# The Effect of Screening and Referral for Social Determinants of Health on Veterans'  Outcomes

> **NIH VA I01** · VA BOSTON HEALTH CARE SYSTEM · 2021 · —

## Abstract

Background: Despite medical advances, up to 70% of health outcomes are due to social determinants of
health (SDoH) - the conditions in which people live and work that shape whether basic needs (e.g., housing,
food) are met. These associations are especially well documented for cardiovascular disease (CVD). In
response, health policy leaders recommend screening and referral (S&R) for unmet needs in clinical settings,
and the American Heart Association recently concluded that the most significant opportunities for reducing
CVD death and disability lie with addressing the social determinants of cardiovascular outcomes. A limited but
promising evidence base supports these recommendations but more rigorous research is needed to guide how
best to intervene on unmet needs that affect health.
Significance/Impact: This project addresses the Office of Social Work’s priority to link Veterans with resources
and services in support of treatment goals, the Office of Patient Centered Care and Cultural Transformation’s
priority to enhance the physical, emotional, and social well-being of the whole person, the Office of Health
Equity’s priority to reduce disparities, and the HSR&D priorities of health equity and population health. Our
study will provide much-needed evidence to document the burden of Veterans’ unmet needs, inform how best
to address unmet needs, and assess how such a process can affect adherence (to medications and
appointments), utilization, and clinical outcomes.
Innovation: VA currently systematically screens for only two unmet needs (homelessness and food insecurity).
Identification of other unmet needs (and referral to address them) occurs on an ad hoc basis, with varying
approaches among clinics/ clinicians. We will implement comprehensive screening of eight unmet needs and
systematic referral, developing tools and processes that, if efficacious, can be implemented within VA (and
other) clinical systems. VA is currently funding several studies related to SDoH, but none test interventions that
systematically identify a wide range of unmet social needs among Veterans and connect Veterans with
identified needs to social service resources.
Specific Aims: 1) Describe the burden and distribution of eight unmet needs (i.e., housing; food insecurity;
utility insecurity; transportation; legal guidance; employment; safety; and social isolation) among Veterans with
or at-risk for CVD, and identify their associations with sociodemographic characteristics, and baseline health-
related behaviors and clinical outcomes; 2) Compare the effects of three S&R study intervention conditions of
varying intensity on Veterans’ connection to new SDoH resources (primary outcome), reduction of unmet
needs, adherence, and clinical outcomes, and 3) Identify barriers and facilitators to Veterans’ connecting with
social services and having needs met, and explanatory factors for observed RCT outcomes.
Methodology: We propose a 3-year, two-phased mixed methods study. In Phas...

## Key facts

- **NIH application ID:** 9943776
- **Project number:** 1I01HX003060-01A1
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Deborah Gurewich
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-02-01 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9943776

## Citation

> US National Institutes of Health, RePORTER application 9943776, The Effect of Screening and Referral for Social Determinants of Health on Veterans'  Outcomes (1I01HX003060-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9943776. Licensed CC0.

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