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ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 9  |  Page : 5026-5034

Comparing the performance of two social risk screening tools in a vulnerable subpopulation


1 Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, USA
2 Hutchinson Institute for Cancer Outcomes Research, 1100 Fairview Ave. N., Seattle, WA, USA
3 Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, USA
4 Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Rd Suite 200 Aurora, CO, USA
5 University of California San Francisco, Department of Family and Community Medicine, 505 Parnassus Ave, San Francisco, CA, USA
6 Kaiser Permanent Southern California, Research and Evaluation Department, 100 S Los Robles Ave, Pasadena, CA 91101 Pasadena; Kaiser Permanente School of Medicine, Health Systems Science Department, 98 S. Los Robles Ave., Pasadena, CA, USA

Correspondence Address:
Dr. Cara C Lewis
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA 98101
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_650_20

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Background: Research shows the profound impact of social factors on health, lead many healths systems to incorporate social risk screening. To help healthcare systems select among various screening tools we compared two tools, the Your Current Life Situation (YCLS) and the Accountable Health Communities (AHC) Screening tools, on key psychometric properties. Method: Kaiser Permanente Southern California subsidized exchange members (n = 1008) were randomly invited to complete a survey containing either the YCLS or the AHC tool, as well as other measures related to care experience and health. Healthcare use was measured through the electronic health record. Agreement between the AHC and YCLS was assessed using adjusted kappas for six domains (food – worry, food – pay, insecure housing, housing quality, transportation, utilities). To assess predictive validity, items on the AHC and YCLS were compared to self-rated health and receipt of a flu shot. Results: Responders (n = 450) and non-responders (n = 558) significantly differed on sex, language, and depression (P < 0.05) but not anxiety, race/ethnicity, or healthcare use. Agreement between the AHC and YCLS tools was substantial on all items (kappas > 0.60) except for housing quality (kappa 0.52). Four out of six screening questions on the AHC tool and four out of seven on the YCLS tool were associated with self-rated health (P < 0.03). No social needs were associated with flu shot receipt except utilities on the AHC tool (P = 0.028). Conclusion: In this sample, the AHC and YCLS tools are similar in their ability to screen for social risks. Differences observed likely stem from the timeframe and wording of the questions, which can be used to guide selection in healthcare systems.


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