Is Area-Level Social Vulnerability Index Associated With Patient-Level Health-Related Social Needs in Hand Surgery?

Abstract

Background: Social drivers of health (SDOH) are area-level, nonmedical factors that affect health outcomes. By contrast, health-related social needs (HRSNs) are individual patient reported and are being deployed in some payment models. SDOH are often used to broadly represent health disparities of communities through metrics, such as the Social Vulnerability Index (SVI); however, the association of area-level SVI to individual HRSNs has not been well studied in hand surgery, which has implications for addressing social risks to improve health and in quality measurement.

Methods: We conducted a prospective cohort study of new patients presenting to an outpatient hand surgery clinic. Patients completed a questionnaire that included demographic information, zip code, the Accountable Health Communities HRSNs Screening Tool, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). Following completion of the survey, zip code was used to calculate SVI. Cohen kappa coefficients (k) were calculated to measure interrater agreement between SVI and HRSNs, SVI and QuickDASH, and HRSNs and QuickDASH.

Results: We included 80 patients in the study. The most commonly reported HRSNs were safety (33, 41.25%) followed by housing (14, 17.5%) and food (11, 13.75%). Seven SVIs were represented across the cohort. No notable agreement was observed between SVI and HRSNs. In addition, no notable agreement was observed between SVI or HRSNs and QuickDASH score.

Conclusion: Although the importance of identifying SDOH is growing, the ability of these area-level measures to accurately reflect individual HRSNs is not well understood. HRSNs may represent an opportunity for patient-centered assessments of needs and to guide resource deployment to improve outcomes for hand surgery patients.

Level of evidence: Level II prognostic study.