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Broaddus-Shea ET, Jimenez-Zambrano A, Holliman BD, Connelly L, Huebschmann AG, Nederveld A. Unpacking patient perspectives on social needs screening: A mixed methods study in western Colorado primary care practices. PATIENT EDUCATION AND COUNSELING 2024; 125:108298. [PMID: 38735120 DOI: 10.1016/j.pec.2024.108298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Explore factors influencing patient comfort with and perceived helpfulness of screening for health-related social needs. METHODS In a parallel secondary mixed-methods analysis of data from three primary care clinics, we used logistic regression to examine effects of practice- and patient-level factors on comfort with and perceived helpfulness of social needs screening. We applied narrative analysis to 20 patient interviews to further understand how patients' lived experiences influenced their perceptions of screening. RESULTS Among 511 patients, receiving an explanation about screening was associated with increased odds of comfort (OR 2.1, 95% CI [1.1-4.30]) and perceived helpfulness (OR 4.7 [2.8-7.8]). Those experiencing more needs were less likely to report comfort (3 + needs vs. 0: OR 0.2 [0.1-0.5]). Narratives elucidated how a history of stigmatizing experiences increased discomfort disclosing needs and captured how relationship quality with healthcare teams influenced perceptions of screening for patients with extensive needs. CONCLUSION Practice-level (screening explanation and therapeutic rapport) and patient-level factors (history and extent of needs) are key influences on comfort with and perceived helpfulness of screening. PRACTICE IMPLICATIONS Good communication about screening benefits all patients. Patients with extensive social needs may require additional sensitivity to their past experiences.
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Affiliation(s)
- Elena T Broaddus-Shea
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Andrea Jimenez-Zambrano
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauri Connelly
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amy G Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Duncan CA, Jacobs MA, Gao Y, Mader M, Schmidt S, Davila H, Hadlandsmyth K, Shireman PK, Hausmann LRM, Tessler RA, Strayer A, Vaughan Sarrazin M, Hall DE. Care Fragmentation, Social Determinants of Health, and Postoperative Mortality in Older Veterans. J Surg Res 2024; 300:514-525. [PMID: 38875950 DOI: 10.1016/j.jss.2024.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Veterans Affairs Surgical Quality Improvement Program (VASQIP) benchmarking algorithms helped the Veterans Health Administration (VHA) reduce postoperative mortality. Despite calls to consider social risk factors, these algorithms do not adjust for social determinants of health (SDoH) or account for services fragmented between the VHA and the private sector. This investigation examines how the addition of SDoH change model performance and quantifies associations between SDoH and 30-d postoperative mortality. METHODS VASQIP (2013-2019) cohort study in patients ≥65 y old with 2-30-d inpatient stays. VASQIP was linked to other VHA and Medicare/Medicaid data. 30-d postoperative mortality was examined using multivariable logistic regression models, adjusting first for clinical variables, then adding SDoH. RESULTS In adjusted analyses of 93,644 inpatient cases (97.7% male, 79.7% non-Hispanic White), higher proportions of non-veterans affairs care (adjusted odds ratio [aOR] = 1.02, 95% CI = 1.01-1.04) and living in highly deprived areas (aOR = 1.15, 95% CI = 1.02-1.29) were associated with increased postoperative mortality. Black race (aOR = 0.77, CI = 0.68-0.88) and rurality (aOR = 0.87, CI = 0.79-0.96) were associated with lower postoperative mortality. Adding SDoH to models with only clinical variables did not improve discrimination (c = 0.836 versus c = 0.835). CONCLUSIONS Postoperative mortality is worse among Veterans receiving more health care outside the VA and living in highly deprived neighborhoods. However, adjusting for SDoH is unlikely to improve existing mortality-benchmarking models. Reduction efforts for postoperative mortality could focus on alleviating care fragmentation and designing care pathways that consider area deprivation. The adjusted survival advantage for rural and Black Veterans may be of interest to private sector hospitals as they attempt to alleviate enduring health-care disparities.
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Affiliation(s)
- Carly A Duncan
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Michael A Jacobs
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Yubo Gao
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Michael Mader
- South Texas Veterans Healthcare System, San Antonio, Texas
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas
| | - Heather Davila
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Katherine Hadlandsmyth
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; Department of Anesthesia, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Paula K Shireman
- Departments of Primary Care & Rural Medicine and Medical Physiology, School of Medicine, Texas A&M Health, Bryan, Texas
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert A Tessler
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrea Strayer
- VA Quality Scholar, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; College of Nursing, The University of Iowa, Iowa City, Iowa
| | - Mary Vaughan Sarrazin
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Daniel E Hall
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Butler JL, Johnson CM, Hardison-Moody A, Bowen SK. Food Insecurity Associated with Higher Stress, Depressive Symptoms, and Lower Diet Quality among Women Caregivers in North Carolina. Nutrients 2024; 16:2491. [PMID: 39125371 PMCID: PMC11314069 DOI: 10.3390/nu16152491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Research suggests a bidirectional relationship between food insecurity and stress, but few studies have examined associations of food insecurity with stress and other indicators of cardiometabolic health, including depression, diet quality, and body weight, among lower-income women in the U.S. METHODS This cross-sectional study analyzed data from lower-income women caregivers living in North Carolina (n = 100): 42% Black/African American, 25% Hispanic/Latina, and 33% White women. Multivariable linear regression models were used to determine associations of food insecurity status with perceived stress, depressive symptoms, diet quality, and body mass index (BMI). Multivariable logistic regression models were used to determine associations of food insecurity with clinical depression and BMI ≥ 30 kg/m2. Associations were examined with and without adjustment for perceived stress. RESULTS Forty-two percent of the sample were experiencing food insecurity. Compared to food secure caregivers, food-insecure caregivers had significantly higher perceived stress (β: +7.51; 95%CI: 4.19, 10.84) and depressive symptoms (β: +3.55; 95%CI: 0.54, 6.56) and lower diet quality (β: -9.10; 95%CI: -15.81, -2.40). Associations with BMI outcomes were not statistically significant. CONCLUSION Findings support removing stigma in nutrition assistance programs and clinical interactions, motivate future longitudinal studies, and inform the development of destigmatizing interventions for health promotion or disease prevention.
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Affiliation(s)
- J. Lauren Butler
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA;
- Nutrition and Dietetics Department, University of North Florida, Jacksonville, FL 32224, USA
| | - Cassandra M. Johnson
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA;
| | - Annie Hardison-Moody
- Department of Agricultural and Human Sciences, North Carolina University, Raleigh, NC 27695, USA;
| | - Sarah K. Bowen
- Department of Sociology and Anthropology, North Carolina University, Raleigh, NC 27695, USA;
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Calloway EE, Coakley KE, Carpenter LR, Gargano T, Yaroch AL. Benefits of using both the Hunger Vital Sign and brief nutrition security screener in health-related social needs screening. Transl Behav Med 2024; 14:445-451. [PMID: 38954835 DOI: 10.1093/tbm/ibae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Food security is a commonly screened for health-related social need at hospitals and community settings, and until recently, there were no tools to additionally screen for nutrition security. The purpose of this study was to assess the potential advantage of including a one-item brief nutrition security screener (BNSS) alongside the commonly used two-item Hunger Vital Sign (HVS) food security screener for identifying individuals with diet-related health risks. Cross-sectional survey data were collected from April to June 2021. Generalized linear mixed models were used to assess associations between screening status and dietary and health variables. Recruitment was done across five states (California, Florida, Maryland, North Carolina, and Washington) from community-based organizations. Participants (n = 435) were, on average, 44.7 years old (SD = 14.5), predominantly women (77%), and racially/ethnically diverse. In adjusted analyses, being in the food insecure and nutrition insecure group (but not the food insecure and nutrition secure or food secure and nutrition insecure groups) was associated with significantly increased odds for self-reported "fair" or "poor" general health [OR = 2.914 (95% CI = 1.521-5.581)], reporting at least one chronic condition [2.028 (1.024-4.018)], and "low" fruit and vegetable intake [2.421 (1.258-4.660)], compared with the food secure and nutrition secure group. These findings support using both the HVS and BNSS simultaneously in health-related social needs screening to identify participants at the highest risk for poor dietary and health outcomes and warrant further investigation into applying these screeners to clinical and community settings.
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Affiliation(s)
- Eric E Calloway
- The Center for Nutrition and Health Impact, Omaha, NE 68154, USA
| | - Kathryn E Coakley
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, USA
| | - Leah R Carpenter
- The Center for Nutrition and Health Impact, Omaha, NE 68154, USA
| | - Tony Gargano
- The Center for Nutrition and Health Impact, Omaha, NE 68154, USA
| | - Amy L Yaroch
- The Center for Nutrition and Health Impact, Omaha, NE 68154, USA
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Thom B, Aviki EM, Lapen K, Thompson T, Chino F. Screening for Health-Related Social Needs and Financial Toxicity Among Patients With Cancer Treated With Radiation Therapy: Findings From a Quality Improvement Project. J Am Coll Radiol 2024:S1546-1440(24)00598-2. [PMID: 38971414 DOI: 10.1016/j.jacr.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Financial toxicity is common among patients with cancer, as are co-occurring health-related social risks (HRSRs). There is limited evidence to support best practices in screening for HRSRs and financial toxicity in the cancer context. This analysis sought to understand variations of identified needs based on treatment course using data from a large screening program. METHODS This 2022 to 2023 screening quality improvement program included four services (breast, gastrointestinal, gynecologic, thoracic) at an urban comprehensive cancer center. The Comprehensive Score for Financial Toxicity measured financial toxicity. Patients completed an HRSR checklist documenting food, housing, medication, or transportation insecurity and financial borrowing practices. Differences were evaluated by treatment course (radiation therapy [RT] versus other treatment and RT plus chemotherapy versus other treatment). RESULTS Screening surveys were sent to 70,983 unique patients; 38,249 completed a screening survey (54% response rate). Of responders, 4% (n = 1,686) underwent RT in the 120 days before their survey, and 3% (n = 1,033) received RT in combination with chemotherapy. Overall, patients receiving RT had lower unadjusted Comprehensive Score for Financial Toxicity scores, indicating worse financial toxicity. The proportion of patients receiving RT reporting unmet transportation (15% versus 12%, P < .001) and food (13% versus 11%, P = .02) needs was significantly higher than for patients not receiving RT. More patients receiving RT borrowed money than did patients not receiving RT (17% versus 15%, P = .02). In multivariable models, RT (alone or in combination) was associated with worse financial toxicity and transportation difficulties. CONCLUSIONS Screening for financial toxicity and HRSR is possible at a large cancer center. Patients receiving RT have higher transportation insecurity and worse financial toxicity compared with those receiving other treatments. Tailored intervention throughout the treatment trajectory is essential.
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Affiliation(s)
- Bridgette Thom
- University of North Carolina School of Social Work, Chapel Hill, North Carolina; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina; Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Emeline M Aviki
- New York University Grossman Long Island School of Medicine, Mineola, New York; New York University Langone Health, Perlmutter Cancer Center, Mineola, New York; Medical Director of Network Integration and Strategy, New York University Perlmutter Cancer Center-Long Island
| | - Kaitlyn Lapen
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tess Thompson
- University of North Carolina School of Social Work, Chapel Hill, North Carolina; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, New York, New York; Director of the Memorial Sloan Kettering Cancer Center Affordability Working Group
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Wadhwani SI, Alvarado A, Shifman HP, Bautista B, Yalung J, Squires JE, Campbell K, Ebel NH, Hsu E, Vittorio J, Zielsdorf S, Desai DM, Bucuvalas JC, Gottlieb L, Kotagal U, Lyles CR, Ackerman SL, Lai JC. Caregivers' and providers' perspectives of social and medical care after pediatric liver transplant: Results from the multicenter SOCIAL-Tx study. Liver Transpl 2024; 30:717-727. [PMID: 38166123 PMCID: PMC11176037 DOI: 10.1097/lvt.0000000000000327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024]
Abstract
Disparities exist in pediatric liver transplant (LT). We characterized barriers and facilitators to providing transplant and social care within pediatric LT clinics. This was a multicenter qualitative study. We oversampled caregivers reporting household financial strain, material economic hardship, or demonstrating poor health literacy. We also enrolled transplant team members. We conducted semistructured interviews with participants. Caregiver interviews focused on challenges addressing transplant and household needs. Transplant provider interviews focused on barriers and facilitators to providing social care within transplant teams. Interviews were recorded, transcribed, and coded according to the Capability, Opportunity, Motivation-Behavior model. We interviewed 27 caregivers and 27 transplant team members. Fifty-two percent of caregivers reported a household income <$60,000, and 62% reported financial resource strain. Caregivers reported experiencing (1) high financial burdens after LT, (2) added caregiving labor that compounds the financial burden, (3) dependency on their social network's generosity for financial and logistical support, and (4) additional support being limited to the perioperative period. Transplant providers reported (1) relying on the pretransplant psychosocial assessment for identifying social risks, (2) discomfort initiating social risk discussions in the post-transplant period, (3) reliance on social workers to address new social risks, and (4) social workers feeling overburdened by quantity and quality of the social work referrals. We identified barriers to providing effective social care in pediatric LT, primarily a lack of comfort in assessing and addressing new social risks in the post-transplant period. Addressing these barriers should enhance social care delivery and improve outcomes for these children.
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Affiliation(s)
| | | | | | | | - Jared Yalung
- University of California, San Francisco, San Francisco, CA
| | | | | | | | - Evelyn Hsu
- Seattle Children’s Hospital, Seattle, WA
| | - Jennifer Vittorio
- Columbia University Medical Center, New York, NY
- New York University Langone Health, New York, NY
| | | | | | | | - Laura Gottlieb
- University of California, San Francisco, San Francisco, CA
| | - Uma Kotagal
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Viswanathan M, Kennedy SM, Sathe N, Eder ML, Ng V, Kugley S, Lewis MA, Gottlieb LM. Evaluating Intensity, Complexity, and Potential for Causal Inference in Social Needs Interventions: A Review of a Scoping Review. JAMA Netw Open 2024; 7:e2417994. [PMID: 38904959 PMCID: PMC11193129 DOI: 10.1001/jamanetworkopen.2024.17994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/19/2024] [Indexed: 06/22/2024] Open
Abstract
Importance Interventions that address needs such as low income, housing instability, and safety are increasingly appearing in the health care sector as part of multifaceted efforts to improve health and health equity, but evidence relevant to scaling these social needs interventions is limited. Objective To summarize the intensity and complexity of social needs interventions included in randomized clinical trials (RCTs) and assess whether these RCTs were designed to measure the causal effects of intervention components on behavioral, health, or health care utilization outcomes. Evidence Review This review of a scoping review was based on a Patient-Centered Outcomes Research Institute-funded evidence map of English-language US-based RCTs of social needs interventions published between January 1, 1995, and April 6, 2023. Studies were assessed for features related to intensity (defined using modal values as providing as-needed interaction, 8 participant contacts or more, contacts occurring every 2 weeks or more often, encounters of 30 minutes or longer, contacts over 6 months or longer, or home visits), complexity (defined as addressing multiple social needs, having dedicated staff, involving multiple intervention components or practitioners, aiming to change multiple participant behaviors [knowledge, action, or practice], requiring or providing resources or active assistance with resources, and permitting tailoring), and the ability to assess causal inferences of components (assessing interventions, comparators, and context). Findings This review of a scoping review of social needs interventions identified 77 RCTs in 93 publications with a total of 135 690 participants. Most articles (68 RCTs [88%]) reported 1 or more features of high intensity. All studies reported 1 or more features indicative of high complexity. Because most studies compared usual care with multicomponent interventions that were moderately or highly dependent on context and individual factors, their designs permitted causal inferences about overall effectiveness but not about individual components. Conclusions and Relevance Social needs interventions are complex, intense, and include multiple components. Our findings suggest that RCTs of these interventions address overall intervention effectiveness but are rarely designed to distinguish the causal effects of specific components despite being resource intensive. Future studies with hybrid effectiveness-implementation and sequential designs, and more standardized reporting of intervention intensity and complexity could help stakeholders assess the return on investment of these interventions.
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Affiliation(s)
| | | | - Nila Sathe
- RTI International, Research Triangle Park, North Carolina
| | | | - Valerie Ng
- RTI International, Research Triangle Park, North Carolina
| | - Shannon Kugley
- RTI International, Research Triangle Park, North Carolina
| | - Megan A. Lewis
- RTI International, Research Triangle Park, North Carolina
| | - Laura M. Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco
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GOTTLIEB LAURAM, HESSLER DANIELLE, WING HOLLY, GONZALEZ‐ROCHA ALEJANDRA, CARTIER YURI, FICHTENBERG CAROLINE. Revising the Logic Model Behind Health Care's Social Care Investments. Milbank Q 2024; 102:325-335. [PMID: 38273221 PMCID: PMC11176407 DOI: 10.1111/1468-0009.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
Policy Points This article summarizes recent evidence on how increased awareness of patients' social conditions in the health care sector may influence health and health care utilization outcomes. Using this evidence, we propose a more expansive logic model to explain the impacts of social care programs and inform future social care program investments and evaluations.
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Affiliation(s)
- LAURA M. GOTTLIEB
- University of CaliforniaSan Francisco
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - DANIELLE HESSLER
- University of CaliforniaSan Francisco
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - HOLLY WING
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - ALEJANDRA GONZALEZ‐ROCHA
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - YURI CARTIER
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - CAROLINE FICHTENBERG
- University of CaliforniaSan Francisco
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
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Handerer F, Kinderman P, Nevard I, Tai S. Development and content validation of a questionnaire to assess the social determinants of mental health in clinical practice. Front Psychiatry 2024; 15:1377751. [PMID: 38832330 PMCID: PMC11145063 DOI: 10.3389/fpsyt.2024.1377751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/11/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction There is growing consensus that consideration of the Social Determinants of Mental Health should be at the centre of mental health care provision. To facilitate this, a validated means to assess mental health service users' social contextual information is arguably needed. We therefore developed a questionnaire to assess the Social Determinants of Mental Health in clinical practice. Methods Our guideline-informed development consisted of three steps; i) construct and purpose definition, ii) initial item generation based on the literature, similar questionnaires, and a selection of the ICD-10, iii) evaluation, revision, and content validation of the questionnaire. Initially we developed 249 items that were reduced, revised, and validated in several stages to 73 items. Content validation of the questionnaire was achieved through surveys and focus groups including mental health care service users and professionals. Results The surveys and focus groups indicated the need for a standardised assessment of adverse social factors and highlighted that the benefits of such an assessment would be a more holistic approach to identifying and addressing fundamental factors involved in the development of mental health difficulties. Importantly, this study also revealed how any assessment of the Social Determinants of Mental Health must prioritise the assessed person having a central role in the process and control over their own data. The focus groups identified contradicting recommendations regarding the most suitable context to administer the questionnaire. Discussion The resulting questionnaire can be considered to be theoretically robust and partially validated. Future research is discussed.
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Affiliation(s)
- Fritz Handerer
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Peter Kinderman
- Institute of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Imogen Nevard
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| | - Sara Tai
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
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Kruse GR, Percac-Lima S, Barber-Dubois M, Davies ME, Gundersen DA, Ho O, Mascioli L, Munshi M, Perry S, Singh D, Thomas A, Emmons KM, Haas JS. Bundling Colorectal Cancer Screening Outreach with Screening for Social Risk in Federally Qualified Health Centers: A Stepped-Wedge Implementation-Effectiveness Study. J Gen Intern Med 2024; 39:1188-1195. [PMID: 38332440 PMCID: PMC11116362 DOI: 10.1007/s11606-024-08654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Bundling is combining individual interventions to meet quality metrics. Bundling offers of cancer screening with screening for social determinants of health (SDOH) may enable health centers to assist patients with social risks and yield efficiencies. OBJECTIVE To measure effects of bundling fecal immunochemical testing (FIT) and SDOH screening in federally qualified health centers (FQHCs). DESIGN Clustered stepped-wedge trial. PARTICIPANTS Four Massachusetts FQHCs randomized to implement bundled FIT-SDOH over 8-week "steps." INTERVENTION Outreach to 50-75-year-olds overdue for CRC screening to offer FIT with SDOH screening. The implementation strategy used facilitation and training for data monitoring and reporting. MAIN MEASURES Implementation process descriptions, data from facilitation meetings, and CRC and SDOH screening rates. Rates were compared between implementation and control FQHCs in each "step" by fitting generalized linear mixed-effects models with random intercepts for FQHCs, patients, and "step" by FQHC. KEY RESULTS FQHCs tailored implementation processes to their infrastructure, workflows, and staffing and prioritized different groups for outreach. Two FQHCs used population health outreach, and two integrated FIT-SDOH within established programs, such as pre-visit planning. Of 34,588 patients overdue for CRC screening, 54% were female; 20% Black, 11% Latino, 10% Asian, and 47% white; 32% had Medicaid, 16% Medicare, 32% private insurance, and 11% uninsured. Odds of CRC screening completion in implementation "steps" compared to controls were higher overall and among groups prioritized for outreach (overall: adjusted odds ratio (aOR) 2.41, p = 0.005; prioritized: aOR 2.88, p = 0.002). Odds of SDOH screening did not differ across "steps." CONCLUSIONS As healthcare systems are required to conduct more screenings, it is notable that outreach for a long-standing cancer screening requirement increased screening, even when bundled with a newer screening requirement. This outreach was feasible in a real-world safety-net clinical population and may conserve resources, especially compared to more complex or intensive outreach strategies. CLINICAL TRIALS REGISTRATION NCT04585919.
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Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Madeline E Davies
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana Farber Cancer Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Oanh Ho
- Harbor Health Services, Inc., Mattapan, MA, USA
| | - Lynette Mascioli
- Massachusetts League of Community Health Centers, Boston, MA, USA
| | - Mehezbin Munshi
- Massachusetts League of Community Health Centers, Boston, MA, USA
| | - Sarah Perry
- Harbor Health Services, Inc., Mattapan, MA, USA
| | - Deepinder Singh
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Chuang E, Safaeinili N. Addressing Social Needs in Clinical Settings: Implementation and Impact on Health Care Utilization, Costs, and Integration of Care. Annu Rev Public Health 2024; 45:443-464. [PMID: 38134403 DOI: 10.1146/annurev-publhealth-061022-050026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
In recent years, health care policy makers have focused increasingly on addressing social drivers of health as a strategy for improving health and health equity. Impacts of social, economic, and environmental conditions on health are well established. However, less is known about the implementation and impact of approaches used by health care providers and payers to address social drivers of health in clinical settings. This article reviews current efforts by US health care organizations and public payers such as Medicaid and Medicare to address social drivers of health at the individual and community levels. We summarize the limited available evidence regarding intervention impacts on health care utilization, costs, and integration of care and identify key lessons learned from current implementation efforts.
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Affiliation(s)
- Emmeline Chuang
- School of Social Welfare, Mack Center on Public and Nonprofit Management in the Human Services, University of California, Berkeley, California, USA;
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford University, Stanford, California, USA
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12
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Smithers LG, MacPhail C, Chan L, Downes M, Neadley K, Boyd M. In-person versus electronic screening for social risks among carers of pediatric inpatients: A mixed methods randomized trial. Eur J Pediatr 2024; 183:2301-2309. [PMID: 38427037 PMCID: PMC11035429 DOI: 10.1007/s00431-024-05470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
We aimed to compare disclosure of social risks according to self-report on an iPad versus face-to-face questions from a health professional and to explore carers' experiences of screening. This two-arm, parallel group, randomized trial was conducted from January 19, 2021, to December 17, 2021, in a public hospital pediatric ward serving a disadvantaged area of an Australian capital city. Carers of children aged ≤ 5 years admitted to the Children's Ward were eligible. The primary outcome was disclosure of social risks. The screener included nine items on food security, household utilities, transport, employment, personal and neighborhood safety, social support, housing and homelessness. Disclosure of social risks was similar between the self-completion (n = 193) and assisted-completion (n = 193) groups for all 9 items, ranging 4.1% higher for worrying about money for food (95% CI - 11.4, 3.1%) among the assisted-completion group, to 5.7% (-1.6, 13.0%) higher for unemployment among the self-completion group. In qualitative interviews, participants were positive about screening for social risks in the hospital ward setting and the majority indicated a preference for self-completion. Conclusion: Differences in the disclosure of social risks according to self- versus assisted-completion were small, suggesting that either method could be used. Most carers expressed a preference for self- completion, which is therefore recommended as the ideal mode for such data collection for Australian pediatric inpatient settings. Trial registration: Australia New Zealand Clinical Trial Registry ( www.anzctry.org.au ; #ACTRN12620001326987; date of registration 8 December 2020). What is Known: • Most evidence on screening of social risks in pediatric inpatient settings is from the USA. • Little is known about disclosure of social risks in countries with universal health care and social welfare. What is New: • Disclosure of social risks was similar for electronic compared with face-to-face screening. • Carers preferred electronic completion over face-to-face completion.
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Affiliation(s)
- Lisa Gaye Smithers
- School of Health and Society, University of Wollongong, Northfields Road, Wollongong, NSW, 2522, Australia.
- School of Public Health, University of Adelaide, Adelaide, SA, Australia.
| | - Catherine MacPhail
- School of Health and Society, University of Wollongong, Northfields Road, Wollongong, NSW, 2522, Australia
| | - Lily Chan
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Maeve Downes
- Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
| | - Kate Neadley
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Mark Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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13
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Wang ML, Gago CM, Rodriguez K. Digital Redlining-The Invisible Structural Determinant of Health. JAMA 2024; 331:1267-1268. [PMID: 38497952 DOI: 10.1001/jama.2024.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This Viewpoint describes digital redlining as racialized inequities in access to technology infrastructure, including access to health care, education, employment, and social services.
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Affiliation(s)
- Monica L Wang
- Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, Massachusetts
| | - Cristina M Gago
- Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts
| | - Kate Rodriguez
- Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts
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14
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Kim RG, Ballantyne A, Conroy MB, Price JC, Inadomi JM. Screening for social determinants of health among populations at risk for MASLD: a scoping review. Front Public Health 2024; 12:1332870. [PMID: 38660357 PMCID: PMC11041393 DOI: 10.3389/fpubh.2024.1332870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Social determinants of health (SDoH) have been associated with disparate outcomes among those with metabolic dysfunction-associated steatotic liver disease (MASLD) and its risk factors. To address SDoH among this population, real-time SDoH screening in clinical settings is required, yet optimal screening methods are unclear. We performed a scoping review to describe the current literature on SDoH screening conducted in the clinical setting among individuals with MASLD and MASLD risk factors. Methods Through a systematic literature search of MEDLINE, Embase, and CINAHL Complete databases through 7/2023, we identified studies with clinic-based SDoH screening among individuals with or at risk for MASLD that reported pertinent clinical outcomes including change in MASLD risk factors like diabetes and hypertension. Results Ten studies (8 manuscripts, 2 abstracts) met inclusion criteria involving 148,151 patients: 89,408 with diabetes and 25,539 with hypertension. Screening was primarily completed in primary care clinics, and a variety of screening tools were used. The most commonly collected SDoH were financial stability, healthcare access, food insecurity and transportation. Associations between clinical outcomes and SDoH varied; overall, higher SDoH burden was associated with poorer outcomes including elevated blood pressure and hemoglobin A1c. Conclusion Despite numerous epidemiologic studies showing associations between clinical outcomes and SDoH, and guidelines recommending SDoH screening, few studies describe in-clinic SDoH screening among individuals with MASLD risk factors and none among patients with MASLD. Future research should prioritize real-time, comprehensive assessments of SDoH, particularly among patients at risk for and with MASLD, to mitigate disease progression and reduce MASLD health disparities.
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Affiliation(s)
- Rebecca G. Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - April Ballantyne
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Molly B. Conroy
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Jennifer C. Price
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - John M. Inadomi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
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15
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Graboyes EM, Lee SC, Lindau ST, Adams AS, Adjei BA, Brown M, Sadigh G, Incudine A, Carlos RC, Ramsey SD, Bangs R. Interventions addressing health-related social needs among patients with cancer. J Natl Cancer Inst 2024; 116:497-505. [PMID: 38175791 DOI: 10.1093/jnci/djad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
Health-related social needs are prevalent among cancer patients; associated with substantial negative health consequences; and drive pervasive inequities in cancer incidence, severity, treatment choices and decisions, and outcomes. To address the lack of clinical trial evidence to guide health-related social needs interventions among cancer patients, the National Cancer Institute Cancer Care Delivery Research Steering Committee convened experts to participate in a clinical trials planning meeting with the goal of designing studies to screen for and address health-related social needs among cancer patients. In this commentary, we discuss the rationale for, and challenges of, designing and testing health-related social needs interventions in alignment with the National Academy of Sciences, Engineering, and Medicine 5As framework. Evidence for food, housing, utilities, interpersonal safety, and transportation health-related social needs interventions is analyzed. Evidence regarding health-related social needs and delivery of health-related social needs interventions differs in maturity and applicability to cancer context, with transportation problems having the most maturity and interpersonal safety the least. We offer practical recommendations for health-related social needs interventions among cancer patients and the caregivers, families, and friends who support their health-related social needs. Cross-cutting (ie, health-related social needs agnostic) recommendations include leveraging navigation (eg, people, technology) to identify, refer, and deliver health-related social needs interventions; addressing health-related social needs through multilevel interventions; and recognizing that health-related social needs are states, not traits, that fluctuate over time. Health-related social needs-specific interventions are recommended, and pros and cons of addressing more than one health-related social needs concurrently are characterized. Considerations for collaborating with community partners are highlighted. The need for careful planning, strong partners, and funding is stressed. Finally, we outline a future research agenda to address evidence gaps.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Simon C Lee
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Cancer Center, University of Kansas, Kansas City, KS, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA
| | - Alyce S Adams
- Departments of Health Policy/Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Office of Cancer Health Equity and Community Engagement, Stanford Cancer Institute, Stanford Medicine, Stanford, CA, USA
| | - Brenda A Adjei
- Office of the Associate Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Mary Brown
- Adena Cancer Center, Hematology and Oncology, Chillicothe, OH, USA
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA
| | | | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Scott D Ramsey
- Department of Pharmacy, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Rick Bangs
- SWOG Cancer Research Network, Portland, OR, USA
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16
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Astorino JA, Pratt-Chapman ML, Schubel L, Lee Smith J, White A, Sabatino SA, Littlejohn R, Buckley BO, Taylor T, Arem H. Contextual Factors Relevant to Implementing Social Risk Factor Screening and Referrals in Cancer Survivorship: A Qualitative Study. Prev Chronic Dis 2024; 21:E22. [PMID: 38573795 PMCID: PMC10996388 DOI: 10.5888/pcd21.230352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Introduction Social risk factors such as food insecurity and lack of transportation can negatively affect health outcomes, yet implementation of screening and referral for social risk factors is limited in medical settings, particularly in cancer survivorship. Methods We conducted 18 qualitative, semistructured interviews among oncology teams in 3 health systems in Washington, DC, during February and March 2022. We applied the Exploration, Preparation, Implementation, Sustainment Framework to develop a deductive codebook, performed thematic analysis on the interview transcripts, and summarized our results descriptively. Results Health systems varied in clinical and support staff roles and capacity. None of the participating clinics had an electronic health record (EHR)-based process for identifying patients who completed their cancer treatment ("survivors") or a standardized cancer survivorship program. Their capacities also differed for documenting social risk factors and referrals in the EHR. Interviewees expressed awareness of the prevalence and effect of social risk factors on cancer survivors, but none employed a systematic process for identifying and addressing social risk factors. Recommendations for increasing screening for social risk factors included designating a person to fulfill this role, improving data tracking tools in the EHR, and creating systems to maintain up-to-date information and contacts for community-based organizations. Conclusion The complexity of cancer care workflows and lack of reimbursement results in a limited ability for clinic staff members to screen and make referrals for social risk factors. Creating clinical workflows that are flexible and tailored to staffing realities may contribute to successful implementation of a screening and referral program. Improving ongoing communication with community-based organizations to address needs was deemed important by interviewees.
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Affiliation(s)
- Joseph A Astorino
- The George Washington Cancer Center, The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Mandi L Pratt-Chapman
- The George Washington Cancer Center, The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Laura Schubel
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia
| | - Judith Lee Smith
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robin Littlejohn
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia
| | - Bryan O Buckley
- Department of General Medicine, Georgetown University, Washington, District of Columbia
| | | | - Hannah Arem
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia
- Department of Oncology, Georgetown University, Washington, District of Columbia
- MedStar Health Research Institute, 3007 Tilden St NW, Ste 6N, Washington, DC 20008
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17
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Cullen D, Samuels-Kalow ME. Measured Twice: Time for the Expansion of Social Care Interventions and Patient-Centered Outcomes. Ann Emerg Med 2024; 83:314-317. [PMID: 38180400 DOI: 10.1016/j.annemergmed.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Danielle Cullen
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Pediatrics, Perelman School of Medicine, Philadelphia, PA
| | - Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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18
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Dako F, Holden N, Narayan A, Guerra C. Understanding Health-Related Social Risks. J Am Coll Radiol 2024:S1546-1440(24)00280-1. [PMID: 38461918 DOI: 10.1016/j.jacr.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
Because of the established contribution of social factors to health outcomes, approaches that address upstream determinants of health have increasingly been recognized as cost-effective means to improve population health. Understanding and usage of precise terminology is important to facilitate collaboration across disciplines. Social determinants of health affect everyone, not just the socially and economically disadvantaged, whereas health-related social risks (HRSR) are specific adverse conditions at the individual or family level that are associated with poor health and related to the immediate challenges individuals face. Health-related social needs account for patient preference in addressing identified social risks. The use of validated screening tools is important to capture risk factors in a standardized fashion to support research and quality improvement. There is a paucity of studies that address HRSR in the context of radiology. This review provides an understanding of HRSR and outlines various ways in which radiologists can work to mitigate them.
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Affiliation(s)
- Farouk Dako
- Director, Center for Global and Population Health Research in Radiology, Senior Fellow, Leonard Davis Institute of Health Economics, and Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Natasha Holden
- College of Osteopathic Medicine of the Pacific Western University of Health Sciences, Pomona, California
| | - Anand Narayan
- Vice Chair, Health Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carmen Guerra
- Vice Chair of Diversity and Inclusion, Department of Medicine, and Associate Director of Diversity and Inclusion, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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19
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Chang E, Psek W. The relationship between community social risk factors and regional hospital-reported cash, negotiated, and chargemaster prices for 14 common services. BMC Health Serv Res 2024; 24:299. [PMID: 38448915 PMCID: PMC10918866 DOI: 10.1186/s12913-024-10762-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Social risk factors are key drivers of the geographic variation in spending in the United States but little is known how community-level social risk factors are associated with hospital prices. Our objective was to describe the relationship between regional hospital-reported prices and social risk factors by price type (chargemaster, cash, commercial, Medicare, and Medicaid). METHODS This cross-sectional analysis used newly available hospital-reported prices from acute general hospitals in 2022. The prices were for 14 common services. Prices were winsorized at 98%, wage index-adjusted, standardized by service, and aggregated to hospital service areas (HSAs). For social risk, we used 23 measures across 5 domains of social risk (socioeconomic position; race, ethnicity, and culture; gender; social relationships; and residential and community context). Spearman's correlation was used to estimate associations between median prices and social risk by price type. RESULTS Prices were reported from 2,386 acute general hospitals in 45% (1,502 of 3,436) HSAs. Correlations between regional prices and other social risk factors varied by price type (range: -0.19 to 0.31). Chargemaster and cash prices were significantly correlated with the most community characteristics (10 of 23, 43%) followed by commercial prices (8, 35%). Medicare and Medicaid prices were only significantly correlated with 1 measure (all p < 0.01). All price types were significantly correlated with the percentage of uninsured (all p < 0.01). Chargemaster, cash, and commercial prices were positively correlated with percentage of Hispanic residents, residents with limited English proficiency, and non-citizens (all p < 0.05). CONCLUSIONS While regional correlations between prices and social risk factors were weak across all prices, chargemaster, cash, and commercial prices were more like closely aligned with community-level social risk factors than the two public payers (Medicare and Medicaid). Chargemaster, cash, and commercial hospital prices appeared to be higher in socially disadvantaged communities. Further research is needed to clarify the relationship between prices and community social risk factors.
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Affiliation(s)
- Eva Chang
- Advocate Aurora Research Institute, Advocate Health, 945 N. 12th St, 53233, Milwaukee, WI, USA.
| | - Wayne Psek
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Springer R, Erroba J, O'Malley JP, Huguet N. Differences in up-to-date colorectal and cervical cancer screening rates by ethnicity and preferred language: An analysis across patient-, clinic-, and area-level data sources. SSM Popul Health 2024; 25:101612. [PMID: 38322786 PMCID: PMC10844668 DOI: 10.1016/j.ssmph.2024.101612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/08/2024] Open
Abstract
Research objective There is interest in using clinic- and area-level data to inform cancer control, but it is unclear what value these sources may add in combination with patient-level data sources. This study aimed to investigate associations of up-to-date colorectal and cervical cancer screenings at community health centers (CHCs) with ethnicity and language variables at patient-, clinic-, and area-levels, while exploring whether patient-level associations differed based on clinic-level patient language and ethnicity distributions. Study design This was a cross-sectional study using data from multiple sources, including electronic health records, clinic patient panel data, and area-level demographic data. The study sample included English-preferring Hispanic, Spanish-preferring Hispanic, English-preferring non-Hispanic, and non-English-preferring non-Hispanic patients eligible for either colorectal cancer (N = 98,985) or cervical cancer (N = 129,611) screenings in 2019 from 130 CHCs in the OCHIN network in CA, OR, and WA. Population studied The study population consisted of adults aged 45+ eligible for colorectal cancer screening and adults with a cervix aged 25-65 eligible for cervical cancer screening. Principal findings Spanish-preferring Hispanic patients were significantly more likely to be up-to-date with colorectal and cervical cancer screenings than other groups. Patients seen at clinics with higher concentrations of Spanish-preferring Hispanics were significantly more likely to be up-to-date, as were individuals residing in areas with higher percentages of Spanish-speaking residents. Differential associations between patient ethnicity and language and up-to-date colorectal cancer screenings were greater among patients seen at clinics with higher concentrations of Spanish-preferring Hispanics. Conclusions The findings highlight that Spanish-speaking Hispanics seen in CHCs have higher rates of up-to-date cervical and colorectal cancer screenings than other groups and that this relationship is stronger at clinics with higher percentages of Spanish-preferring Hispanic patients. Our findings suggest area-level variables are not good substitutions for patient-level data, but variables at the clinic patient panel-level are more informative.
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Affiliation(s)
- Rachel Springer
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy Erroba
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
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21
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Danielson EC, Li W, Suleiman L, Franklin PD. Social risk and patient-reported outcomes after total knee replacement: Implications for Medicare policy. Health Serv Res 2024; 59:e14215. [PMID: 37605376 PMCID: PMC10771904 DOI: 10.1111/1475-6773.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To determine whether county-level or patient-level social risk factors are associated with patient-reported outcomes after total knee replacement when added to the comprehensive joint replacement risk-adjustment model. DATA SOURCES AND STUDY SETTING Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the Social Vulnerability Index from the Centers for Disease Control and Prevention. STUDY DESIGN This prospective longitudinal cohort measured the change in patient-reported pain and physical function from baseline to 12 months after surgery. The cohort included a nationally diverse sample of adult patients who received elective unilateral knee replacement between 2012 and 2015. DATA COLLECTION/EXTRACTION METHODS Using a national network of over 230 surgeons in 28 states, the cohort study enrolled patients from diverse settings and collected one-year outcomes after the surgery. Patients <65 years of age or who did not report outcomes were excluded. PRINCIPAL FINDINGS After adjusting for clinical and demographic factors, we found patient-reported race, education, and income were associated with patient-reported pain or functional scores. Pain improvement was negatively associated with Black race (CI = -8.71, -3.02) and positively associated with higher annual incomes (≥$45,00) (CI = 0.07, 2.33). Functional improvement was also negatively associated with Black race (CI = -5.81, -0.35). Patients with higher educational attainment (CI = -2.35, -0.06) reported significantly less functional improvement while patients in households with three adults reported greater improvement (CI = 0.11, 4.57). We did not observe any associations between county-level social vulnerability and change in pain or function. CONCLUSIONS We found patient-level social factors were associated with patient-reported outcomes after total knee replacement, but county-level social vulnerability was not. Our findings suggest patient-level social factors warrant further investigation to promote health equity in patient-reported outcomes after total knee replacement.
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Affiliation(s)
- Elizabeth C. Danielson
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Wenjun Li
- Department of Public Health, Center for Health Statistics and Biostatistics Core, Health Statistics and Geography LabUniversity of MassachusettsLowellMassachusettsUSA
| | - Linda Suleiman
- Department of Orthopaedic SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Patricia D. Franklin
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Orthopaedic SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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22
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Savitz ST, Inselman S, Nyman MA, Lee M. Evaluation of the Predictive Value of Routinely Collected Health-Related Social Needs Measures. Popul Health Manag 2024; 27:34-43. [PMID: 37903241 DOI: 10.1089/pop.2023.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
The objective was to assess the value of routinely collected patient-reported health-related social needs (HRSNs) measures for predicting utilization and health outcomes. The authors identified Mayo Clinic patients with cancer, diabetes, or heart failure. The HRSN measures were collected as part of patient-reported screenings from June to December 2019 and outcomes (hospitalization, 30-day readmission, and death) were ascertained in 2020. For each outcome and disease combination, 4 models were used: gradient boosting machine (GBM), random forest (RF), generalized linear model (GLM), and elastic net (EN). Other predictors included clinical factors, demographics, and area-based HRSN measures-area deprivation index (ADI) and rurality. Predictive performance for models was evaluated with and without the routinely collected HRSN measures as change in area under the curve (AUC). Variable importance was also assessed. The differences in AUC were mixed. Significant improvements existed in 3 models of death for cancer (GBM: 0.0421, RF: 0.0496, EN: 0.0428), 3 models of hospitalization (GBM: 0.0372, RF: 0.0640, EN: 0.0441), and 1 of death (RF: 0.0754) for diabetes, and 1 model of readmissions (GBM: 0.1817), and 3 models of death (GBM: 0.0333, RF: 0.0519, GLM: 0.0489) for heart failure. Age, ADI, and the Charlson comorbidity index were the top 3 in variable importance and were consistently more important than routinely collected HRSN measures. The addition of routinely collected HRSN measures resulted in mixed improvement in the predictive performance of the models. These findings suggest that existing factors and the ADI are more important for prediction in these contexts. More work is needed to identify predictors that consistently improve model performance.
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Affiliation(s)
- Samuel T Savitz
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Shealeigh Inselman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Nyman
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Minji Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
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Giron NC, Cole MB, Nguyen KH. Use of and barriers to adopting standardized social risk screening tools in federally qualified health centers during the first year of the COVID-19 pandemic. Health Serv Res 2024; 59 Suppl 1:e14232. [PMID: 37715519 PMCID: PMC10796290 DOI: 10.1111/1475-6773.14232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To describe the national rate of social risk factor screening adoption among federally qualified health centers (FQHCs), examine organizational factors associated with social risk screening adoption, and identify barriers to utilizing a standardized screening tool in 2020. DATA SOURCE 2020 Uniform Data System, a 100% sample of all US FQHCs (N = 1375). STUDY DESIGN We used multivariable linear probability models to assess the association between social risk screening adoption and key FQHC characteristics. We used descriptive statistics to describe variations in screening tool types and barriers to utilizing standardized tools. We thematically categorized open-ended responses about tools and barriers. DATA COLLECTION None. PRINCIPAL FINDINGS In 2020, 68.9% of FQHCs screened patients for any social risk factors. Characteristics associated with a greater likelihood of screening adoption included having high proportions of patients best served in a language other than English (18.8 percentage point [PP] increase, 95% CI: 6.0, 31.6) and being larger in size (10.3 PP increase, 95% CI: 0.7, 20.0). Having higher proportions of uninsured patients (14.2 PP decrease, 95% CI: -25.5, -0.3) and participating in Medicaid-managed care contracts (7.3 PP decrease, 95% CI: -14.2, -0.3) were associated with lower screening likelihood. Among screening FQHCs, the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) was the most common tool (47.1%). Among non-screening FQHCs, common barriers to using a standardized tool included lack of staff training to discuss social issues (25.2%), inability to include screening in patient intake (21.7%), and lack of funding for addressing social needs (19.2%). CONCLUSIONS Though most FQHCs screened for social risk factors in 2020, various barriers have prevented nearly 1 in 3 FQHCs from adopting a screening tool. Policies that provide FQHCs with resources to support training and workflow changes may increase screening uptake and facilitate engagement with other sectors.
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Affiliation(s)
- Nicole C Giron
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Megan B Cole
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kevin H Nguyen
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Mainous AG, Orlando FA, Yin L, Sharma P, Wu V, Saguil A. Inflammation and poverty as individual and combined predictors of 15-year mortality risk in middle aged and older adults in the US. Front Med (Lausanne) 2024; 10:1261083. [PMID: 38293298 PMCID: PMC10824842 DOI: 10.3389/fmed.2023.1261083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/27/2023] [Indexed: 02/01/2024] Open
Abstract
Background Chronic systemic inflammation and poverty are both linked to an increased mortality risk. The goal of this study was to determine if there is a synergistic effect of the presence of inflammation and poverty on the 15-year risk of all-cause, heart disease and cancer mortality among US adults. Methods We analyzed the nationally representative National Health and Nutrition Examination Survey (NHANES) 1999 to 2002 with linked records to the National Death Index through the date December 31, 2019. Among adults aged 40 and older, 15-year mortality risk associated with inflammation, C-reactive protein (CRP), and poverty was assessed in Cox regressions. All-cause, heart disease and cancer mortality were the outcomes. Results Individuals with elevated CRP at 1.0 mg/dL and poverty were at greater risk of 15-year adjusted, all-cause mortality (HR = 2.45; 95% CI 1.64, 3.67) than individuals with low CRP and were above poverty. For individuals with just one at risk characteristic, low inflammation/poverty (HR = 1.58; 95% CI 1.30, 1.93), inflammation/above poverty (HR = 1.59; 95% CI 1.31, 1.93) the mortality risk was essentially the same and substantially lower than the risk for adults with both. Individuals with both elevated inflammation and living in poverty experience a 15-year heart disease mortality risk elevated by 127% and 15-year cancer mortality elevated by 196%. Discussion This study extends the past research showing an increased mortality risk for poverty and systemic inflammation to indicate that there is a potential synergistic effect for increased mortality risk when an adult has both increased inflammation and is living in poverty.
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Affiliation(s)
- Arch G. Mainous
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, United States
- Department of Health Services Research Management, and Policy, University of Florida, Gainesville, FL, United States
| | - Frank A. Orlando
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, United States
| | - Lu Yin
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, United States
| | - Pooja Sharma
- Department of Health Services Research Management, and Policy, University of Florida, Gainesville, FL, United States
| | - Velyn Wu
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, United States
| | - Aaron Saguil
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, United States
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Ng R, Gunatillaka N, Skouteris H, Blane D, Blewitt C, Nielsen S, Sturgiss E. Screening for Unstable Housing in a Healthcare Setting. Public Health Rev 2023; 44:1606438. [PMID: 38205340 PMCID: PMC10777743 DOI: 10.3389/phrs.2023.1606438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Objectives: To describe existing tools for screening patients for unstable housing in a healthcare setting. Methods: A literature search was completed to retrieve articles published in the last 10 years on screening patients for unstable housing in a healthcare setting. Results: The current literature on screening patients for homelessness in healthcare settings describes a variety of tools administered by a range of healthcare providers, but all are based in the United States. Conclusion: The studies revealed the potential for effective screening in healthcare settings and positive engagement of patients and providers with screening. Key areas for future research include innovative methods of screening and evaluation of reliability and validity for a broader range of tools.
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Affiliation(s)
- Raeann Ng
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Nilakshi Gunatillaka
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David Blane
- Department of General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Claire Blewitt
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
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26
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Cotangco K, Pineda E, Hingarh V, Nyakudarika NC, Cohen JG, Holschneider CH. Integrating social care into gynecologic oncology: Identifying and addressing patient's social needs. Gynecol Oncol 2023; 179:138-144. [PMID: 37980768 PMCID: PMC11218889 DOI: 10.1016/j.ygyno.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE We aimed to identify social needs of gynecologic oncology patients using a self-administered social needs assessment tool (SNAT), compare the SNAT to a formal social work assessment performed by cancer care navigators (CCN), and provide SNAT-informed community resources. METHODS We analyzed prospectively collected data from a performance improvement initiative in a safety-net gynecologic oncology clinic between October 2021 and July 2022. We screened for eight social needs domains, health literacy, desire for social work, and presence of urgent needs. Clinicodemographic data were abstracted from the electronic medical record. Univariate descriptive statistics were used. Inter-rater reliability for social needs domains was assessed using percent agreement. RESULTS 1010 unique patients were seen over this study period. 488 (48%) patients completed the SNAT, of which 265 (54%) screened positive for ≥1 social need. 83 (31%) patients were actively receiving cancer treatment, 140 (53%) were in post-treatment surveillance, and 42 (16%) had benign gynecologic diagnoses. Transportation (19% vs 25%), housing insecurity (18% vs 19%), and desire to speak with a social worker (16% vs 27%) were the 3 most common needs in both the entire cohort and among patients actively receiving cancer treatment. 78% patients in active treatment were seen by a CCN and received SNAT informed community resources. The percent agreement between the SNAT and formal CCN assessment ranged from 72%-94%. CONCLUSIONS The self-administered SNAT identified many unmet social needs among gynecologic oncology patients, corresponded well with the formal social work CCN assessment, and informed the provision of community resources.
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Affiliation(s)
- Katherine Cotangco
- Department of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Veda Hingarh
- Department of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Natsai C Nyakudarika
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, City of Hope Orange County, Irvine, CA, USA
| | - Christine H Holschneider
- Department of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Drewry MB, Yanguela J, Khanna A, O'Brien S, Phillips E, Bevel MS, McKinley MW, Corbie G, Dave G. A Systematic Review of Electronic Community Resource Referral Systems. Am J Prev Med 2023; 65:1142-1152. [PMID: 37286015 PMCID: PMC10696135 DOI: 10.1016/j.amepre.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Community Resource Referral Systems delivered electronically through healthcare information technology systems (e.g., electronic medical records) have become more common in efforts to address patients' unmet health-related social needs. Community Resource Referral System connects patients with social supports such as food assistance, utility support, transportation, and housing. This systematic review identifies barriers and facilitators that influence the Community Resource Referral System's implementation in the U.S. by identifying and synthesizing peer-reviewed literature over a 15-year period. METHODS This systematic review was conducted following PRISMA guidelines. A search was conducted on five scientific databases to capture the literature published between January 2005 and December 2020. Data analysis was conducted from August 2021 to July 2022. RESULTS This review includes 41 articles of the 2,473 initial search results. Included literature revealed that Community Resource Referral Systems functioned to address a variety of health-related social needs and were delivered in different ways. Integrating the Community Resource Referral Systems into clinic workflows, maintenance of community-based organization inventories, and strong partnerships between clinics and community-based organizations facilitated implementation. The sensitivity of health-related social needs, technical challenges, and associated costs presented as barriers. Overall, electronic medical records-integration and automation of the referral process was reported as advantageous for the stakeholders. DISCUSSION This review provides information and guidance for healthcare administrators, clinicians, and researchers designing or implementing electronic Community Resource Referral Systems in the U.S. Future studies would benefit from stronger implementation science methodological approaches. Sustainable funding mechanisms for community-based organizations, clear stipulations regarding how healthcare funds can be spent on health-related social needs, and innovative governance structures that facilitate collaboration between clinics and community-based organizations are needed to promote the growth and sustainability of Community Resource Referral Systems in the U.S.
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Affiliation(s)
- Maura B Drewry
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina.
| | - Juan Yanguela
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Anisha Khanna
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Sara O'Brien
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Ethan Phillips
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Malcolm S Bevel
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina; Augusta University, Department of Medicine, Augusta, Georgia
| | - Mary W McKinley
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Giselle Corbie
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Gaurav Dave
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
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Bensken WP, McGrath BM, Gold R, Cottrell EK. Area-level social determinants of health and individual-level social risks: Assessing predictive ability and biases in social risk screening. J Clin Transl Sci 2023; 7:e257. [PMID: 38229891 PMCID: PMC10790234 DOI: 10.1017/cts.2023.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction Area-level social determinants of health (SDoH) and individual-level social risks are different, yet area-level measures are frequently used as proxies for individual-level social risks. This study assessed whether demographic factors were associated with patients being screened for individual-level social risks, the percentage who screened positive for social risks, and the association between SDoH and patient-reported social risks in a nationwide network of community-based health centers. Methods Electronic health record data from 1,330,201 patients with health center visits in 2021 were analyzed using multilevel logistic regression. Associations between patient characteristics, screening receipt, and screening positive for social risks (e.g., food insecurity, housing instability, transportation insecurity) were assessed. The predictive ability of three commonly used SDoH measures (Area Deprivation Index, Social Deprivation Index, Material Community Deprivation Index) in identifying individual-level social risks was also evaluated. Results Of 244,155 (18%) patients screened for social risks, 61,414 (25.2%) screened positive. Sex, race/ethnicity, language preference, and payer were associated with both social risk screening and positivity. Significant health system-level variation in both screening and positivity was observed, with an intraclass correlation coefficient of 0.55 for social risk screening and 0.38 for positivity. The three area-level SDoH measures had low accuracy, sensitivity, and area under the curve when used to predict individual social needs. Conclusion Area-level SDoH measures may provide valuable information about the communities where patients live. However, policymakers, healthcare administrators, and researchers should exercise caution when using area-level adverse SDoH measures to identify individual-level social risks.
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Affiliation(s)
- Wyatt P. Bensken
- Department of Research, OCHIN,
Portland, OR, USA
- Quantitative Sciences Core, OCHIN,
Portland, OR, USA
| | - Brenda M. McGrath
- Department of Research, OCHIN,
Portland, OR, USA
- Quantitative Sciences Core, OCHIN,
Portland, OR, USA
| | - Rachel Gold
- Department of Research, OCHIN,
Portland, OR, USA
- Kaiser Permanente Center for Health Research,
Portland, OR, USA
| | - Erika K. Cottrell
- Department of Research, OCHIN,
Portland, OR, USA
- Oregon Health and Science University, Portland,
OR, USA
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29
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Bauchner H, Rivara FP. Improving Child Health Research: The Role of Randomized Clinical Trials. J Pediatr 2023; 262:113641. [PMID: 37517647 DOI: 10.1016/j.jpeds.2023.113641] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Howard Bauchner
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA.
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Edwards B, Schaefer EW, Murray-Kolb LE, Daymont C. Evaluation of Income and Food Insecurity as Risk Factors for Failure to Thrive: An Analysis of National Survey Data. Clin Pediatr (Phila) 2023; 62:862-870. [PMID: 36661103 PMCID: PMC10411026 DOI: 10.1177/00099228221150705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Limited data exist regarding the relationship between socioeconomic risk factors and failure to thrive (FTT). Using data from the National Health and Nutrition Examination Survey (NHANES) from years 1999 to 2014, we sought to determine whether there was a higher prevalence of underweight (<5th percentile weight-for-age [WFA], weight-for-length [WFL], or body mass index-for-age [BFA]), and, therefore, likely a higher risk of FTT, in US children <3 years with low household income or food insecurity compared with children without these factors. Among 7356 evaluated children, there were no significant differences in the prevalence of underweight by adjusted household income quintile, food security, household Women, Infants, and Children (WIC) status, or federal poverty income ratio. These findings do not support a link between low income or food security and underweight in children and, therefore, do not provide support for an association between low income or food security and FTT.
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Affiliation(s)
- Bathai Edwards
- Penn State College of Medicine, Hershey, PA, USA
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Eric W. Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Laura E. Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Carrie Daymont
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
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LeLaurin JH, De La Cruz J, Theis RP, Thompson LA, Lee JH, Shenkman EA, Salloum RG. Parent Perspectives on Electronic Health Record-Based Social Needs Screening and Documentation: A Qualitative Study. Acad Pediatr 2023; 23:1446-1453. [PMID: 37301284 PMCID: PMC10592213 DOI: 10.1016/j.acap.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Social needs interventions in clinical settings can improve child health outcomes; however, they are not routinely delivered in routine pediatric care. The electronic health record (EHR) can support these interventions, but parent engagement in the development of EHR-based social needs interventions is lacking. The aim of this study was to assess parent perspectives on EHR-based social needs screening and documentation and identify family-centered approaches for screening design and implementation. METHODS We enrolled 20 parents from four pediatric primary care clinics. Parents completed a social risk questionnaire from an existing EHR module and participated in qualitative interviews. Parents were asked about the acceptability of EHR-based social needs screening and documentation and preferences for screening administration. A hybrid deductive-inductive approach was used to analyze qualitative data. RESULTS Parents identified the benefits of social needs screening and documentation but expressed concerns related to privacy, fear of negative outcomes, and use of outdated documentation. Some felt self-administered electronic questionnaires would mitigate parent discomfort and encourage disclosure of social needs, while others felt face-to-face screening would be more effective. Parents stressed the importance of transparency on the purpose of social needs screening and the use of data. CONCLUSIONS This work can inform the design and implementation of EHR-based social needs interventions that are acceptable and feasible for parents. Findings suggest strategies such as clear communication and multi-modal delivery methods may enhance intervention uptake. Future work should integrate feedback from multiple stakeholders to design and evaluate interventions that are family-centered and feasible to implement in clinical settings.
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Affiliation(s)
- Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics (JH LeLaurin, J De La Cruz, RP Theis, LA Thompson, EA Shenkman, and RG Salloum),University of Florida College of Medicine, Gainesville.
| | - Jacqueline De La Cruz
- Department of Health Outcomes and Biomedical Informatics (JH LeLaurin, J De La Cruz, RP Theis, LA Thompson, EA Shenkman, and RG Salloum),University of Florida College of Medicine, Gainesville
| | - Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics (JH LeLaurin, J De La Cruz, RP Theis, LA Thompson, EA Shenkman, and RG Salloum),University of Florida College of Medicine, Gainesville
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics (JH LeLaurin, J De La Cruz, RP Theis, LA Thompson, EA Shenkman, and RG Salloum),University of Florida College of Medicine, Gainesville; Department of Pediatrics (LA Thompson), Wake Forest School of Medicine, Winston-Salem, NC
| | - Ji-Hyun Lee
- Department of Biostatistics (J-H Lee), College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville; Division of Quantitative Sciences (J-H Lee), University of Florida Health Cancer Center, University of Florida, Gainesville
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics (JH LeLaurin, J De La Cruz, RP Theis, LA Thompson, EA Shenkman, and RG Salloum),University of Florida College of Medicine, Gainesville
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics (JH LeLaurin, J De La Cruz, RP Theis, LA Thompson, EA Shenkman, and RG Salloum),University of Florida College of Medicine, Gainesville
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Phelan ST. Screening for Social Determinants of Health During Prenatal Care: Why, What, and How. Obstet Gynecol Clin North Am 2023; 50:629-638. [PMID: 37500221 DOI: 10.1016/j.ogc.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
As more data from maternal mortality reviews are available, it has become clear that social determinants of health have major impacts on the morbidity and mortality of mothers and infants. The ability to verify and address these requires an effective screening process during prenatal care. The challenges include selection of an appropriate tool for use in pregnancy; incorporating the tool into the clinical flow to ensure screening of all pregnant patients; and developing an approach to address the issues, be it providing emotional support, management within the clinic, or referring to outside resources.
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Ashe JJ, Baker MC, Alvarado CS, Alberti PM. Screening for Health-Related Social Needs and Collaboration With External Partners Among US Hospitals. JAMA Netw Open 2023; 6:e2330228. [PMID: 37610754 PMCID: PMC10448297 DOI: 10.1001/jamanetworkopen.2023.30228] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
Importance In recent years, hospitals and health systems have reported increasing rates of screening for patients' individual and community social needs, but few studies have explored the national landscape of screening and interventions directed at addressing health-related social needs (HRSNs) and social determinants of health (SDOH). Objective To evaluate the associations of hospital characteristics and area-level socioeconomic indicators to quantify the presence and intensity of hospitals' screening practices, interventions, and collaborative external partnerships that seek to measure and ameliorate patients' HRSNs and SDOH. Design, Setting, and Participants This cross-sectional study used national data from the American Hospital Association Annual Survey Database for fiscal year 2020. General-service, acute-care, nonfederal hospitals were included in the study's final sample, representing nationally diverse hospital settings. Data were analyzed from July 2022 to February 2023. Exposures Organizational characteristics and area-level socioeconomic indicators. Main Outcomes and Measures The outcomes of interest were hospital-reported patient screening of and strategies to address 8 HRSNs and 14 external partnership types to address SDOH. Composite scores for screening practices and external partnership types were calculated, and ordinary least-square regression analyses tested associations of organizational characteristics with outcome measures. Results Of 2858 US hospital respondents (response rate, 67.0%), most hospitals (79.2%; 95% CI, 77.7%-80.7%) reported screening patients for at least 1 HRSN, with food insecurity or hunger needs (66.1%; 95% CI, 64.3%-67.8%) and interpersonal violence (66.4%; 95% CI, 64.7%-68.1%) being the most commonly screened social needs. Most hospitals (79.4%; 95% CI, 66.3%-69.7%) reported having strategies and programs to address patients' HRSNs; notably, most hospitals (52.8%; 95% CI, 51.0%-54.5%) had interventions for transportation barriers. Hospitals reported a mean of 4.03 (95% CI, 3.85-4.20) external partnership types to address SDOH and 5.69 (5.50-5.88) partnership types to address HRSNs, with local or state public health departments and health care practitioners outside of the health system being the most common. Hospitals with accountable care contracts (ACCs) and bundled payment programs (BPPs) reported higher screening practices (ACC: β = 1.03; SE = 0.13; BPP: β = 0.72; SE = 0.14), interventions (ACC: β = 1.45; SE = 0.12; BPP: β = 0.61; SE = 0.13), and external partnership types to address HRSNs (ACC: β = 2.07; SE = 0.23; BPP: β = 1.47; SE = 0.24) and SDOH (ACC: β = 2.64; SE = 0.20; BPP: β = 1.57; SE = 0.21). Compared with nonteaching, government-owned, and for-profit hospitals, teaching and nonprofit hospitals were also more likely to report more HRSN-directed activities. Patterns based on geographic and area-level socioeconomic indicators did not emerge. Conclusions and Relevance This cross-sectional study found that most US hospitals were screening patients for multiple HRSNs. Active participation in value-based care, teaching hospital status, and nonprofit status were the characteristics most consistently associated with greater overall screening activities and number of related partnership types. These results support previously posited associations about which types of hospitals were leading screening uptake and reinforce understanding of the role of hospital incentives in supporting health equity efforts.
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Affiliation(s)
- Jason J. Ashe
- Association of American Medical Colleges, Washington, District of Columbia
| | - Matthew C. Baker
- Association of American Medical Colleges, Washington, District of Columbia
| | - Carla S. Alvarado
- Association of American Medical Colleges, Washington, District of Columbia
| | - Philip M. Alberti
- Association of American Medical Colleges, Washington, District of Columbia
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Clapp J, Calvo-Friedman A, Davis N. Addressing Health-Related Social Needs-Costs and Optimism. JAMA Intern Med 2023; 183:774-775. [PMID: 37252719 DOI: 10.1001/jamainternmed.2023.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Jenifer Clapp
- Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, New York
| | - Alessandra Calvo-Friedman
- Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, New York
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Nichola Davis
- Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Torres CIH, Gold R, Kaufmann J, Marino M, Hoopes MJ, Totman MS, Aceves B, Gottlieb LM. Social Risk Screening and Response Equity: Assessment by Race, Ethnicity, and Language in Community Health Centers. Am J Prev Med 2023; 65:286-295. [PMID: 36990938 PMCID: PMC10652909 DOI: 10.1016/j.amepre.2023.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Little has previously been reported about the implementation of social risk screening across racial/ethnic/language groups. To address this knowledge gap, the associations between race/ethnicity/language, social risk screening, and patient-reported social risks were examined among adult patients at community health centers. METHODS Patient- and encounter-level data from 2016 to 2020 from 651 community health centers in 21 U.S. states were used; data were extracted from a shared Epic electronic health record and analyzed between December 2020 and February 2022. In adjusted logistic regression analyses stratified by language, robust sandwich variance SE estimators were applied with clustering on patient's primary care facility. RESULTS Social risk screening occurred at 30% of health centers; 11% of eligible adult patients were screened. Screening and reported needs varied significantly by race/ethnicity/language. Black Hispanic and Black non-Hispanic patients were approximately twice as likely to be screened, and Hispanic White patients were 28% less likely to be screened than non-Hispanic White patients. Hispanic Black patients were 87% less likely to report social risks than non-Hispanic White patients. Among patients who preferred a language other than English or Spanish, Black Hispanic patients were 90% less likely to report social needs than non-Hispanic White patients. CONCLUSIONS Social risk screening documentation and patient reports of social risks differed by race/ethnicity/language in community health centers. Although social care initiatives are intended to promote health equity, inequitable screening practices could inadvertently undermine this goal. Future implementation research should explore strategies for equitable screening and related interventions.
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Affiliation(s)
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente and OCHIN, Inc., Portland, Oregon
| | | | - Miguel Marino
- Department of Family Medicine, OHSU, Portland, Oregon
| | | | - Molly S Totman
- Quality, Community Care Cooperative, Boston, Massachusetts
| | - Benjamín Aceves
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Vest JR, Mazurenko O. Non-response Bias in Social Risk Factor Screening Among Adult Emergency Department Patients. J Med Syst 2023; 47:78. [PMID: 37480515 PMCID: PMC10439727 DOI: 10.1007/s10916-023-01975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
Healthcare organizations increasingly use screening questionnaires to assess patients' social factors, but non-response may contribute to selection bias. This study assessed differences between respondents and those refusing participation in a social factor screening. We used a cross-sectional approach with logistic regression models to measure the association between subject characteristics and social factor screening questionnaire participation. The study subjects were patients from a mid-western state safety-net hospital's emergency department. Subjects' inclusion criteria were: (1) ≥ 18 years old, (2) spoke English or Spanish, and (3) able to complete a self-administered questionnaire. We classified subjects that consented and answered the screening questionnaire in full as respondents. All others were non-respondents. Using natural language processing, we linked all subjects' participation status to demographic characteristics, clinical data, an area-level deprivation measure, and social risk factors extracted from clinical notes. We found that nearly 6 out of every 10 subjects approached (59.9%), consented, and completed the questionnaire. Subjects with prior documentation of financial insecurity were 22% less likely to respond to the screening questionnaire (marginal effect = -22.40; 95% confidence interval (CI) = -41.16, -3.63; p = 0.019). No other factors were significantly associated with response. This study uniquely contributes to the growing social determinants of health literature by confirming that selection bias may exist within social factor screening practices and research studies.
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Affiliation(s)
- Joshua R Vest
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health - Indianapolis, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, 46202, USA
| | - Olena Mazurenko
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health - Indianapolis, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA.
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LeLaurin JH, De La Cruz J, Theis RP, Thompson LA, Lee JH, Shenkman EA, Salloum RG. Pediatric primary care provider and staff perspectives on the implementation of electronic health record-based social needs interventions: A mixed-methods study. J Clin Transl Sci 2023; 7:e160. [PMID: 37528941 PMCID: PMC10388413 DOI: 10.1017/cts.2023.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Interventions to address social needs in clinical settings can improve child and family health outcomes. Electronic health record (EHR) tools are available to support these interventions but are infrequently used. This mixed-methods study sought to identify approaches for implementing social needs interventions using an existing EHR module in pediatric primary care. Methods We conducted focus groups and interviews with providers and staff (n = 30) and workflow assessments (n = 48) at four pediatric clinics. Providers and staff completed measures assessing the acceptability, appropriateness, and feasibility of social needs interventions. The Consolidated Framework for Implementation Research guided the study. A hybrid deductive-inductive approach was used to analyze qualitative data. Results Median scores (range 1-5) for acceptability (4.9) and appropriateness (5.0) were higher than feasibility (3.9). Perceived barriers to implementation related to duplicative processes, parent disclosure, and staffing limitations. Facilitators included the relative advantage of the EHR module compared to existing documentation practices, importance of addressing social needs, and compatibility with clinic culture and workflow. Self-administered screening was seen as inappropriate for sensitive topics. Strategies identified included providing resource lists, integrating social needs assessments with existing screening questionnaires, and reducing duplicative documentation. Conclusions This study offers insight into the implementation of EHR-based social needs interventions and identifies strategies to promote intervention uptake. Findings highlight the need to design interventions that are feasible to implement in real-world settings. Future work should focus on integrating multiple stakeholder perspectives to inform the development of EHR tools and clinical workflows to support social needs interventions.
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Affiliation(s)
- Jennifer H. LeLaurin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jacqueline De La Cruz
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ryan P. Theis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lindsay A. Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ji-Hyun Lee
- Division of Quantitative Sciences, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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Davis VH, Dainty KN, Dhalla IA, Sheehan KA, Wong BM, Pinto AD. "Addressing the bigger picture": A qualitative study of internal medicine patients' perspectives on social needs data collection and use. PLoS One 2023; 18:e0285795. [PMID: 37285324 DOI: 10.1371/journal.pone.0285795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND There is increasing interest in collecting sociodemographic and social needs data in hospital settings to inform patient care and health equity. However, few studies have examined inpatients' views on this data collection and what should be done to address social needs. This study describes internal medicine inpatients' perspectives on the collection and use of sociodemographic and social needs information. METHODS A qualitative interpretive description methodology was used. Semi-structured interviews were conducted with 18 patients admitted to a large academic hospital in Toronto, Canada. Participants were recruited using maximum variation sampling for diverse genders, races, and those with and without social needs. Interviews were coded using a predominantly inductive approach and a thematic analysis was conducted. RESULTS Patients expressed that sociodemographic and social needs data collection is important to offer actionable solutions to address their needs. Patients described a gap between their ideal care which would attend to social needs, versus the reality that hospital-based teams are faced with competing priorities and pressures that make it unfeasible to provide such care. They also believed that this data collection could facilitate more holistic, integrated care. Patients conveyed a need to have a trusting and transparent relationship with their provider to alleviate concerns surrounding bias, discrimination, and confidentiality. Lastly, they indicated that sociodemographic and social needs data could be useful to inform care, support research to inspire social change, and assist them with navigating community resources or creating in-hospital programs to address unmet social needs. CONCLUSIONS While the collection of sociodemographic and social needs information in hospital settings is generally acceptable, there were varied views on whether hospital staff should intervene, as their priority is medical care. The results can inform the implementation of social data collection and interventions in hospital settings.
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Affiliation(s)
- Victoria H Davis
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Katie N Dainty
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Irfan A Dhalla
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen A Sheehan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Brian M Wong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Kamdar N, Khan S, Brostow DP, Spencer L, Roy S, Sisson A, Hundt NE. Association between modifiable social determinants and mental health among post-9/11 Veterans: A systematic review. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023; 9:8-26. [PMID: 37886122 PMCID: PMC10601397 DOI: 10.3138/jmvfh-2022-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Introduction As U.S. Veterans reintegrate from active duty to civilian life, many are at risk for negative modifiable social determinants of health. The prevalence of mental health conditions among Veterans is also high. Awareness of the associations between these two factors is growing. This systematic review provides a comprehensive analysis of the current state of knowledge of the associations between modifiable social determinants and mental health among U.S. Veterans. Methods The authors systematically searched four databases and identified 28 articles representing 25 unique studies that met inclusion criteria. Findings from the studies were extracted and synthesized on the basis of modifiable social determinants. Study quality and risk of bias were assessed using the Methodological Quality Questionnaire. Results The studies identified in the systematic review examined three modifiable social determinants of health: 1) housing stability, 2) employment and finances, and 3) social support. Although the lack of validity for measures of housing stability, employment, and finances compromised study quality, the overall evidence suggests that Veterans with access to supportive social determinants had better mental health status. Evidence was particularly robust for the association between strong social support and lower symptoms of posttraumatic stress disorder. Discussion Current evidence suggests the need to consider modifiable social determinants of health when designing mental health interventions. However, more research encompassing a wider range of modifiable social determinants such as food security, education, and transportation and using comprehensive methods and validated instruments is needed. Future research also needs to intentionally include Veterans from diverse racial-ethnic groups.
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Affiliation(s)
- Nipa Kamdar
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States
| | - Sundas Khan
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States
| | - Diana P. Brostow
- Veterans Health Administration Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, United States
| | - Lia Spencer
- Brandeis University, Waltham, Massachusetts, United States
| | - Sharmily Roy
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Amy Sisson
- The Texas Medical Center Library, Houston, Texas, United States
| | - Natalie E. Hundt
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
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Lee JS, MacLeod KE, Kuklina EV, Tong X, Jackson SL. Social Determinants of Health-Related Z Codes and Health Care Among Patients With Hypertension. AJPM FOCUS 2023; 2:100089. [PMID: 37790640 PMCID: PMC10546517 DOI: 10.1016/j.focus.2023.100089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Tracking social needs can provide information on barriers to controlling hypertension and the need for wraparound services. No recent studies have examined ICD-10-CM social determinants of health-related Z codes (Z55-Z65) to indicate social needs with a focus on patients with hypertension. Methods Three cohorts were identified with a diagnosis of hypertension during 2016-2017 and continuously enrolled in fee-for-service insurance through June 2021: (1) commercial, age 18-64 years (n=1,024,012); (2) private insurance to supplement Medicare (Medicare Supplement), age ≥65 years (n=296,340); and (3) Medicaid, age ≥18 years (n=146,484). Both the proportion of patients and healthcare encounters or visits with social determinants of health-related Z code were summarized annually. Patient and visit characteristics were summarized for 2019. Results In 2020, the highest annual documentation of social determinants of health-related Z codes was among Medicaid beneficiaries (3.02%, 0.46% commercial, 0.42% Medicare Supplement); documentation was higher among inpatient than among outpatient visits for all insurance types. Z63 (related to primary support group) was more common among commercial and Medicare Supplement beneficiaries, and Z59 (housing and economic circumstances) was more common among Medicaid beneficiaries. The 2019 total unadjusted medical expenditures were 1.85, 1.78, and 1.61 times higher for those with social determinants of health-related Z code than for those without commercial, Medicare Supplement, and Medicaid, respectively. Patients with social determinants of health-related Z code also had higher proportions of diagnosed chronic conditions. Among Medicaid beneficiaries, differences in the presence of social determinants of health-related Z code by race or ethnicity were observed. Conclusions Although currently underreported, social determinants of health-related Z codes provide an opportunity to integrate social and medical data and may help decision makers understand the need for additional services among individuals with hypertension.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kara E. MacLeod
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- ASRT, Inc., Atlanta, Georgia
| | - Elena V. Kuklina
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Berg KA, DeRenzo M, Carpiano RM, Lowenstein I, Perzynski AT. Go-along interview assessment of community health priorities for neighborhood renewal. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 71:437-452. [PMID: 36947385 DOI: 10.1002/ajcp.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 01/05/2023] [Accepted: 02/02/2023] [Indexed: 06/06/2023]
Abstract
Healthcare systems are increasingly investing in approaches to address social determinants of health and health disparities. Such initiatives dovetail with certain approaches to neighborhood development, such as the EcoDistrict standard for community development, that prioritize both ecologically and socially sustainable neighborhoods. However, healthcare system and community development initiatives can be untethered from the preferences and lived realities of residents in the very neighborhoods upon which they focus. Utilizing the go-along approach to collecting qualitative data in situ, we interviewed 19 adults to delineate residents' community health perspectives and priorities. Findings reveal health priorities distinct from clinical outcomes, with residents emphasizing social connectedness, competing intra- and interneighborhood perceptions that potentially thwart social connectedness, and a neighborhood emplacement of agency, dignity, and self-worth. Priorities of healthcare systems and community members alike must be accounted for to optimize efforts that promote health and social well-being by being valid and meaningful to the community of focus.
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Affiliation(s)
- Kristen A Berg
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maria DeRenzo
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, Ohio, USA
| | - Richard M Carpiano
- School of Public Policy, University of California, Riverside, California, USA
- Department of Sociology, University of California, Riverside, California, USA
- Center for Healthy Communities, University of California, Riverside, California, USA
| | | | - Adam T Perzynski
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Gold R, Kaufmann J, Cottrell EK, Bunce A, Sheppler CR, Hoopes M, Krancari M, Gottlieb LM, Bowen M, Bava J, Mossman N, Yosuf N, Marino M. Implementation Support for a Social Risk Screening and Referral Process in Community Health Centers. NEJM CATALYST INNOVATIONS IN CARE DELIVERY 2023; 4:10.1056/CAT.23.0034. [PMID: 37153938 PMCID: PMC10161727 DOI: 10.1056/cat.23.0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Evidence is needed about how to effectively support health care providers in implementing screening for social risks (adverse social determinants of health) and providing related referrals meant to address identified social risks. This need is greatest in underresourced care settings. The authors tested whether an implementation support intervention (6 months of technical assistance and coaching study clinics through a five-step implementation process) improved adoption of social risk activities in community health centers (CHCs). Thirty-one CHC clinics were block-randomized to six wedges that occurred sequentially. Over the 45-month study period from March 2018 to December 2021, data were collected for 6 or more months preintervention, the 6-month intervention period, and 6 or more months postintervention. The authors calculated clinic-level monthly rates of social risk screening results that were entered at in-person encounters and rates of social risk-related referrals. Secondary analyses measured impacts on diabetes-related outcomes. Intervention impact was assessed by comparing clinic performance based on whether they had versus had not yet received the intervention in the preintervention period compared with the intervention and postintervention periods. In assessing the results, the authors note that five clinics withdrew from the study for various bandwidth-related reasons. Of the remaining 26, a total of 19 fully or partially completed all 5 implementation steps, and 7 fully or partially completed at least the first 3 steps. Social risk screening was 2.45 times (95% confidence interval [CI], 1.32-4.39) higher during the intervention period compared with the preintervention period; this impact was not sustained postintervention (rate ratio, 2.16; 95% CI, 0.64-7.27). No significant difference was seen in social risk referral rates during the intervention or postintervention periods. The intervention was associated with greater blood pressure control among patients with diabetes and lower rates of diabetes biomarker screening postintervention. All results must be interpreted considering that the Covid-19 pandemic began midway through the trial, which affected care delivery generally and patients at CHCs particularly. Finally, the study results show that adaptive implementation support was effective at temporarily increasing social risk screening. It is possible that the intervention did not adequately address barriers to sustained implementation or that 6 months was not long enough to cement this change. Underresourced clinics may struggle to participate in support activities over longer periods without adequate resources, even if lengthier support is needed. As policies start requiring documentation of social risk activities, safety-net clinics may be unable to meet these requirements without adequate financial and coaching/technical support.
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Affiliation(s)
- Rachel Gold
- Lead Research Scientist, OCHIN, Portland, Oregon, USA
- Senior Investigator, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Jorge Kaufmann
- Biostatistician, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Erika K Cottrell
- Senior Investigator, OCHIN, Portland, Oregon, USA
- Research Associate Professor, Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Arwen Bunce
- Qualitative Research Scientist, OCHIN, Portland, Oregon, USA
| | - Christina R Sheppler
- Research Associate III, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Megan Hoopes
- Manager of Research Analytics, OCHIN, Portland, Oregon, USA
| | | | - Laura M Gottlieb
- Professor of Family and Community Medicine, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Meg Bowen
- Practice Coach, OCHIN, Portland, Oregon, USA
| | | | - Ned Mossman
- Director of Social and Community Health, OCHIN, Portland, Oregon, USA
| | - Nadia Yosuf
- Project Manager III, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Miguel Marino
- Assistant Professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Aceves B, De Marchis E, Loomba V, Brown EM, Gottlieb LM. Stakeholder perspectives on social screening in US healthcare settings. BMC Health Serv Res 2023; 23:246. [PMID: 36915136 PMCID: PMC10012605 DOI: 10.1186/s12913-023-09214-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Evidence on the health impacts of social conditions has led US healthcare systems to consider identifying and addressing social adversity-e.g. food, housing, and transportation insecurity-in care delivery settings. Social screening is one strategy being used to gather patient information about social circumstances at the point of care. While several recent studies describe the rapid proliferation of social screening activities, little work has explored either why or how to implement social screening in clinical settings. Our study objectives were to assess diverse healthcare stakeholder perspectives on both the rationale for social screening and evidence needed to inform practice and policy-relevant implementation decisions. METHODS We convened five focus groups with US experts representing different stakeholder groups: patient advocates, community-based organizations, healthcare professionals, payers, and policymakers. In total, 39 experts participated in approximately 90-minute long focus groups conducted between January-March 2021. A inductive thematic analysis approach was used to analyze discussions. RESULTS Three themes emerged from focus groups, each reflecting the tension between the national enthusiasm for screening and existing evidence on the effectiveness and implementation of screening in clinical settings: (1) ambiguity about the rationale for social screening; (2) concerns about the relavence of screening tools and approaches, particularly for historically marginalized populations; (3) lack of clarity around the resources needed for implementation and scaling. CONCLUSION While participants across groups described potential benefits of social screening, they also highlighted knowledge gaps that interfered with realizing these benefits. Efforts to minimize and ideally resolve these knowledge gaps will advance future social screening practice and policy.
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Affiliation(s)
- Benjamín Aceves
- School of Public Health, San Diego State University, 5500 Campanile Drive, 92182, San Diego, CA, USA.
| | - Emilia De Marchis
- Department of Family & Community Medicine, University of California, San Francisco, 995 Potrero Ave, 94110, San Francisco, CA, USA
| | - Vishalli Loomba
- Social Interventions Research and Evaluation Network, University of California, San Francisco, 3333 California Street, Suite 465, 94118, San Francisco, CA, USA
| | - Erika M Brown
- Social Interventions Research and Evaluation Network, University of California, San Francisco, 3333 California Street, Suite 465, 94118, San Francisco, CA, USA
| | - Laura M Gottlieb
- Department of Family & Community Medicine, University of California, San Francisco, 995 Potrero Ave, 94110, San Francisco, CA, USA
- Social Interventions Research and Evaluation Network, University of California, San Francisco, 3333 California Street, Suite 465, 94118, San Francisco, CA, USA
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Harle CA, Wu W, Vest JR. Accuracy of Electronic Health Record Food Insecurity, Housing Instability, and Financial Strain Screening in Adult Primary Care. JAMA 2023; 329:423-424. [PMID: 36749341 PMCID: PMC10408256 DOI: 10.1001/jama.2022.23631] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/06/2022] [Indexed: 02/08/2023]
Abstract
This study assesses the accuracy of electronic health record–based screening questionnaires about social risk factors using external single-domain questionnaires as a comparator.
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Affiliation(s)
- Christopher A. Harle
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville
| | - Wei Wu
- Department of Psychology, Indiana University–Purdue University, Indianapolis
| | - Joshua R. Vest
- Department of Health Policy and Management, Indiana University, Indianapolis
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Simon RC, Kim J, Schmidt S, Brimhall BB, Salazar CI, Wang CP, Wang Z, Sarwar ZU, Manuel LS, Damien P, Shireman PK. Association of Insurance Type With Inpatient Surgery 30-Day Complications and Costs. J Surg Res 2023; 282:22-33. [PMID: 36244224 DOI: 10.1016/j.jss.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/10/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Safety-net hospitals (SNHs) have higher postoperative complications and costs versus low-burden hospitals. Do low socioeconomic status/vulnerable patients receive care at lower-quality hospitals or are there factors beyond providers' control? We studied the association of private, Medicare, and vulnerable insurance type with complications/costs in a high-burden SNH. METHODS Retrospective inpatient cohort study using National Surgical Quality Improvement Program (NSQIP) data (2013-2019) with cost data risk-adjusted by frailty, preoperative serious acute conditions (PASC), case status, and expanded operative stress score (OSS) to evaluate 30-day unplanned reoperations, any complication, Clavien-Dindo IV (CDIV) complications, and hospitalization variable costs. RESULTS Cases (Private 1517; Medicare 1224; Vulnerable 3648) with patient mean age 52.3 y [standard deviation = 14.7] and 47.3% male. Adjusting for frailty and OSS, vulnerable patients had higher odds of PASC (aOR = 1.71, CI = 1.39-2.10, P < 0.001) versus private. Adjusting for frailty, PASC and OSS, Medicare (aOR = 1.27, CI = 1.06-1.53, P = 0.009), and vulnerable (aOR = 2.44, CI = 2.13-2.79, P < 0.001) patients were more likely to undergo urgent/emergent surgeries. Vulnerable patients had increased odds of reoperation and any complications versus private. Variable cost percentage change was similar between private and vulnerable after adjusting for case status. Urgent/emergent case status increased percentage change costs by 32.31%. We simulated "switching" numbers of private (3648) versus vulnerable (1517) cases resulting in an estimated variable cost of $49.275 million, a 25.2% decrease from the original $65.859 million. CONCLUSIONS Increased presentation acuity (PASC and urgent/emergent surgeries) in vulnerable patients drive increased odds of complications and costs versus private, suggesting factors beyond providers' control. The greatest impact on outcomes may be from decreasing the incidence of urgent/emergent surgeries by improving access to care.
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Affiliation(s)
- Richard C Simon
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Jeongsoo Kim
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas
| | - Bradley B Brimhall
- Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, Texas; University Health, San Antonio, Texas
| | | | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas
| | - Zhu Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas
| | - Zaheer U Sarwar
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas; University Health, San Antonio, Texas
| | - Laura S Manuel
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas
| | - Paul Damien
- Department of Information, Risk, and Operations Management, Red McCombs School of Business, University of Texas, Austin, Texas
| | - Paula K Shireman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas; University Health, San Antonio, Texas; Departments of Primary Care & Rural Medicine and Medical Physiology, School of Medicine, Texas A&M Health, Bryan, Texas.
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46
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Savage Hoggard CL, Kaufman A, Michener JL, Phillips RL. Academic Medicine's Fourth Mission: Building on Community-Oriented Primary Care to Achieve Community-Engaged Health Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:175-179. [PMID: 36327385 PMCID: PMC9855726 DOI: 10.1097/acm.0000000000004991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 2021 article, "Now is our time to act: Why academic medicine must embrace community collaboration as its fourth mission," by Association of American Medical Colleges (AAMC) authors, including AAMC president and CEO Dr. David J. Skorton, offers 2 aims that are highly related: community collaboration and health equity. The AAMC's call to prioritize community collaboration and health equity as pillars of the academic medicine mission echo earlier work on community-oriented primary care (COPC) and an even more robust model that builds on COPC, community-engaged health care (CEHC). COPC is a tested, systematic approach to health care by which a health clinic or system collaborates with a community to reshape priorities and services based on assessed health needs and determinants of health. COPC affirms health inequities' socioeconomic and political roots, emphasizing health care as a relationship, not a transaction or commodity. Communities where COPC is implemented often see reductions in health inequities, especially those related to socioeconomic, structural, and environmental factors. COPC was the foundation on which community health centers were built, and early models had demonstrable effects on community health and engagement. Several academic health centers build on COPC to achieve CEHC. In CEHC, primary care remains critical, but more of the academic health center's functions are pulled into community engagement and trust building. Thus, the AAMC has described and embraced a care and training model for which there are good, longitudinal examples among medical schools and teaching hospitals. Spreading CEHC and aligning the Community Health Needs Assessment requirements of academic health centers with the fourth mission could go a long way to improving equity, building trust, and repairing the social contract for health care.
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Affiliation(s)
- Courtney L. Savage Hoggard
- C.L. Savage Hoggard is a medical student, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Arthur Kaufman
- A. Kaufman is vice president for community health, University of New Mexico Health Sciences, Albuquerque, New Mexico
| | - J. Lloyd Michener
- J.L. Michener is professor emeritus, Department of Family Medicine and Community Health, Duke School of Medicine, Durham, North Carolina
| | - Robert L. Phillips
- R.L. Phillips Jr is founding executive director, Center for Professionalism and Value in Health Care, Washington, DC
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Abstract
PURPOSE OF REVIEW This article outlines updates in social determinants of health (SDOH) screening practices in pediatric healthcare and community settings. The transition to value-based care and the COVID-19 pandemic have both had significant impacts on screening practices, with implications for providers, communities, and policymakers. RECENT FINDINGS The COVID-19 pandemic has exacerbated social needs for vulnerable patients and families, resulting in increased recognition by healthcare teams through screening. Policy frameworks like value-based care that aim to deliver whole-child care in the community are reorienting the logistics of screening, including screening in acute-care settings and community settings. Recent studies on family and provider perspectives should be integrated into screening practices. SUMMARY Despite significant advances in and expansion of SDOH screening in the pediatric healthcare setting, there remain limitations and future research needs. More data is needed to evaluate social need screeners and interventions, and determine how healthcare systems, communities, and states can spread and scale such interventions based on outcomes and value measurements. Population-based social indices have the potential to augment individual patient screening, but this remains a future research need.
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Affiliation(s)
- Abby L Nerlinger
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Nemours Children's Hospital, Delaware, Wilmington, Delaware
| | - Gift Kopsombut
- University of Central Florida
- Nemours Children's Hospital, Florida, Orlando, Florida, USA
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Shi JJ, Lei X, Chen YS, Chavez-MacGregor M, Bloom E, Schlembach P, Shaitelman SF, Buchholz TA, Kaiser K, Ku K, Smith BD, Smith GL. Socioeconomic Barriers to Randomized Clinical Trial Retention in Patients Treated With Adjuvant Radiation for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 116:122-131. [PMID: 36724858 DOI: 10.1016/j.ijrobp.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE Socioeconomic barriers contribute to breast cancer clinical trial enrollment disparities. We sought to identify whether socioeconomic disadvantage also is associated with decreased trial retention. METHODS AND MATERIALS We performed a secondary analysis of 253 (of 287) patients enrolled in a randomized phase 3 trial of conventionally fractionated versus hypofractionated whole-breast irradiation. The outcome of trial retention versus dropout was defined primarily based on whether the patient completed breast cosmesis outcomes assessment at 3-year follow-up, and secondarily, at 5-year follow-up. Associations of retention with severity of socioeconomic disadvantage, quantified by patients' home neighborhood area deprivation index (ADI) rank (1 [least] to 100 [most deprivation]), were tested using the Kruskal-Wallis test and multivariate logistic regression. Associations of retention with patients' use of social resource assistance were analyzed using the χ2 test. RESULTS In total, 21.7% (n = 55) of patients dropped out by 3 years and 36.7% (n = 92) by 5 years. Median ADI was 36.5 (interquartile range, 22-57) for retained and 46.0 (interquartile range, 29-60) for dropout patients. Dropout was associated with more severe socioeconomic deprivation (ADI ≥45 vs <45) at 3 years (odds ratio, 3.63; 95% confidence interval, 1.62-8.15; P = .002) and 5 years (odds ratio, 2.55; 95% confidence interval, 1.37-4.76; P = .003). While on study, patients who ultimately dropped out were more likely to require resource assistance for practical (transportation, housing, financial) than psychological needs (distress, grief) or advance care planning (P = .03). CONCLUSIONS In this study, ADI was associated with disparities in clinical trial retention of patients with breast cancer receiving adjuvant radiation treatment. Results suggest that developing multidimensional interventions that extend beyond routine social determinants needs screening are needed, not only to enhance initial clinical trial access and enrollment but also to enable robust long-term retention of socioeconomically disadvantaged patients and improve the validity and generalizability of reported long-term trial clinical and patient-reported outcomes.
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Affiliation(s)
- Julia J Shi
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Lei
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Elizabeth Bloom
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Kelsey Kaiser
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimberly Ku
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Grace L Smith
- University of Texas MD Anderson Cancer Center, Houston, Texas.
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Keruakous AR, Soror N, Jiménez S, Ashley R, Keruakous M, Sadek BT. Barriers driving health care disparities in utilization of age-appropriate screening. Front Public Health 2023; 11:1100466. [PMID: 36935668 PMCID: PMC10020215 DOI: 10.3389/fpubh.2023.1100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Amany R Keruakous
- Department of Internal Medicine, Georgia Cancer Center, Augusta University at Medical College of Georgia, Augusta, GA, United States
| | - Noha Soror
- Section of Hematology-Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sarah Jiménez
- Department of Internal Medicine, Georgia Cancer Center, Augusta University at Medical College of Georgia, Augusta, GA, United States
| | - Rachel Ashley
- Department of Internal Medicine, Georgia Cancer Center, Augusta University at Medical College of Georgia, Augusta, GA, United States
| | - Mai Keruakous
- Mercer County Community College, West Windsor, NJ, United States
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Krishnamurthy S, Soltany KA, Montez K. Incorporating Health Policy and Advocacy Curricula Into Undergraduate Medical Education in the United States. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231191601. [PMID: 37538104 PMCID: PMC10395184 DOI: 10.1177/23821205231191601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023]
Abstract
Physicians serve as crucial advocates for their patients. Undergraduate medical education (UME) must move beyond the biomedical model, built upon the perception that health is defined purely in the absence of illness, to also incorporate population health through health policy, advocacy, and community engagement to account for structural and social determinants of health. Currently, the US guidelines for UME lack structured training in health policy or advocacy, leaving trainees ill-equipped to assume their role as physician-advocates or to engage with communities. There is an undeniable need to educate future physicians on legislative advocacy toward improving the social determinants of health through the creation of evidence-based health policy, in addition to training in effective techniques to engage in partnership with the communities in which physicians serve. The authors of this article also present curricular case studies around two programs at their institution that could be used to implement similar programs at other US medical schools.
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Affiliation(s)
- Sudarshan Krishnamurthy
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kevin Alexander Soltany
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kimberly Montez
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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