Expert panel identified health-related social needs and methodological considerations for a polysocial risk score

ObjectivesA polysocial risk score, which summaries multiple different health-related social needs (HRSNs) into a single likelihood of risk, could support more effective patient and population health management. Nevertheless, developing a polysocial risk score faces uncertainties and challenges due the HRSNs differing etiologies and interventions, cooccurrence, and variation in information availability. MethodsA 3-round Delphi technique to elicit expert opinion and develop a preliminary polysocial risk score approach. Expert panel members included physicians (n=8), social service professionals & staff (n=9), and patients (n=6). For physicians, the primary qualification was direct patient care experience in screening or asking about patients health-related social needs. Social service professionals & staff had titles of: nurse, patient care assistant, patient advocate, community health worker, director of community services. Round 1 obtained an initial importance of HRSNs on general health & well-being and total healthcare cost. Panelists also suggested additional HRSNs Responses served as discussion points for Round 2. Five focus groups explored how HRSNs should be ranked; additional HRSNs to include; timing of measurements; management of non-response and missing data; and concerns about bias and equity. We analyzed the transcripts using a consensus coding approach. Panelists then completed a follow-up survey. ResultsPanelists identified 17 HRSNs relevant to health and well-being for inclusion in a polysocial risk score. Methodology concerns ranging from the sources and quality of data, non-random missing information, data timeliness, and the need for different risk scores by population. Panelist also raised concerns about potential bias and missaplication of a polysocial risk score. ConclusionA polysocial risk score is a potentially useful addition to the growing methodologies to better understand and address HRSNs. Nevertheless, development is potentially complicated and fraught with challenges.