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The Association of Health-Related Social Needs (HRSNs) and Delays in Seeking Care among Hand Clinic Patients
Chidimma R Okpara, MS
1, Sara L Eppler, MPH, CHES
1, Thompson Zhuang, MD MBA
2, Brady T Evans, MD, MBA
1; Robin N Kamal, MD, MBA, MS
1(1)Stanford University, Redwood City, CA, (2)University of Pennsylvania, Philadelphia, PA
In orthopaedic hand surgery, the impact of Health?Related Social Needs (HRSNs), such as housing instability and food insecurity, on delays and clinical outcomes is underrecognized and routine screening is lacking. Common hand conditions like carpal tunnel syndrome and trigger finger demonstrate disparities in timely access and functional outcomes linked to unmet social needs. This study explores whether HRSNs are associated with patient delayed care in outpatient hand surgery and examines relationships among HRSNs, delays, the CDC's Social Vulnerability Index (SVI), and QuickDASH.
We conducted a prospective, cross-sectional study of adult patients presenting to an academic hand surgery clinic from April to May 2025. Participants completed a survey assessing demographics, HRSNs, upper extremity function (QuickDASH), and delays in seeking care. Social vulnerability was measured by SVI. Subjective and objective delays were analyzed using the Three Stages of Delay Model (appraisal, illness, utilization). We used descriptive statistics, bivariate analyses, and multivariable logistic and linear regressions to assess associations between HRSNs, delays, SVI, and functional outcomes, adjusting for age, sex, race/ethnicity, and income.
We included 116 patients in the study. In our cohort, 38 (32.8%) reported 1 or more HRSNs. Of those 38, 19 (50%) subjectively reported delays in seeking care, and 35 (92.1%) experienced at least one objectively measured delay stage. Those with HRSNs were more likely to earn < $150,000 (66% vs. 0%, p < 0.00001), be unemployed (18% vs. 8%), disabled (21% vs. 0%), have lower education, and have Medicaid (18% vs. 1%). This group also had worse function (mean QuickDASH 43.9 vs. 22.0, p < 0.00001). Financial concerns (55%), housing (40%), and family/community support (29%) were the most common HRSNs. Although SVI scores were higher in the HRSN group (0.65 vs. 0.57, p = 0.16), only low income predicted HRSNs (AOR 16.9, p = 0.00017). Participants with ? 2 HRSNs had higher odds of subjective delay (AOR = 10.69, p = 0.02). Family/community support needs increased odds of subjective delay (AOR = 13.90, p = 0.005). Each additional HRSN increased QuickDASH by 16-36 points (all p ? 0.016), showing a dose-response effect.
Patients with greater HRSN burden had significantly worse upper extremity function and higher odds of delaying care, particularly when family/community support needs were unmet. These findings highlight the importance of implementing HRSN screening and referrals into outpatient hand clinic workflows. Structured community interventions and protocols may help reduce delays and improve functional outcomes for patients with HRSNs.
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