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Brown CO, Perez Y, Campa M, Sorto G, Sonik R, Taira BR. COVID-19 Disruptions to Social Care Delivery: A Qualitative Study in Two Large, Safety-Net Primary Care Clinics. J Gen Intern Med 2024; 39:2515-2521. [PMID: 39060785 PMCID: PMC11436498 DOI: 10.1007/s11606-024-08952-y] [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: 12/16/2023] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Social care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs. OBJECTIVE To describe the effects of the COVID-19 pandemic on established social care delivery in a primary care setting. DESIGN We used qualitative semi-structured interviews of stakeholders to assess barriers and facilitators to social care delivery in the primary care setting during the COVID-19 health emergency. Data was analyzed using a hybrid inductive/deductive thematic analysis approach with both the Consolidated Framework for Implementation Research (CFIR) and the Screen-Navigate-Connect-Address-Evaluate model of social care integration. SETTING Two safety-net, hospital-based primary care clinics with established screening for food insecurity, homelessness, and legal needs. PARTICIPANTS Six physicians, six nurses, six members of the social work team (clinical social workers and medical case workers), six community health workers, and six patients (total N = 30) completed interviews. RESULTS Four major themes were identified. (1) A strained workforce experienced challenges confronting increased levels of HRSNs. (2) Vulnerable populations experienced a disproportionate negative impact in coping with effects of the COVID-19 pandemic on HRSNs. (3) COVID-19 protections compounded social isolation but did not extinguish the sense of community. (4) Fluctuations in the social service landscape led to variable experiences. CONCLUSIONS The COVID-19 pandemic disrupted established social care delivery in a primary care setting. Many of the lessons learned about challenges to social care delivery when health systems are strained are important considerations that can inform efforts to expand social care delivery.
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Affiliation(s)
| | | | | | - Gerson Sorto
- Neighborhood Legal Services of Los Angeles, Pacoima, CA, USA
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Nguyen KH, Cole MB. Social Risk Factors, Health Insurance Coverage, and Inequities in Access to Care. Am J Prev Med 2024:S0749-3797(24)00307-6. [PMID: 39396362 DOI: 10.1016/j.amepre.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 09/09/2024] [Accepted: 09/09/2024] [Indexed: 10/15/2024]
Abstract
INTRODUCTION Social risk factors are associated with worse access to care. This study measured the prevalence of social risk factors among low-income adults, assessed the relationship between number of social risk factors and access to care, and examined heterogeneity by health insurance type. METHODS Using 2022 Behavioral Risk Factor Surveillance Survey data from 39 states, the association between number of SRFs (0, 1, 2-3, 4, or more) and three access to care measures (having a personal doctor, having a routine checkup, and inability to see doctor because of cost) were measured using multivariable linear probability models. The analysis was stratified by health insurance coverage type (private, Medicare, Medicaid, or uninsured) to assess whether effects were differential. Analyses were conducted in 2024. RESULTS Among 90,208 low-income adults, 46.6% reported at least one SRF. Compared to people who reported no SRFs, those who reported four or more were more likely to report being unable to afford care (28.21 percentage points [PP], p<0.001) and less likely to have a personal doctor (-4.98 PP, p<0.001) or routine checkup in the last two years (-4.29 PP, p<0.001). The magnitude of disparity by number of SRFs in inability to afford care was larger among privately insured and uninsured people compared to those with Medicare or Medicaid coverage. CONCLUSIONS Higher levels of SRFs were associated with worse access to care among low-income adults. Policies that minimize cost-related barriers to care, coupled with care delivery reforms and social policies that address SRFs, may improve access to care.
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Affiliation(s)
- Kevin H Nguyen
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
| | - Megan B Cole
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
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Winslow VA, Lindau ST, Huang ES, Asay S, Johnson AE, Borson S, Thompson K, Makelarski JA. Caring for dementia caregivers: How well does social risk screening reflect unmet needs? J Am Geriatr Soc 2024. [PMID: 39315491 DOI: 10.1111/jgs.19200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/25/2024] [Accepted: 09/01/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Unmet social and caregiving needs can make caregiving for a person with dementia more difficult. Although national policy encourages adoption of systematic screening for health-related social risks (HRSRs) in clinical settings, the accuracy of these risk-based screening tools for detecting unmet social needs is unknown. METHODS We used baseline data from dementia caregivers (N = 343) enrolled in a randomized controlled trial evaluating CommunityRx-Dementia, a social care intervention conducted on Chicago's South Side. We assessed caregivers' (1) unmet social and caregiving needs by querying need for 14 resource types and (2) HRSRs using the Center for Medicare & Medicaid Services (CMS) Accountable Health Communities (AHC) screening tool. Using unmet social needs as the reference, we examined the sensitivity of the AHC tool to detect food, housing, and transportation needs. Analyses were stratified by gender. RESULTS Most caregivers were women (78%), non-Hispanic (96%), Black (81%), partnered (58%) and had an annual household income ≥$50K (64%). Unmet social and caregiving needs were similarly prevalent among women and men caregivers (87% had ≥1 need, 43% had ≥5 needs). HRSRs were also prevalent. The most common HRSR was lack of social support (45%). Housing instability, difficulty with utilities and having any HRSRs were significantly more prevalent among women (all p < 0.05). The AHC screener had low sensitivity for detecting unmet food (39%, 95% confidence interval [CI]: 27%-53%), housing (42%, 95% CI: 31%-53%), and transportation (22%, 95% CI: 14%-31%) needs. Sensitivity did not differ by gender for food (41% for women and 30% for men, p = 0.72) or housing (44% for women and 29% for men, p = 0.37) needs. For transportation needs, sensitivity was 27% for women versus 0% for men (p = 0.01). CONCLUSIONS Men and women caregivers have high rates of unmet social needs that are often missed by the CMS-recommended risk-based screening method. Findings indicate a role for need-based screening in implementing social care.
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Affiliation(s)
- Victoria A Winslow
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Elbert S Huang
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, Illinois, USA
- Department of Medicine - Section of General Internal Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Spencer Asay
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Amber E Johnson
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Soo Borson
- Department of Family Medicine, Keck USC School of Medicine, California, Los Angeles, USA
| | - Katherine Thompson
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer A Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
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Chino F, Narayan AK, Sadigh G. Identifying and Addressing Health-Related Social Risks and Needs: Our Role. J Am Coll Radiol 2024; 21:1333-1335. [PMID: 38971412 DOI: 10.1016/j.jacr.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Affiliation(s)
- Fumiko Chino
- Affordability Working Group and the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; leadership roles at American Society for Radiation Oncology as a member of the Health Equity, Diversity and Inclusion Counsel, Member, the Steering Committee of American Society of Clinical Oncology Quality; Director the Costs of Care Group; Consulting Editor for JCO Oncology Practice; Associate Editor for Advances in Radiation Oncology.
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Vice Chair, ACR Patient- and Family-Centered Care Outreach Committee; Treasurer, Wisconsin Radiological Society; Treasurer, Assistant Editor, Journal of the American College of Radiology; Associate Editor, Radiology
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California Irvine, Irvine, California; associate Editor at Journal of American College of Radiology; Director of Health Services and Comparative Effectiveness Outcome Research; Associate Chair for Faculty Development at University of California Irvine
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Cuyegkeng A, Hao Z, Rashidi A, Bansal R, Dhillon J, Sadigh G. Prevalence of financial hardship and health-related social needs among patients with missed radiology appointments. Clin Imaging 2024; 113:110232. [PMID: 39096889 DOI: 10.1016/j.clinimag.2024.110232] [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: 05/23/2024] [Revised: 06/23/2024] [Accepted: 07/08/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE We aimed to evaluate the prevalence of financial hardship and Health-Related Social Needs (HRSN) among patients who missed their radiology appointment. METHODS English-speaking adult patients, with a missed outpatient imaging appointment at any of a tertiary care imaging centers between 11/2022 and 05/2023 were eligible. We measured self-reported general financial worry using Comprehensive Score for Financial Toxicity (COST), imaging hardship (worry that the current imaging is a financial hardship to patient and their family), material hardship (e.g., medical debt), cost-related care nonadherence, and HRSNs including housing instability, food insecurity, transportation problems, and utility help needs. RESULTS 282 patients were included (mean age 54.7 ± 15.0 years; 70.7 % female). Majority were non-Hispanic White (52.4 %), followed by Asian (23.0 %) and Hispanic (16.0 %) racial/ethnic background. Most missed appointments were patient-initiated (74.8 %); 13.5 % due to cost or insurance coverage and 6.4 % due to transportation and parking. Mean COST score was 26.8 with 44.4 % and 28.8 % reporting their illness and imaging as a source of financial hardship. 18.3 % and 35.2 % endorsed cost-related care nonadherence and material hardship. 32.7 % had at least one HRSNs with food insecurity the most common (25.4 %). Only 12.5 % were previously screened for financial hardship or HRSNs. Having comorbidity and living in more disadvantaged neighborhoods was associated with higher report of financial hardship and HRSNs. CONCLUSION Financial hardship and HRSNs are common among those who miss radiology appointments. There needs to be more rigorous screening for financial hardship and HRSNs at every health encounter and interventions should be implemented to address these.
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Affiliation(s)
- Andrew Cuyegkeng
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Zuxian Hao
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Ali Rashidi
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Riya Bansal
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Jasmine Dhillon
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America.
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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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Wang VHC, Holm J, Pagán JA. Use of calibration to improve the precision of estimates obtained from All of Us data. J Am Med Inform Assoc 2024:ocae181. [PMID: 38981110 DOI: 10.1093/jamia/ocae181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/19/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVES To highlight the use of calibration weighting to improve the precision of estimates obtained from All of Us data and increase the return of value to communities from the All of Us Research Program. MATERIALS AND METHODS We used All of Us (2017-2022) data and raking to obtain prevalence estimates in two examples: discrimination in medical settings (N = 41 875) and food insecurity (N = 82 266). Weights were constructed using known population proportions (age, sex, race/ethnicity, region of residence, annual household income, and home ownership) from the 2020 National Health Interview Survey. RESULTS About 37% of adults experienced discrimination in a medical setting. About 20% of adults who had not seen a doctor reported being food insecure compared with 14% of adults who regularly saw a doctor. CONCLUSIONS Calibration using raking is cost-effective and may lead to more precise estimates when analyzing All of Us data.
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Affiliation(s)
- Vivian Hsing-Chun Wang
- Center for Population and Health Services Research, Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, United States
| | - Julie Holm
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY 10003, United States
| | - José A Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY 10003, United States
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Richwine C, Meklir S. Hospitals' collection and use of data to address social needs and social determinants of health. Health Serv Res 2024. [PMID: 38952231 DOI: 10.1111/1475-6773.14341] [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: 07/03/2024] Open
Abstract
OBJECTIVE To assess differences in hospitals' collection and use of data on patients' health-related social needs (HRSN) by availability of programs or strategies in place to address patients' HRSN and social determinants of health (SDOH) of communities. DATA SOURCES The 2021 American Hospital Association Annual Survey and 2022 Information Technology (IT) Supplement. STUDY DESIGN This cross-sectional study described hospitals' engagement in screening and the availability of programs or strategies to address nine different HRSN. We assessed differences in screening rates and uses of data collected through screening among hospitals with and without programs or strategies in place to address HRSN or SDOH using Chi-squared tests of independence. DATA COLLECTION/EXTRACTION METHODS Analyses were restricted to IT Supplement respondents with complete data for social needs questions asked in the Annual Survey (N = 1997). PRINCIPAL FINDINGS In 2022, hospitals used social needs data collected through screening for various purposes including discharge planning and clinical decision-making at their hospital as well as to refer patients to needed resources and assess community-level needs. Hospitals with a program or strategy in place had higher rates of screening across all domains and higher rates of using of data collected through screening for uses involving exchange or coordination with external entities. CONCLUSIONS Collection of social needs data may help inform the development of programs or strategies to address HRSN and SDOH, which in turn can enable providers to screen for these needs and use the data in the near term for care delivery and in the long term to address community and population needs.
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Affiliation(s)
- Chelsea Richwine
- Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Samantha Meklir
- Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, Washington, DC, USA
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Timperley J, Doll J, Tadé Y, Refaie WA. Health related social needs and social determinants of health: Navigating the convoluted path of health equity in surgery. Am J Surg 2024; 233:148-151. [PMID: 38350747 DOI: 10.1016/j.amjsurg.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Affiliation(s)
- Jillian Timperley
- Department of Surgery, CHI Health Creighton University Medical Center, 7710 Mercy Road, Omaha, NE, 68124, USA.
| | - Joy Doll
- Department of Surgery, CHI Health Creighton University Medical Center, 7710 Mercy Road, Omaha, NE, 68124, USA.
| | - Yanick Tadé
- Department of Surgery, CHI Health Creighton University Medical Center, 7710 Mercy Road, Omaha, NE, 68124, USA.
| | - Waddah Al- Refaie
- Department of Surgery, CHI Health Creighton University Medical Center, 7710 Mercy Road, Omaha, NE, 68124, USA.
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Bretsch JK, Wallace AS, McCoy R. Social Needs Screening in Academic Health Systems: A Landscape Assessment. Popul Health Manag 2024; 27:312-319. [PMID: 39069945 DOI: 10.1089/pop.2024.0111] [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: 07/30/2024] Open
Abstract
Screening for social needs has gained traction as an approach to addressing social determinants of health, but it faces challenges regarding standardization, resource allocation, and follow-up care. The year-long study, conducted by the Association of American Medical Colleges, integrated data from conferences, surveys, and key informant interviews to examine the integration of social needs screening into health care services within Academic Health Systems (AHS). The authors' analysis unveiled eight key themes, showcasing AHS's active involvement in targeted social needs screening alongside persistent resource allocation obstacles. AHS are dedicated to efficiently identifying high-risk populations, fostering partnerships with community-based organizations, and embracing technology for closed-loop referrals. However, concerns endure about the utilization of reimbursement codes for social needs and regulatory compliance. AHS confront staffing issues, resource allocation intricacies, and the imperative for seamless integration across clinical and nonclinical departments. Notably, opportunities arise in standardized training, alignment of AHS priorities, exploration of social investment models, and engagement with state-level health information exchanges. Aligning clinical care, research pursuits, and community engagement endeavors holds promise for AHS in effectively addressing social needs.
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Affiliation(s)
- Jennifer K Bretsch
- Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Andrea S Wallace
- University of Utah College of Nursing, Salt Lake City, Utah, USA
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rosha McCoy
- Association of American Medical Colleges, Washington, District of Columbia, USA
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Albin JL, Thomas OW, Marvasti FF, Reilly JM. There and Back Again: A Forty-Year Perspective on Physician Nutrition Education. Adv Nutr 2024; 15:100230. [PMID: 38705195 PMCID: PMC11251405 DOI: 10.1016/j.advnut.2024.100230] [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: 02/05/2024] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report "Nutrition Education in the United States Medical Schools," little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care.
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Affiliation(s)
- Jaclyn Lewis Albin
- Departments of Internal Medicine and Pediatrics, the University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | | | - Farshad Fani Marvasti
- Department of Family, Community, and Preventive Medicine, University of Arizona College of Medicine-Phoenix and School of Nutritional Sciences and Wellness, College of Agricultural, Life and Environmental Sciences, University of Arizona, Tucson, AZ, United States
| | - Jo Marie Reilly
- Clinical Family Medicine and Population and Public Health, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
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Osei Baah F, Sharda S, Davidow K, Jackson S, Kernizan D, Jacobs JA, Baumer Y, Schultz CL, Baker-Smith CM, Powell-Wiley TM. Social Determinants of Health in Cardio-Oncology: Multi-Level Strategies to Overcome Disparities in Care: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024; 6:331-346. [PMID: 38983377 PMCID: PMC11229550 DOI: 10.1016/j.jaccao.2024.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 07/11/2024] Open
Abstract
Addressing the need for more equitable cardio-oncology care requires attention to existing disparities in cardio-oncologic disease prevention and outcomes. This is particularly important among those affected by adverse social determinants of health (SDOH). The intricate relationship of SDOH, cancer diagnosis, and outcomes from cardiotoxicities associated with oncologic therapies is influenced by sociopolitical, economic, and cultural factors. Furthermore, mechanisms in cell signaling and epigenetic effects on gene expression link adverse SDOH to cancer and the CVD-related complications of oncologic therapies. To mitigate these disparities, a multifaceted strategy is needed that includes attention to health care access, policy, and community engagement for improved disease screening and management. Interdisciplinary teams must also promote cultural humility and competency and leverage new health technology to foster collaboration in addressing the impact of adverse SDOH in cardio-oncologic outcomes.
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Affiliation(s)
- Foster Osei Baah
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Sonal Sharda
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kimberly Davidow
- Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA
| | - Sadhana Jackson
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Daphney Kernizan
- Preventive Cardiology Program, Cardiac Center, Nemours Children's Health, Panama City, Florida, USA
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Joshua A Jacobs
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Corinna L Schultz
- Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA
| | - Carissa M Baker-Smith
- Preventive Cardiology Program, Cardiac Center, Nemours Children's Health, Wilmington, Delaware, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
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Kim KK, Backonja U. Perspectives of community-based organizations on digital health equity interventions: a key informant interview study. J Am Med Inform Assoc 2024; 31:929-939. [PMID: 38324738 PMCID: PMC10990549 DOI: 10.1093/jamia/ocae020] [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: 06/09/2023] [Revised: 12/14/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Health and healthcare are increasingly dependent on internet and digital solutions. Medically underserved communities that experience health disparities are often those who are burdened by digital disparities. While digital equity and digital health equity are national priorities, there is limited evidence about how community-based organizations (CBOs) consider and develop interventions. METHODS We conducted key informant interviews in 2022 purposively recruiting from health and welfare organizations engaged in digital equity work. Nineteen individuals from 13 organizations serving rural and/or urban communities from the local to national level participated in semi-structured interviews via Zoom regarding their perspectives on digital health equity interventions. Directed content analysis of verbatim interview transcripts was conducted to identify themes. RESULTS Themes emerged at individual, organizational, and societal levels. Individual level themes included potential benefits from digital health equity, internet access challenges, and the need for access to devices and digital literacy. Organizational level themes included leveraging community assets, promising organizational practices and challenges. For the societal level, the shifting complexity of the digital equity ecosystem, policy issues, and data for needs assessment and evaluation were described. Several example case studies describing these themes were provided. DISCUSSION AND CONCLUSION Digital health equity interventions are complex, multi-level endeavors. Clear elucidation of the individual, organizational, and societal level factors that may impact digital health equity interventions are necessary to understanding if and how CBOs participate in such initiatives. This study presents unique perspectives directly from CBOs driving programs in this new arena of digital health equity.
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Affiliation(s)
- Katherine K Kim
- MITRE Corporation, Health Innovation Center, McLean, VA 22102, United States
- Department of Public Health Sciences/Division of Health Informatics, School of Medicine, University of California Davis, Sacramento, CA 95817, United States
| | - Uba Backonja
- MITRE Corporation, Health Innovation Center, McLean, VA 22102, United States
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Angah N, Meedzan B, Pruzinsky N, O'Connell A, Hart L, Cobbs-Lomax D, Vanderwoude P. Leveraging Technology and Workflow Optimization for Health-Related Social Needs Screening: An Improvement Project at a Large Health System. Jt Comm J Qual Patient Saf 2024; 50:24-33. [PMID: 38087722 DOI: 10.1016/j.jcjq.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The collection of health-related social needs (HRSN) data at one large health system has historically been inconsistent. This project was aimed to increase annual HRSN screening rates by standardizing data collection in the electronic health record (EHR) through optimized clinical workflows. METHODS The authors designed a standard screening questionnaire in alignment with the Accountable Health Communities model, and they conducted interviews with eleven US-based health systems and one medical center on best practices for ambulatory HRSN screening and interventions, which identified five possible methods to administer the questionnaire. After testing, the authors opted to send questionnaires to patients through the patient portal three days prior to an ambulatory visit. For inpatients, in-person interviews were implemented. Staff implementing the updated processes included registered nurses, social workers, preventive health coordinators, and community health workers. RESULTS The annual screening rate for all active ambulatory patients increased from 0.4% to 15.9% (p < 0.001), and 10.7% of all patients had at least one health-related social need. The annual screening rate for inpatients was estimated to be zero at baseline and increased by 66 percentage points (p < 0.001). The most prevalent health-related social need in both settings was financial resource strain, followed closely by food insecurity. CONCLUSION Well-designed interventions and technology support were effective in achieving improved screening and data collection. Leadership support, building interventions within preexisting workflows, and ensuring standard data capture in the EHR were key factors leading to successful process improvement.
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Franz B, Burns A, Kueffner K, Bhardwaj M, Yeager VA, Singh S, Puro N, Cronin CE. A national overview of nonprofit hospital community benefit programs to address the social determinants of health. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad078. [PMID: 38770037 PMCID: PMC11103730 DOI: 10.1093/haschl/qxad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/24/2023] [Accepted: 12/01/2023] [Indexed: 05/22/2024]
Abstract
Decades of research have solidified the crucial role that social determinants of health (SDOH) play in shaping health outcomes, yet strategies to address these upstream factors remain elusive. The aim of this study was to understand the extent to which US nonprofit hospitals invest in SDOH at either the community or individual patient level and to provide examples of programs in each area. We analyzed data from a national dataset of 613 hospital community health needs assessments and corresponding implementation strategies. Among sample hospitals, 69.3% (n = 373) identified SDOH as a top-5 health need in their community and 60.6% (n = 326) reported investments in SDOH. Of hospitals with investments in SDOH, 44% of programs addressed health-related social needs of individual patients, while the remaining 56% of programs addressed SDOH at the community level. Hospitals that were major teaching organizations, those in the Western region of the United States, and hospitals in counties with more severe housing problems had greater odds of investing in SDOH at the community level. Although many nonprofit hospitals have integrated SDOH-related activities into their community benefit work, stronger policies are necessary to encourage greater investments at the community-level that move beyond the needs of individual patients.
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Affiliation(s)
- Berkeley Franz
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, United States
| | - Ashlyn Burns
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University—Indianapolis, Indianapolis, IN 46202, United States
| | - Kristin Kueffner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
| | - Meeta Bhardwaj
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, United States
| | - Valerie A Yeager
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University—Indianapolis, Indianapolis, IN 46202, United States
| | - Simone Singh
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
| | - Neeraj Puro
- Department of Health Administration, College of Business, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Cory E Cronin
- College of Health Sciences and Professions, Ohio University, Athens, OH 45701, United States
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Ferrante LE, Cohen AB. All the Lonely People: Social Isolation and Loneliness in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1703-1704. [PMID: 38038602 PMCID: PMC10704229 DOI: 10.1513/annalsats.202309-833ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
| | - Andrew B Cohen
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; and
- VA Connecticut Healthcare System, West Haven, Connecticut
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