Data Note
June, 2022
Peter Shin, Jessica Sharac, Feygele Jacobs, Sara Rosenbaum
Executive Summary
Poverty, lack of safe, affordable housing, hunger and poor nutrition, exposure to domestic violence, and other social conditions all have been shown to deeply affect both short- and long-term health outcomes. For over five decades, community health centers have been engaged in efforts to identify their patients’ social and health risks and to help fashion responsive solutions. Using information from HRSA’s 2020 nationwide Uniform Data System (UDS), this Data Note examines the extent of community health center involvement in systematic efforts to screen patients for the presence of one or more social determinants of health (SDoH). Based on the reported data, we characterized health centers as being engaged in SDoH activities if the health center reported collecting data on patients’ individual social risk factors, the health center indicated that it utilized one or more standardized social-risk screeners, and/or the health center reported any data on the number of patients who screened positive for social risks.
Key Findings
- Based on our definition of SDoH engagement, three in four (75 percent) health centers in 2020 were engaged in SDoH activities. This is a higher share than the nearly seven in ten (69 percent) health centers that reported collecting data on patient social risks in the 2020 UDS.
- Nearly half (47 percent) of health centers reported using a standardized social risk screening tool, considered important for completely and accurately collecting information on health risks.
- Six in ten health centers that reported collecting data on patients’ individual social risks also reported using a standardized screener.
- Health centers reported nearly 790,000 patients who screened positive for financial strain, and approximately 495,100 patients screened positive for food insecurity, 412,000 for housing insecurity, and 303,000 for lack of transportation or access to public transportation.
- Health centers engaged in SDoH activities were significantly more likely to be larger, urban, located in a Medicaid expansion state, and to show greater Medicaid participation. Conversely, SDoH screening appeared to pose greater challenges for smaller health centers that were more reliant on health center grant funding and practicing in non-Medicaid expansion states – ironically, states whose residents are at especially high risk of poverty and burdened by poor health.
Reaching the goal of universal health center social risk engagement will require targeted grant support as well as Medicaid performance investments aimed at more fully reflecting the range of costs associated with social risk screening and reporting.
Background
From their earliest days, community health centers have been designed to address the social determinants of health (SDoH) by bridging patient-level health care services and population health.[1] Health centers have focused not only on providing high-quality primary care for their patients and connecting them with needed social services but have also pursued community- and population-wide health improvements. As care providers, health centers actively screen their patients for social risk factors[2] and provide care management aimed at facilitating greater access to services. Many health centers offer other health and nutrition services onsite[3] and improve access to services through onsite insurance application and enrollment assistance. This deep commitment to both patient and population health is embedded in the DNA of the legislation that established the health centers program and is captured in the health center governance model requiring patient-majority boards of directors. Further, this health care model is essential to the communities served by health centers, which by law must be medically underserved as measured by deep poverty, elevated health risks, and higher social needs. In 2020, 1,375 community health centers served 28.6 million patients across approximately 13,600 sites.[4] Approximately nine in ten health center patients were low-income and nearly half (46 percent) were covered by Medicaid that year.[5]
Patient social risk screening lies at the heart of current efforts to identify and address patient-level health risks as well as risks that are sufficiently present to be of broader, population-wide concern.[6] For years, health centers have screened patients for health and social risks. Beginning in 2019, the Health Resources and Services Administration (HRSA), which administers the Health Center Program through its Bureau of Primary Health Care (BPHC), began more systematically capturing information about health center social risk screening activities by modifying the Uniform Data System (UDS), the national reporting system that collects universal information on health center patients, services, revenue, staffing, and other matters. The 2019 UDS added variables to measure whether health centers were collecting data on individual patients’ social risk factors (outside of other data already reported in the UDS) and which standardized screeners, if any, they used to screen patients for social risk factors.[7] In 2020, HRSA added two new variables to collect information on the number of patients who screened positive for selected social risks, and health centers’ reasons for not using a standardized screener, if they did not do so.[8]
In this Data Note we document the extent of health center engagement in social risk screening, examine the organizational and financial factors associated with patient social risk screening activities, and identify potential opportunities and challenges for addressing social determinants of health.
Social Risk Screening Activities
Approximately seven in ten health centers reported collecting patient-level social risk factor data. Figure 1 shows the share of community health centers that reported collecting data on individual patients' social risk factors in 2020. One in four health centers reported plans to screen for social risk, while a small percentage (six percent) reported no plans to collect patient social risk data.
Figure 1. Share of community health centers that collected data on individual patients' social risk factors, 2020
Note: Percentages may not sum to 100% due to rounding.
Source: Health Resources and Services Administration. (2021). 2020 Health Center Data: Table EHR: Health Center Health Information Technology (HIT) Capabilities. https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=EHR&year=2020
All health centers were asked which, if any, standardized screeners they used (they could select more than one).[9]As shown in Figure 2, the most commonly used standardized screener in 2020 (used by 36 percent of all health centers) was PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks and Experience), which was designed by the National Association of Community Health Centers, the Association of Asian Pacific Community Health Organizations, and the Oregon Primary Care Association.[10]
Figure 2. Patient social risk standardized screeners used by community health centers, 2020
Note: Reporting health centers were instructed to select all that apply. Percentages were calculated based on all 1,375 health centers, including those that reported that they did not collect social risk data, because all health centers reported data for this variable.
Source: GWU analysis of 2020 UDS data. HRSA. (2021). 2020 UDS National Data: Table EHR. https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=EHR&year=2020
Health centers were asked if they utilized a standardized screener irrespective of whether they indicated that they collected social risk data, or not. Nearly half (47 percent) of all health centers reported using one or more standard screening tools while 42 percent did not (see Appendix for details). Of those health centers that reported collecting social risk factor data, 60 percent used at least one standardized screener while one in four (25 percent) did not (Figure 3).
Figure 3. Reported utilization of standardized social risk screeners by community health centers, 2020
Note: Reporting health centers were instructed to select all that apply. Health centers that reported using at least one standardized screener were categorized as using one or more standardized screener, even if they also reported using an “Other” screener or not using a standardized screener.
Source: GWU analysis of 2020 UDS data. HRSA. (2021). 2020 UDS National Data: Table EHR. https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=EHR&year=2020
Health centers that reported not using a standardized screener identified a number of reasons for not doing so, including financial and staffing limitations. Figure 4 shows the most commonly cited reasons were inability to include the screener with patient intake and clinical workflow, and lack of training for staff to discuss these issues with patients (24 percent each). One in five (21 percent) health centers reported that lack of funding for addressing unmet social needs of patients was a barrier to using a standardized screener, while 18 percent reported unfamiliarity with these assessments or had not considered using them. Only seven percent of these health centers reported that using a standardized screener for social risk was not needed. Additionally, 38 percent cited other reasons, including that their health center was currently in the process of planning for or implementing the use of a standardized screener, was trying to incorporate the use of a standardized screener into their Electronic Health Record (EHR) system, or disruptions or delays due to the COVID-19 pandemic.
Figure 4. Community health centers' reasons for not using a standardized screener for social risks, 2020
Note: Health centers that reported not using a standardized screener were instructed to select all that apply. Percentages are based on 591 health centers that responded to this question in 2020.
Source: GWU analysis of 2020 UDS data. Health Resources and Services Administration. (2021). 2020 Health Center Data: National Data. https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=Full&year=2020
Health centers that reported using a standardized or other screener, whether or not they reported collecting social risk data (see Appendix), were also asked to report the number of patients who screened positive for the following social risks: food insecurity, housing insecurity, financial strain, and lack of transportation or access to public transportation. Figure 5 shows the number of health center patients identified with these social risks. Among the four identified social risk factors, the most common was financial strain. While nearly 790,000 patients were identified as having financial strain, this figure contrasts sharply with UDS-reported figures on patient income and financial status. In 2020, 91 percent of health center patients were reported as low-income and 68 percent as poor[11] equating to an estimated 25.8 million low-income patients and more than 19 million living in poverty.[12] Nearly half a million (495,100) patients screened were identified as food insecure and approximately 412,000 and 303,000 had problems with housing insecurity and transportation, respectively.
Figure 5. Number of community health center patients who screened positive for selected social risk factors, 2020
Note: 747 health centers reported the number of patients who screened positive for social risks (even if they reported zero patients) in the 2020 UDS, n=673 for collects social risk data and n=74 for does not collect social risk data.
Source: GWU analysis of 2020 UDS data. Health Resources and Services Administration. (2021). 2020 Health Center Data: Table EHR: Health Center Health Information Technology (HIT) Capabilities. https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=EHR&year=2020
Community health centers’ engagement in SDoH activities and differences by engagement status
To better understand the scale of health center SDoH activities, we characterized health centers as being engaged in SDoH activities if they: 1) reported collecting data on patients’ individual social risk factors; 2) used one or more standardized social risk screeners; and/or 3) reported any data on the number of patients who screened positive for social risks, even if they reported identifying zero (0) patients. Overall, 75 percent of health centers could be considered to be engaged in SDoH activities in 2020. (See Appendix Table A1 for the share of health centers in each state that are engaged in SDoH activities based on this definition). Based on a simple bivariate analysis comparing health centers engaged in SDoH activities with those that are not, Table 1 shows the various possible factors that may be associated with health centers’ SDoH engagement.
Community health centers that are engaged in SDoH activities are significantly more likely to be located in urban locations, and in states that expanded Medicaid under the Affordable Care Act. The majority of engaged health centers (758 out of a total of 1,036) were located in Medicaid expansion states. Engaged health centers were also significantly more likely to participate in a health information exchange (HIE) for the electronic exchange of clinical information.
Health center size appears to be a significant factor. Health centers engaged in SDoH activities had an average of ten sites and 22,327 patients, compared to non-engaged health centers with an average of eight sites and 16,106 patients. The average proportion of special populations, including homeless and migrant agricultural patients, as well as racial/ethnic minorities, were relatively the same in both engaged and non-engaged health centers. However, health centers engaged with SDoH activities had a significantly smaller percentage of uninsured patients on average, and a significantly larger share and number of Medicaid patients compared to those that were not engaged in SDoH activities.
Provision by the center of enabling services, which are critical for facilitating medical care, did not significantly differ between either group of health centers. Instead, SDOH-engaged health centers had significantly larger shares of mental health staff members and visits and higher-quality screening for depression such as the use of standardized screening and follow-up plans..[13]
In terms of financial factors, health centers that are engaged in SDoH relied more heavily on Medicaid as a percentage of total revenue. Conversely, non-engaged health centers relied more on Bureau of Primary Health Care (BPHC) health center grant funding and had greater uninsured patient burdens, as measured by the average number and share of uninsured patients. In general, Medicaid per-patient revenue rates and level of grant funding per patient had no significant association with SDoH engagement.
Table 1. Community health center engagement in SDoH activities by key UDS variables, 2020
| UDS 2020 variable | Not engaged in SDoH activities | Engaged in SDoH activities |
| Number of community health centers | 339 | 1,036 |
| Percentage of community health centers | 25% | 75% |
| Total patients | 5,459,940 | 23,130,957 |
| Total low-income patients | 4,947,396 | 20,889,225 |
| Total poor patients | 3,663,510 | 15,472,306 |
| Location and participation in a HIE | ||
| Location in Medicaid expansion state* | ||
| Non-expansion | 36% | 26% |
| Medicaid expansion | 64% | 75% |
| Urban or rural* | ||
| Rural | 49% | 40% |
| Urban | 51% | 60% |
| Health center electronically exchanges clinical information with a health information exchange (HIE)* | ||
| No | 55% | 42% |
| Yes | 45% | 58% |
| Health center size (averages) | ||
| Number of sites* | 8.2 | 10.4 |
| Number of patients* | 16,106 | 22,327 |
| Health center population (averages) | ||
| Percentage of homeless patients | 7% | 7% |
| Percentage of migrant patients | 3% | 2% |
| Percentage of total patients who are racial/ethnic minority members | 57% | 56% |
| Percentage of uninsured patients* | 27% | 23% |
| Percentage of Medicaid patients* | 39% | 43% |
| Medicaid patients* | 6,867 | 10,538 |
| Uninsured patients* | 3,858 | 4,761 |
| Enabling services and mental health variables (averages) | ||
| Share of enabling services staff out of total staff FTEs | 9% | 10% |
| Share of enabling services visits (out of total clinic and virtual visits) | 4% | 5% |
| Share of mental health staff out of total staff FTEs* | 5% | 6% |
| Share of mental health visits (out of total clinic and virtual visits)* | 11% | 13% |
| Percentage of patients 12 years of age and older who were (1) screened for depression with a standardized tool and, if screening was positive, (2) had a follow-up plan documented* | 60% | 65% |
| Revenue (averages) | ||
| Total revenue per patient | $1,400 | $1,445 |
| Medicaid revenue per patient | $914 | $1,009 |
| Grant revenue per patient | $730 | $691 |
| Share of total revenue from Medicaid* | 27% | 32% |
| Share of total revenue from BPHC grant revenue* | 34% | 28% |
| Operating margin | 9% | 6% |
Note: Statistically significant difference by SDoH engagement at the p<0.05 level
Source: GWU analysis of 2020 Uniform Data System data, Health Resources and Services Administration
Given health centers’ dependence on Medicaid, it is not surprising to find that location in a Medicaid expansion state, greater Medicaid patient volume, and share of total revenue from Medicaid were all positively associated with engagement in SDoH activities. These findings suggest that health centers require a critical volume of Medicaid patients or Medicaid revenue to better underwrite health-related SDoH costs. The significance of HIE capabilities likely reflects the availability of infrastructure that allows health centers to better connect with their health care and community partners or to work in a larger effort (i.e., network) to address patient social needs. This is consistent with the literature which indicates that adequate reimbursement for health-related social screening services, more comprehensive and integrated screening tools, and sufficient clinic and community resources to address positive cases are necessary for improving quality of care and outcomes.[14],[15]
Conclusion and Implications
The growing focus on health equity as a guiding principle for the U.S. health system, along with the COVID-19 pandemic, has underscored the urgency of addressing social and community-level risk and the need for considered investment to ensure patient and community health. This analysis shows that as of 2020, approximately three in four (75 percent) health centers were engaged in SDoH activities. Since then, as COVID-19 has ravaged communities across the U.S., the need for such activities has only grown.
Based on our simple bivariate analysis, engaged health centers appear to be those practices with a large volume of Medicaid patients and located in a Medicaid expansion state that provides enough resource leverage to support SDoH engagement. However, the findings also suggest significant missed opportunities for better screening of risks with more support, better training, standardized tools, and most importantly, addressing health-related social needs.
SDoH-engaged health centers serve more than 23 million patients, of whom nearly 21 million (90 percent) are low-income.[16] The fact that the data show fewer than 790,000 reported cases of patients with financial strain suggests that certain risks are being under-counted. This may be the result of the financial and staffing constraints noted by health centers, as well as insufficient community resources and partnerships.[17]
Our findings suggest the crucial need for greater investment in social risk screening and reporting. This support can come through grants. It also can come through payment innovations that better capture the cost and time needed to conduct social risk screening and report results. In this vein, an alternative payment methodology (APM), now under development by Primary Care Associations, health centers, and Medicaid agencies in numerous states, could allow for greater flexibility in staffing to promote an approach to care that more fully supports rigorous screening for social risks using validated risk screening tools. The cost of such innovations is fully permissible under Medicaid’s FQHC coverage and payment system, since patient social risk screening is an integral part of both preventive and treatment visits.
Non-engaged health centers tend to be located in non-expansion states, derive relatively low revenue from Medicaid, are smaller, and are more reliant on health center grant funding. Yet because of where they are located – disproportionately in the poorest states, which tend to be rural, non-expansion states – these health centers may, in fact, have even greater proportions of patients with elevated social risks. Greater targeted levels of grant funding could help to overcome the challenges these health centers face in implementing standardized screening activities, adopting data collection and referral systems, training and hiring staff to engage in SDoH, and networking with other providers and partners to advance community health.
Appendix
Table A1: Community health centers’ engagement in SDoH activities, 2020
| State | Percentage of health centers engaged in SDoH activities | State | Percentage of health centers engaged in SDoH activities |
| AK | 59% | NC | 69% |
| AL | 71% | ND | 50% |
| AR | 83% | NE | 71% |
| AZ | 78% | NH | 100% |
| CA | 74% | NJ | 70% |
| CO | 100% | NM | 69% |
| CT | 100% | NV | 63% |
| DC | 100% | NY | 86% |
| DE | 100% | OH | 86% |
| FL | 62% | OK | 52% |
| GA | 74% | OR | 80% |
| HI | 86% | PA | 83% |
| IA | 93% | PR | 73% |
| ID | 86% | RI | 100% |
| IL | 73% | SC | 65% |
| IN | 85% | SD | 50% |
| KS | 79% | TN | 69% |
| KY | 68% | TX | 64% |
| LA | 56% | UT | 69% |
| MA | 97% | VA | 69% |
| MD | 65% | VT | 73% |
| ME | 89% | WA | 70% |
| MI | 85% | WI | 75% |
| MN | 63% | WV | 75% |
| MO | 100% | WY | 33% |
| MS | 70% | Total U.S. | 75% |
| MT | 93% |
Notes: Health centers are characterized as being engaged in SDoH activities if they: 1) reported collecting data on patients’ individual social risk factors; 2) used one or more standardized social risk screeners; or 3) reported any data on the number of patients who screened positive for social risks, even if they reported identifying zero (0) patients. The table includes Puerto Rico (PR) but excludes three U.S. territories/COFA states (the Federated States of Micronesia, Guam, and the Marshall Islands) that reported any SDoH engagement (25%, 100%, and 100%, respectively). Health centers in American Samoa, the Northern Mariana Islands, Palau, and the U.S. Virgin Islands did not report any SDoH engagement and are excluded from the table. Source: GWU analysis of 2020 Uniform Data System data, Health Resources and Services Administration
Details on UDS SDoH variables and methodological challenges
The 2019 and 2020 UDS captured data on social risk in a series of independent questions. The first question posed (Table EHR, Line 11) is: “Does your health center collect data on individual patients' social risk factors, outside of the data reportable in the UDS?”[18] All health centers, irrespective of whether they responded yes or no to question 11, were then able to respond to item 12, “Which standardized screener(s) for social risk factors, if any, do you use? (Select all that apply.)” In response to this question, health centers could select from a list of standardized screeners, describe the “Other”[19] type of screener they used, and/or to report “We do not use a standardized screener.”[20]All 1,375 health centers, whether or not they reported collecting social risk data, reported on this variable; percentages based on all 1,375 health centers[21] are reported in Figure 2. Among health centers that reported on Line 11 that they did not collect social risk data in 2020, 18 percent nonetheless reported the use of one or more standardized screeners (see Figure 3). It is not clear from the data how to interpret this finding. A small number of health centers reported that they used one standardized screener, but also that they did not use a standardized screener; these health centers were categorized as using one or more standardized screeners, as reported in Figure 3.
Those health centers that reported on Line 12 that they did not use a standardized screener (n=591 in 2020) reported the reasons for not using one; percentages out of those 591 health centers are shown in Figure 4.
In the 2020 UDS, any health centers that reported using a standardized or other type of screener, whether or not they reported collecting social risk data,[22] were asked to report the number of patients who screened positive for the following social risks: food insecurity, housing insecurity, financial strain, and lack of transportation or access to public transportation (Figure 5). Health centers that answered no to Q11 (“Does your health center collect data on individual patients' social risk factors, outside of the data reportable in the UDS?”) were able to report the number of patients with social risks because the patients could have been identified by providers.[23] Over half (54 percent; n=747) of all health centers reported the number of patients who screened positive for any social risk, but 99 reported that zero patients screened positive for any of the four identified risk factors. It is not clear from the data if this means no patients screened positive or that the health center did not screen any patients.
While the 2021 UDS[24] SDoH variables (which have yet to be reported) appear unchanged from 2020 UDS, the SDoH variables were revised to provide greater clarity and a new variable was added[25] for the 2022 UDS.[26] These recent revisions to the UDS SDoH variables should shed more light on health centers’ engagement in SDoH activities and will provide data on the number of health center patients screened for selected social risks, but this data will not be available until the 2022 UDS data is released. The new variable, Question 11a, is asked only of those who reported collecting social risk data through Q11 and asks those health centers to report the number of patients screened for social risk factors using a standardized screener. Those health centers reporting more than zero patients screened are then asked which type of standardized screener they used. Only health centers that report using a standardized or "Other" screener can report the number of patients with selected social risks through Q12a. Question 12b, which asks why health centers are not using a standardized screener, is asked only of health centers that report 0 patients in 11a or those who report not using a standardized screener in question 12a.
[1] Stevens, David M, et al. "Beyond Primary Care: Renewing the Community Health Center Vision for Today's Health Crisis." Journal of Health Care for the Poor and Underserved, vol. 33 no. 2, 2022, p. 1123-1128. Project MUSE, doi:10.1353/hpu.2022.0086. See also Sim, Chao-Chee, et al. "Building Community-Oriented Medicaid Managed Care in Texas And Beyond", Health Affairs Forefront, January 11, 2022. DOI: 10.1377/forefront.20220106.169006
[2] Weir, R. C., Proser, M., Jester, M., Li, V., Hood-Ronick, C. M., & Gurewich, D. (2020). Collecting Social Determinants of Health Data in the Clinical Setting: Findings from National PRAPARE Implementation. Journal of Health Care for the Poor and Underserved, 31(2), 1018-1035. https://muse.jhu.edu/article/756691
[3] https://www.kff.org/medicaid/issue-brief/how-community-health-centers-are-serving-low-income-communities-during-the-covid-19-pandemic-amid-new-and-continuing-challenges/
[4] HRSA. (2020). HRSA Health Center Program. https://bphc.hrsa.gov/sites/default/files/bphc/about/healthcenterfactsheet.pdf
[5] HRSA. (2020). National Health Center Data. https://data.hrsa.gov/tools/data-reporting/program-data/national
[7] Bureau of Primary Health Care. (2020). Table EHR: Health Center Health Information Technology (HIT) Capabilities. https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=EHR&year=2019
[8] Bureau of Primary Health Care. (2020). Uniform Data System Reporting Instructions for 2020 Health Center Data. HRSA. https://bphc.hrsa.gov/sites/default/files/bphc/datareporting/pdf/2020-uds-manual.pdf
[9] See Appendix for further reporting details.
[10] Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) screening tool. The screening tool includes national measures as well as operational measures. https://www.nachc.org/wp-content/uploads/2020/04/PRAPARE-One-Pager-9-2-16-with-logo-and-trademark.pdf
[12] GWU analysis of 2020 UDS data. Estimated numbers are based on the percentage of low-income and poor patients multiplied by the number of total patients reported by each health center in 2020.
[13] Percentage of patients 12 years of age and older who were (1) screened for depression with a standardized tool and, if screening was positive, (2) had a follow-up plan documented
[14] Malhotra, N. A., Nevar, A., Yearby, R., Kleinman, L. C., & Ronis, S. D. (2021). Medicaid's EPSDT Benefit: An Opportunity to Improve Pediatric Screening for Social Determinants of Health. Medical Care Research and Review: MCRR, 78(2), 87–102.
[15] Berger-Jenkins, E., Monk, C., DʼOnfro, K., Sultana, M., Brandt, L., Ankam, J., Vazquez, N., Lane, M., & Meyer, D. (2019). Screening for Both Child Behavior and Social Determinants of Health in Pediatric Primary Care. Journal of Developmental and Behavioral Pediatrics, 40(6), 415–424.
[16] GWU analysis of 2020 UDS data. Estimated numbers are based on the percentage of low-income patients multiplied by the number of total patients reported by each health center in 2020.
[17] Shin et al. (2021), Opportunities and Challenges for Medicaid Managed Care Organizations, Community Health Centers and their Partners in Addressing Social Determinants of Health in Five States. https://publichealth.gwu.edu/sites/default/files/RWJF%20MMC%20SDoH%20Final%20Report.pdf
[18] Personal communication, UDS Support Center, Bureau of Primary Health Care. (September 2021). “In 2020, health centers were able to respond 'No' to Q11, and then go on to identify a standardized tool in Q12 and patients who screened positive in the categories in Q12a. There was not skip logic preventing this.”
[19] Health centers’ “other” responses included using modified versions of the PRAPARE tool, the PHQ-2 or PHQ-9 screening tools, or state- or health-plan specific screening tools.
[21] Note that these percentages differ from those reported by HRSA (https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=EHR&year=2020) because they use a denominator of 947 health centers based on the number of health centers that reported collecting social risk data, even though health centers that did not report collecting social risk data were able to report on their use of standardized screeners.
[22] Personal communication, UDS Support Center, Bureau of Primary Health Care. (September 2021). “The ability to report the four social risks captured hinges solely on the response to Question 12. In 2020, if a health center responded "We do not use a standardized screener" in Q12 then they were not able (italics theirs) to report any patients as having screened positive for the 4 social risk factors in Q12a.”
[23] Personal communication, UDS Support Center, Bureau of Primary Health Care. (September 2021). “In 2020, health centers were also able respond 'No' to Q11, then go on to NOT identify a standardized tool in Q12 (they select Other) and then report numbers in the social risk categories in Q12a. The thought there is that perhaps those health centers do not use a standardized validated social need screening tool, but perhaps their providers do on occasion diagnose these social needs.”