DOI
https://doi.org/10.25772/AXD7-B864
Defense Date
2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Health Related Sciences
First Advisor
M. Paige Powell, MHA, PhD
Abstract
Screening for social needs in hospitals is an effective strategy to measure and address health disparities and improve quality. Social determinants of health (SDOH), the non-medical factors that influence health outcomes such as education and socioeconomic status, are increasingly incorporated into U.S. medical education. Academic medical centers and teaching hospitals may be particularly well-positioned to lead in SDOH-responsive care and achieve outcomes from those efforts.
This study examines whether hospitals affiliated with medical schools or those that sponsor graduate medical education (GME) programs are more likely to screen all patients for SDOH. Among hospitals that universally screen patients, the study explores whether causal inference may be drawn from the presence of new medical learners and hospitals’ reported success in driving improvements in individual and community-level healthcare outcomes based on their SDOH efforts.
The study uses a cross-sectional design analyzing data drawn from the 2023 American Hospital Association (AHA) Annual Survey. The sample consisted of all general medical and surgical hospitals in the U.S. that responded to the 2023 AHA Survey other than federal facilities (n = 4301). Propensity score matching followed by weighted logistic regression models were used to assess whether academic affiliation or the presence of full-time residents predicted universal screening. We then assessed the relationship between resident presence and four healthcare outcomes: 1) better patient health, 2) decreased utilization, 3) decreased costs, and 4) improved community health in hospitals that screen all patients for social needs (n = 1367).
The Presence of Medical Residents increased the likelihood of universal screening by 17%. Among hospitals that screen all patients, those with medical residents were associated with a greater likelihood of reporting Better Patient Health Outcomes (+12%), Decreased Utilization of Healthcare Services (+12%), and Decreased Costs of Health Care (+17%). Medical School Affiliation and Association of American Medical Colleges Membership were not associated with significant results. The Presence of Medical Residents was not significantly associated with Improved Community Health Care Status.
Study results highlight the potentially transformative role of graduate medical education in shaping hospital practices and improving healthcare outcomes both clinically and financially. Through demonstrated associations between the presence of medical residents and both the adoption of universal screening and reports of improved patient health outcomes, decreased utilization, and decreased costs, this research provides evidence for increased support of graduate medical education. Increased funding for and creation of additional GME slots would be the most effective means of support.
These benefits are particularly important for hospitals in underserved areas where impending physician shortages will be felt most acutely through diminished access and growing health disparities. Embedding new medical learners will ease the rapidly increasing shift toward value-based and whole-patient centered care for hospitals that welcome medical residents as integral members of their clinical teams while also improving outcomes and decreasing costs.
Future research should explore longitudinal data to draw greater causal inference and/or incorporate qualitative interviews with clinicians, administrators, and patients to better understand the mechanism(s) underlying these results.
Rights
© Matthew Conrad
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-6-2025