Barriers to patient engagement with community-based resources following social determinants of health (SDOH) screening: a mixed-methods study across hospitals in the Chicago metropolitan area.

Background: Quality and accreditation standards from the centres for medicare and medicaid services have prompted acute care hospitals to integrate social determinants of health (SDOH) screening into clinical workflows. However, the design of SDOH screening and response programmes is not standardised, and actual engagement of patients to use referrals, and barriers to community resources and engagement, remain understudied. Methods: We conducted a mixed-methods study across three hospitals within the Northwestern Medicine health system in metropolitan Chicago and surrounding suburbs. Surveys and interviews were administered to discharged inpatients who screened high risk for social needs and to community-based organisations (CBOs) that received hospital referrals. Quantitative and qualitative analyses assessed barriers to patient engagement. Results: 30 patients and 6 CBO sites were included. The patient survey demonstrated overall low engagement with resources, with most patients not using the provided resources despite agreeing that they matched their social needs and comfort level. Key barriers included limited English proficiency, perceived lack of benefit and difficulty accessing CBO services. CBO responses highlighted operational challenges such as underfunding, understaffing and an inability to track referred patients from hospitals. Conclusion: In this Chicago-based multi-hospital study, substantial gaps were identified between discharge referrals and actual resource utilisation. Strengthening follow-up, bidirectional hospital-CBO communication and community capacity are essential to improve the effectiveness of SDOH screening programmes.