention program.	Quantitative
2	Bensken et al35	Used z-codes to identify HRSN in large national readmissions database. Suggest varying use of z-codes within institutions to document HRSN. Housing and employment emerged as 2 most commonly documented factors. Patients coded in 5 domains had higher readmission rates than those in only 1 domain.
3	Cottrell et al34	More than half of screening included responses only from 1 domain. About 50% of screenings reported came from only 4 sites, out of 106 sites. Patients with incompletely filled survey counted as screened. Screening tools availability does not automatically lead to use.
4	Navathe et al36	Prevalence of social factor in ICD-9 codes plus EHR and MD notes (tobacco use 30%, alcohol use- ∼15%, housing instability <5%, poor social support ∼15%). Physician notes reflected social needs more than ICD-9 codes in patient EHR. Poor social support and housing instability significantly associated with increased readmission risk.
5	Schickedanz et al16	84% support screening for HRSN in clinical settings. 93% and 95% agree that it can improve trust and overall care, respectively. 23% only actually screen patients for social needs always. Differences by health profession toward perceived barriers.
6	Fraze et al22	24% of hospitals sampled screened for all 5 social needs versus 15% physician practices. Only 8% of hospitals reported no screening, compared with 33% in physician practices. Interpersonal violence was the most common social risk screened for in hospitals (75%). Academic medical centers more likely to screen for HRSN compared with other hospitals, 49% versus 23%.
7	Losonczy et al18	Number of doctors who routinely ask about social needs range from 61% to 100%. 80% of doctors reported they would like more resources. 70% reported they would attend educational sessions if available.
8	Phillips et al31	50% reported feeling more confident in ability to discuss access to care issues compared with other HRSN. Barriers: lack of time to address HRSN, unfamiliarity of internal/external resources. Reported need for interdisciplinary education and collaboration.
9	Purnell et al24	Providers who reported moderate/major structural problems more likely to report low skillfulness how to address HRSN, OR 3.2, P < 0.01. 45% reported poor access to written materials in other languages. 21% reported poor access to interpreters. <50% of 1220 clinicians engage in behaviors to address barriers to HRSN >75% of the time.
10	Rogers et al30	69% of patients agreed social needs impact health. 85% responded that health system should ask about social needs. 88% patients reported that health system should help address HRSN. Significant differences observed by race, gender, age, education, and HRSN need history. Compared with males, females more likely to assess (OR 1.4, P < 0.05) and address (OR 1.7, P < 0.001) social needs.
11	Sand-Jecklin et al19	Nurses indicated positive perceptions of health literacy screening implementation in hospital. No significant difference in feasibility scores by years of experience, or age groups. 20% of screened patients were identified as at risk for health literacy limitations.
12	Wahab et al20	Residents identified correctly 97% of patients who were not at risk for low health literacy. Identified correctly only 12.5% of those who were at risk for low health literacy. Residents' knowledge pre- or post-education did not improve. Resident physicians overestimate patient health literacy and its implications to patient care interaction.
13	Zettler et al32	Main HRSN barriers: Physicians asking patients about HRSN interfering with their care (18% all the time, 51% often, and 29% occasionally). Majority of physicians noted time constraints for assisting patients with social needs (34% strongly agree and 47% agree). Majority agreed programs to assist with social needs not readily available (20% strongly agree and 56% agree).
14	Cartier and Gottlieb21	15%–100% of respondents agreed their organization screens for at least 1 HRSN. For hospitals, results ranged for screening between 62% and 91%. 21 of 23 surveys did not provide a denominator for total population served.	Mixed methods
15	Freibott et al27	66% reported food, transportation, and housing needs. Lack of standardized referral process made screening unsustainable or unjustifiable. 4 staff reported screening optimizes health care delivery and outcomes. All staff interviewed reported screening tool was short, enhanced ease of use. Some patients were reluctant to report needs.
16	Hamity et al23	Members/patients and clinicians agreed social needs impact health. Providers were on average not screening for HRSN, yet believed screening may improve trust. Members/patients agreed health system should help address social needs. Both groups reported importance of social needs assessments that leads to actionable information. Both groups reported importance of delineating who should do social needs assessments.
17	Kostelanetz et al15	94% reported HRSN data could be used to improve patient care. 91% and 93% agreed that it could improve trust and communication, respectively. Differences in perceived importance versus actual screening for housing instability, 73% versus 53%. 51% of providers cited lack of resources is biggest barrier to address HRSN. 45% and 33% reported lack of time and support staff as barriers, respectively.
18	Norton et al29	>50% patients had positive perceptions about screening process. 47% of patients screened positive reported inability to connect with resource/help. 40% of patients with positive screening were hard to reach by phone. 25% of patients declined services/help offered after positive screening.
19	Wallace et al25	7% of patients completed the process from screening to referral with community resource. ED staff communicated discomfort expanding roles, questioned usefulness of screening. Patients communicated desire for improved understanding of their social needs. Older male non-White and Hispanic patients were more likely to complete referral process.
20	Dauner and Loomer33	Screening varies by time and clinician. Lack of access to internet, lack of labor, financial, and social services were screening barriers. Occurs informally between inpatient and outpatient settings Lack of systematic process to follow up on referrals also cited as barrier to screening.	Qualitative
21	Drake et al28	Clear communication, proactive initiative, and nonjudgmental attitude valued by patients. Patients shared negative experiences related to discrimination in health care when seeking assistance. Screening completed in <10 min. Patients were receptive to sharing information on HRSN.
22	Powell et al26	Participants reported feeling unable to motivate patients to follow-up after discharge in the setting of substance abuse or mental health struggles. Providers perceived patients distrust in health care system affects screening efforts. Suggestion improving health system visibility in community. Suggestion to increase number of minority providers and staff.

HRSN, health-related social needs; ICD-9, International Classification of Diseases, 9^th Revision; OR, odds ratio.