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

Objectives: A 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. Methods: A 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. Results: Panelists 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. Conclusion: A 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. ### Competing Interest Statement Joshua Vest is a founder and equity holder in Uppstroms, LLC a technology company. ### Funding Statement This work was supported by the Health Disparity and Equity Research Program at the Regenstrief Institute, Indianapolis, IN. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The IRB of Indiana University IRB gave ethical approval for this work (#17119). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data are not available.