Screening for Financial Hardship: Comparing Patient Survey Responses Using Two Different Screening Tools

• Published in: Journal of general internal medicine : JGIM 2024-01, Vol.39 (1), p.120-127
• Main Authors: De Marchis, Emilia H., Fleegler, Eric W., Cohen, Alicia J., Tung, Elizabeth L., Clark, Cheryl R., Ommerborn, Mark J., Lindau, Stacy Tessler, Pantell, Matt, Hessler, Danielle, Gottlieb, Laura M.
• Format: Article
• Language: English
• Subjects: Acceptability; Adult; Aged; Cross-Sectional Studies; Delivery of Health Care; Financial Stress; Food quality; Food security; Government programs; Housing; Humans; Internal Medicine; Medicare; Medicine; Medicine & Public Health; Original Research; Patients; Polls & surveys; Primary care; Questions; Risk assessment; Risk taking; Surveys; Surveys and Questionnaires; United States - epidemiology
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-023-08437-4

Background Healthcare delivery organizations are increasingly screening patients for social risks using tools that vary in content and length. Objectives To compare two screening tools both containing questions related to financial hardship. Design Cross-sectional survey. Participants Convenience sample of adult patients ( n  = 471) in three primary care clinics. Main Measures Participants randomly assigned to self-complete either: (1) a screening tool developed by the Centers for Medicare & Medicaid Services (CMS) consisting of six questions on financial hardship (housing stability, housing quality, food security, transportation security, utilities security); or (2) social and behavioral risk measures recommended by the National Academy of Medicine (NAM), including one question on financial hardship (financial strain). We compared patient acceptability of screening, positive screening rates for financial hardship, patient interest in assistance, and self-rated health. Results Ninety-one percent of eligible/interested patients completed the relevant survey questions to be included in the study ( N  = 471/516). Patient acceptability was high for both tools, though more participants reported screening was appropriate when answering the CMS versus NAM questions (87% vs. 79%, p  = 0.02). Of respondents completing the CMS tool, 57% (132/232) reported at least one type of financial hardship; on the NAM survey, 52% (125/239) reported financial hardship ( p  = 0.36). Nearly twice as many respondents indicated interest in assistance related to financial hardship after completing items on the CMS tool than on the NAM question (39% vs. 21%, p