Can SDOH screening perform better than the SVI and ADI?

Background

SDOH have been a key talking point for most healthcare providers for the better part of a decade and have represented a key focus area for population health experts for even longer.

These social factors, which include where we live, work, play and worship, can have a strong impact on health outcomes. In turn, healthcare professionals have sought to understand the unique SDOH affecting patients to determine effective intervention strategies that can, ideally, promote better outcomes at lower costs.

This latest study looked at how healthcare providers assess SDOH prior to surgery, comparing SDOH screening to more accessible neighborhood-level measures like the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI). The SVI and ADI are not individualized to unique patients but rather give a broad overview of where a patient lives as proxy for individual-level SDOH.

Comparing SVI, ADI and SDOH screenings

The researchers used a set of previously collected SDOH screening results for patients undergoing elective surgery across two hospitals and used their addresses to identify the SVI and ADI for each patient.

From there, the researchers compared the SVI and ADI indications to the results of the SDOH screening. Specifically, they sought to determine whether the SVI and ADI truly captured the social need determined by the individual-level SDOH screening questionnaire.

The analysis showed that the SVI and ADI could not reliably predict the SDOH screening results, indicating that they might be a poor proxy for individualized screening. Solely using the SVI and ADI to determine potential social need could run the risk of misclassifying individuals and allowing them to slip through the cracks.

SVI and ADI might be preferable to individualized SDOH screening because they are publicly and readily available. SDOH screening can be resource-intensive, and individuals might also choose not to complete the questionnaire.

However, the study results indicate that organizations should still prioritize individual-level SDOH screening where possible.

Moreover, policymakers should continue advising hospitals and health systems to use SDOH screenings over area-level assessments, like SVI and ADI.

"In March 2025, the Centers for Medicare & Medicaid Services rescinded their endorsement of assessing patient-level SEDOH status," the researchers acknowledged.

"However, our study cautions against relying solely on neighborhood-level characteristics and proposes a model that integrates psychosocial risk assessment into preoperative care," they concluded. "Our findings suggest that policy should include patient-level assessments to target vulnerabilities more accurately."

Sara Heath has covered news related to patient engagement and health equity since 2015.