JMIR Publications

ABSTRACT

Health systems increasingly screen patients for social determinants of health (SDoH) to connect them with supportive services, yet little is known about whether screening initiatives equitably reach communities in proportion to structural disadvantage. This process evaluation examined whether implementation of a health system SDoH screening initiative reached communities experiencing structural disadvantage and identified geographic gaps in screening reach. UMass Memorial Health implemented system-wide SDoH screening across primary care practices using clinic-based workflows and digital tools, including the patient portal and short message service messaging. Electronic health record data from patients with at least one primary care encounter between April 2022 and May 2025 were geocoded to census tracts and linked to the Structural Racism Effect Index (SREI). Multilevel logistic regression models assessed associations between structural disadvantage, screening completion, and reporting of social needs. A composite SDoH screening equity index combining patient catchment size, screening rates, and SREI was developed to visualize geographic variation in screening reach. Higher SREI was associated with greater odds of reporting at least one social need (OR 1.32; 95% CI 1.25–1.41) but was not associated with screening completion (OR 0.97; 95% CI 0.92–1.02). Mapping identified clusters of census tracts with high structural disadvantage but comparatively low screening reach. Geospatial process evaluation can help health systems identify inequities in screening implementation and guide targeted outreach strategies to improve equitable access to health and social care resources.