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Assaf RR, Assaf RD, Padlipsky PS, Young KDA. A family-centered approach to social needs awareness in the pediatric emergency department. PEC INNOVATION 2024; 4:100283. [PMID: 38689830 PMCID: PMC11059452 DOI: 10.1016/j.pecinn.2024.100283] [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: 09/06/2023] [Revised: 02/01/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Objective We aimed to understand family preferences around reporting and receiving health-related social needs (HRSN) information by assessment modality during pediatric emergency department (PED) visits. Methods Families were randomized into paper (control), cell phone, or tablet modality groups by their child's exam room. Nurses alerted families to complete a single HRSN assessment during routine workflow. We used logistic regression and McNemar's test to assess discordance in modality preference. Results Forty-seven percent of families disclosed at least one HRSN across a total 611 assessments. Disclosure of HRSN was similar by modality. Twenty-three percent of those assigned tablet preferred cell phone (p < 0.001). Two-thirds of families preferred receiving digitally formatted community resources (email or text). There was no difference in preferred timing of HRSN assessment completion. Conclusions Assessment modality did not appear to influence family HRSN disclosure. Families were generally satisfied with all HRSN assessment modalities but demonstrated a particular preference in using personal cell phones over tablets. Digitally formatted community referrals also pose numerous advantages over conventional paper handouts. Innovation Use of personal cell phones is a novel, streamlined method of HRSN interventions in the clinical setting, performing similar to more conventional modalities, with a preference among families when compared to tablets.
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Affiliation(s)
- Raymen Rammy Assaf
- Emergency Medicine Specialists of Orange County, Children's Hospital Orange County, Orange, USA
- Department of Pediatrics, University of California, Irvine (UCI) School of Medicine, Irvine, USA
| | - Ryan David Assaf
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, USA
| | - Patricia Sencer Padlipsky
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
| | - Kelly Dee Ann Young
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
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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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Nummedal MA, King S, Uleberg O, Pedersen SA, Bjørnsen LP. Non-emergency department (ED) interventions to reduce ED utilization: a scoping review. BMC Emerg Med 2024; 24:117. [PMID: 38997631 DOI: 10.1186/s12873-024-01028-4] [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: 08/25/2023] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilization have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or patient groups within the EDs. The purpose of this scoping review was to identify, summarize, and categorize the various types of non-ED-based interventions designed to reduce unnecessary visits to EDs. METHODS This scoping review followed the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A comprehensive structured literature search was performed in the databases MEDLINE and Embase from 2008 to March 2024. The inclusion criteria covered studies reporting on interventions outside the ED that aimed to reduce ED visits. Two reviewers independently screened the records and categorized the included articles by intervention type, location, and population. RESULTS Among the 15,324 screened records, we included 210 studies, comprising 183 intervention studies and 27 systematic reviews. In the primary studies, care coordination/case management or other care programs were the most commonly examined out of 15 different intervention categories. The majority of interventions took place in clinics or medical centers, in patients' homes, followed by hospitals and primary care settings - and targeted patients with specific medical conditions. CONCLUSION A large number of studies have been published investigating interventions to mitigate the influx of patients to EDs. Many of these targeted patients with specific medical conditions, frequent users and high-risk patients. Further research is needed to address other high prevalent groups in the ED - including older adults and mental health patients (who are ill but may not need the ED). There is also room for further research on new interventions to reduce ED utilization in low-acuity patients and in the general patient population.
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Affiliation(s)
- Målfrid A Nummedal
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sarah King
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oddvar Uleberg
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Sindre A Pedersen
- The Medicine and Health Library, Library Section for Research Support, Data and Analysis, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Petter Bjørnsen
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Minnis H. Abuse, neglect and neurodevelopment across the life course: what can paediatricians and child psychiatrists do about this together? The Illingworth-Rees keynote lecture 2023. Arch Dis Child 2024; 109:533-535. [PMID: 37788885 DOI: 10.1136/archdischild-2023-325942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023]
Abstract
Paediatricians and child psychiatrists share complex cases, often associated with abuse, neglect and other 'Adverse Childhood Experiences (ACEs)'. ACEs are associated in a dose-response relationship with both mental and physical health problems across the life span. We found that 9-year-old children who had been abused and neglected were much more likely to also have symptoms of heritable neurodevelopmental conditions (NDCs) such as ADHD, autism and intellectual disabilities. To our surprise, these were not caused by the abuse and neglect. Instead, both the NDCs and the abuse and neglect were being caused by additional genetic factors. We also found that children who have experienced abuse and neglect, and who also have NDCs, are at twice the risk of developing symptoms of severe mental illness in adolescence. This has caused us to develop our 'Double Jeopardy' hypothesis-that experiencing both abuse and neglect and NDCs in childhood might double the risk of a range of physical and mental health problems across the life span.Both paediatricians and child psychiatrists will be faced with children who have complex problems, and they will sometimes need to work together to solve these-whether or not abuse or neglect is in the mix.Dr Corinne Rees's words were prescient: 'The truth that psychological issues and behaviour are integral to all illness indicates the necessity for every doctor to feel competent in considering their relevance'. As paediatricians and child psychiatrists, let's move forward together to overcome the mind-body dichotomy for the benefit of our patients.
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Affiliation(s)
- Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8TB, UK
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Grant RW, McCloskey JK, Uratsu CS, Ranatunga D, Ralston JD, Bayliss EA, Sofrygin O. Predicting Self-Reported Social Risk in Medically Complex Adults Using Electronic Health Data. Med Care 2024:00005650-990000000-00238. [PMID: 38833715 DOI: 10.1097/mlr.0000000000002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Social barriers to health care, such as food insecurity, financial distress, and housing instability, may impede effective clinical management for individuals with chronic illness. Systematic strategies are needed to more efficiently identify at-risk individuals who may benefit from proactive outreach by health care systems for screening and referral to available social resources. OBJECTIVE To create a predictive model to identify a higher likelihood of food insecurity, financial distress, and/or housing instability among adults with multiple chronic medical conditions. RESEARCH DESIGN AND SUBJECTS We developed and validated a predictive model in adults with 2 or more chronic conditions who were receiving care within Kaiser Permanente Northern California (KPNC) between January 2017 and February 2020. The model was developed to predict the likelihood of a "yes" response to any of 3 validated self-reported survey questions related to current concerns about food insecurity, financial distress, and/or housing instability. External model validation was conducted in a separate cohort of adult non-Medicaid KPNC members aged 35-85 who completed a survey administered to a random sample of health plan members between April and June 2021 (n = 2820). MEASURES We examined the performance of multiple model iterations by comparing areas under the receiver operating characteristic curves (AUCs). We also assessed algorithmic bias related to race/ethnicity and calculated model performance at defined risk thresholds for screening implementation. RESULTS Patients in the primary modeling cohort (n = 11,999) had a mean age of 53.8 (±19.3) years, 64.7% were women, and 63.9% were of non-White race/ethnicity. The final, simplified model with 30 predictors (including utilization, diagnosis, behavior, insurance, neighborhood, and pharmacy-based variables) had an AUC of 0.68. The model remained robust within different race/ethnic strata. CONCLUSIONS Our results demonstrated that a predictive model developed using information gleaned from the medical record and from public census tract data can be used to identify patients who may benefit from proactive social needs assessment. Depending on the prevalence of social needs in the target population, different risk output thresholds could be set to optimize positive predictive value for successful outreach. This predictive model-based strategy provides a pathway for prioritizing more intensive social risk outreach and screening efforts to the patients who may be in greatest need.
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Affiliation(s)
- Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jodi K McCloskey
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Connie S Uratsu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Dilrini Ranatunga
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle WA
| | | | - Oleg Sofrygin
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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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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Yeung HM, Ifrah A, Rockman ME. Quantitative Analysis of Characteristics Associated with Patient-Directed Discharges, Representations, and Readmissions: a Safety-Net Hospital Experience. J Gen Intern Med 2024; 39:1173-1179. [PMID: 38114868 PMCID: PMC11116360 DOI: 10.1007/s11606-023-08563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND No clinical tools currently exist to stratify patients' risks of patient-directed discharge (PDD). OBJECTIVE This study aims to identify trends and factors associated with PDD, representation, and readmission. DESIGN This was an IRB-approved, single-centered, retrospective study. PARTICIPANTS Patients aged > 18, admitted to medicine service, were included from January 1st through December 31st, 2019. Patients admitted to ICU or surgical services were excluded. MAIN MEASURES Demographics, insurance information, medical history, social history, rates of events occurrences, and discharge disposition were obtained. KEY RESULTS Of the 16,889 encounters, there were 776 (4.6%) PDDs, 4312 (25.5%) representations, and 2924 (17.3%) readmissions. Of those who completed PDDs, 42.1% represented and 26.4% were readmitted. Male sex, age ≤ 45, insurance type, homelessness, and substance use disorders had higher rates of PDD (OR = 2.0; 4.2; 4.5; 6.2; 5.2; p < 0.0001, respectively). Patients with homelessness, substance use disorders, mental health disorders, or prior history of PDD were more likely to represent (OR = 3.6; 2.0; 2.0; 1.5; p < 0.0001, respectively) and be readmitted (OR = 2.2; 1.6; 1.9; 1.5; p < 0.0001, respectively). Patients aged 30-35 had the highest PDD rate at 16%, but this was not associated with representations or readmissions. Between July and September, the PDD rate peaked at 5.5% and similarly representation and readmission rates followed. The rates of subsequent readmissions after PDDs were nearly two-fold compared to non-PDD patients in later half of the year. 51% of all subsequent readmissions occur within 7 days of PDD, compared to 34% in the non-PDD group (OR = 2.0; p < 0.0001). Patients with primary diagnosis of abscess had 16% PDDs. CONCLUSIONS Factors associated with PDD include male, younger age, insurance type, substance use, homelessness, and primary diagnosis of abscess. Factors associated with representation and readmission are homelessness, substance use disorders, mental health disorders, and prior history of PDD. Further research is needed to develop a risk stratification tool to identify at-risk patients.
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Affiliation(s)
- Ho-Man Yeung
- Department of Medicine, Section in Hospital Medicine, Temple University Hospital, Lewis Katz School of Medicine at Temple University, Philadelphia, USA.
| | - Abraham Ifrah
- Department of Medicine, Section in Hospital Medicine, Temple University Hospital, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
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Samuels-Kalow ME, Mayes K, Cash RE, Schiavoni KH, Vogeli C, Thorndike AN, Camargo CA. Missed Screening for Adverse Social Determinants of Health and Emergency Department Utilization. Ann Emerg Med 2024; 83:416-418. [PMID: 38142374 PMCID: PMC10960706 DOI: 10.1016/j.annemergmed.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Katherine Mayes
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Katherine H Schiavoni
- Population Health Management, Mass General Brigham, Somerville, MA; Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Anne N Thorndike
- Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Bybee SG, Sharareh N, Guo JW, Luther B, Grigorian E, Wang CY, Wong B, Wallace AS. A Secondary Data Analysis of Technology Access as a Determinant of Health and Impediment in Social Needs Screening and Referral Processes. AJPM FOCUS 2024; 3:100189. [PMID: 38322000 PMCID: PMC10844665 DOI: 10.1016/j.focus.2024.100189] [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] [Indexed: 02/08/2024]
Abstract
Introduction Although health systems increasingly integrate social needs screening and referrals into routine care, the effectiveness of these interventions and for whom they work remains unclear. Methods Patients (N=4,608) seen in the emergency department were screened for social needs (e.g., transportation, housing, food) and offered an opportunity to receive outreach from community service specialists. Results Among 453 patients with 1 or more social needs who requested assistance, outreach specialists connected with 95 (21.0%). Patients preferred to be contacted through their telephone (n=21, 60.2%), email (n=126, 28.0%), someone else's telephone (n=30, 6.7%), or first by telephone followed by email (n=23, 5.1%). Preferred contact method varied by patient age; endorsement of unmet transportation, housing, and utility needs; receipt of service outreach; and differences in emergency department utilization from the 6 months before the index visit to the 6 months after. Conclusions Because limited access to a stable telephone or internet connection may prevent patients from connecting with resource referrals, social needs interventions may not benefit the most underserved populations who are at the highest risk of negative health outcomes. Future research should investigate whether communication preferences are an important indicator of needs and how to adapt social needs screening and referral processes so that they are more accessible to populations who may experience more frequent disruptions in methods utilized for digital communication.
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Affiliation(s)
- Sara G. Bybee
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Nasser Sharareh
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jia-Wen Guo
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Brenda Luther
- College of Nursing, University of Utah, Salt Lake City, Utah
| | | | - Ching-Yu Wang
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, Utah
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Messineo E, Bouchelle Z, Strange A, Ciarlante A, VonHoltz L, Murray A, Cullen D. Phone Versus In-Person Navigation of Social Needs and Caregivers' Desire for Resources in the Pediatric Emergency Department. Acad Pediatr 2024; 24:461-468. [PMID: 38159598 DOI: 10.1016/j.acap.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To determine the association between in-person versus telephone-based contact by a resource navigator and caregivers' expressed desire for community-based resources to meet social needs in a pediatric emergency department (PED). METHODS This retrospective observational study used data from the PED in a large, metropolitan, academic children's hospital. Families were approached by resource navigators and offered community-based resources either in-person or by phone during waiting periods in the PED exam room. We used descriptive statistics and chi-square analysis to summarize demographics and mode of contact, and simple and multivariable logistic regression to estimate the association between desire for resources and mode of contact. RESULTS Contact was attempted among 4902 caregivers, with 2918 (59.5%) caregivers approached in-person, 1913 (39.0%) approached by phone, and 71 (1.5%) with no mode of contact recorded. Resource navigators successfully reached 2738 (93.8%) caregivers approached in-person and 1432 (74.9%) caregivers approached by phone. Of caregivers successfully reached, 782 (18.8%) desired resources; 526 (19.2%) in-person, and 256 (17.9%) by phone. Caregivers contacted by phone were no more or less likely to desire resources than caregivers contacted in-person in unadjusted (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.78-1.08) and adjusted analyses (OR = 0.92, 95% CI = 0.77-1.09). CONCLUSIONS Within a large, urban PED, caregivers' expressed desire for community-based resources was no different whether a caregiver was engaged in-person or by phone. This suggests caregivers may be equally receptive to discussing social needs and community-based resources remotely versus in-person. More work is needed to examine if rates of resource connection differ by mode of contact.
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Affiliation(s)
- Elizabeth Messineo
- Children's Hospital at Montefiore (E Messineo), Montefiore Medical Center, Bronx, NY.
| | - Zoe Bouchelle
- National Clinician Scholars Program (Z Bouchelle), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Pediatrics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab (Z Bouchelle and D Cullen), Children's Hospital of Philadelphia, Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Alder Strange
- Perelman School of Medicine (A Strange), University of Pennsylvania, Philadelphia, Pa.
| | - Alyssa Ciarlante
- Center for Healthcare Quality and Analytics (A Ciarlante), Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Lauren VonHoltz
- Department of Pediatrics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Ashlee Murray
- Department of Pediatrics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Violence Prevention (A Murray), Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Danielle Cullen
- Department of Pediatrics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab (Z Bouchelle and D Cullen), Children's Hospital of Philadelphia, Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Clinical Futures (D Cullen), Children's Hospital of Philadelphia Research Institute, Philadelphia, Pa. Dr Messineo is now with 3450 Wayne Ave, Apt 11D, Bronx, NY, 10467..
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Wadhwani SI, Kruse G, Squires J, Ebel N, Gupta N, Campbell K, Hsu E, Zielsdorf S, Vittorio J, Desai DM, Bucuvalas JC, Gottlieb LM, Lai JC. Caregiver Perceptions of Social Risk Screening in Pediatric Liver Transplantation: From the Multicenter SOCIAL-Tx Study. Transplantation 2024; 108:940-946. [PMID: 37831642 PMCID: PMC10963151 DOI: 10.1097/tp.0000000000004835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
BACKGROUND The social determinants of health contribute to adverse post-liver transplant outcomes. Identifying unmet social risks may enable transplant teams to improve long-term outcomes for at-risk children. However, providers may feel uncomfortable asking about household-level social risks in the posttransplant period because they might make their patients/families uncomfortable. METHODS We conducted a mixed-methods analysis of caregiver participants (ie, parents/guardians of pediatric liver transplant recipients) in the Social and Contextual Impact on Children Undergoing Liver Transplantation study to assess their perceptions of provider-based social risk screening. Participants (N = 109) completed a 20-min social determinants of health questionnaire that included questions on the acceptability of being asked intimate social risk questions. A subset of participants (N = 37) engaged in an in-depth qualitative interview to share their perceptions of social risk screening. RESULTS Of 109 participants across 9 US transplant centers, 60% reported financial strain and 30% reported at least 1 material economic hardship (eg, food insecurity, housing instability). Overall, 65% of respondents reported it very or somewhat appropriate and 25% reported being neutral to being screened for social risks in a liver transplant setting. In qualitative analyses, participants reported trust in the providers and a clear understanding of the intention of the screening as prerequisites for liver transplant teams to perform social risk screening. CONCLUSIONS Only a small minority of caregivers found social risk screening unacceptable. Pediatric liver transplant programs should implement routine social risk screening and prioritize the patient and family voices when establishing a screening program to ensure successful implementation.
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Affiliation(s)
| | - Gina Kruse
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James Squires
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | - Evelyn Hsu
- Seattle Children’s Hospital, Seattle, WA
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Patel MR, Zhang G, Heisler M, Piette JD, Resnicow K, Choe HM, Shi X, Song P. A Randomized Controlled Trial to Improve Unmet Social Needs and Clinical Outcomes Among Adults with Diabetes. J Gen Intern Med 2024:10.1007/s11606-024-08708-8. [PMID: 38467918 DOI: 10.1007/s11606-024-08708-8] [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: 09/06/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Adults with type 1 or type 2 diabetes often face financial challenges and other unmet social needs to effective diabetes self-management. OBJECTIVE Whether a digital intervention focused on addressing socioeconomic determinants of health improves diabetes clinical outcomes more than usual care. DESIGN Randomized trial from 2019 to 2023. PARTICIPANTS A total of 600 adults with diabetes, HbA1c ≥ 7.5%, and self-reported unmet social needs or financial burden from a health system and randomized to the intervention or standard care. INTERVENTION CareAvenue is an automated, e-health intervention with eight videos that address unmet social needs contributing to poor outcomes. MEASURES Primary outcome was HbA1c, measured at baseline, and 6 and 12 months after randomization. Secondary outcomes included systolic blood pressure and reported met social needs, cost-related non-adherence (CRN), and financial burden. We examined main effects and variation in effects across predefined subgroups. RESULTS Seventy-eight percent of CareAvenue participants completed one or more modules of the website. At 12-month follow-up, there were no significant differences in HbA1c changes between CareAvenue and control group (p = 0.24). There were also no significant between-group differences in systolic blood pressure (p = 0.29), met social needs (p = 0.25), CRN (p = 0.18), and perceived financial burden (p = 0.31). In subgroup analyses, participants with household incomes 100-400% FPL (1.93 (SE = 0.76), p < 0.01), 201-400% FPL (1.30 (SE = 0.62), p < 0.04), and > 400% FPL (1.27 (SE = 0.64), p < 0.05) had significantly less A1c decreases compared to the control group. CONCLUSIONS On average, CareAvenue participants did not achieve better A1c lowering, met needs, CRN, or perceived financial burden compared to control participants. CareAvenue participants with higher incomes achieved significantly less A1c reductions than control. Further research is needed on social needs interventions that consider tailored approaches to population subgroups. CLINICAL TRIALS REGISTRY ClinicalTrials.gov ID NCT03950973, May 2019.
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Affiliation(s)
- Minal R Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Guanghao Zhang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Michele Heisler
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
- U.S. Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - John D Piette
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- U.S. Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Kenneth Resnicow
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Hae-Mi Choe
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Medical Group, Ann Arbor, MI, USA
| | - Xu Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Peter Song
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Egan KA, Xuan Z, Hofman M, Ma Shum J, Fernández-Pastrana I, Fiechtner L, Sandel M, Buitron de la Vega P, Kistin CJ, Hsu H. Food Pantry Referral and Utilization in a Pediatric Primary Care Clinic. Am J Prev Med 2024; 66:444-453. [PMID: 37813171 PMCID: PMC10922354 DOI: 10.1016/j.amepre.2023.10.006] [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: 06/29/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION This study aimed to characterize progression from screening for food insecurity risk to on-site food pantry referral to food pantry utilization in pediatric primary care. METHODS This retrospective study included 14,280 patients aged 0-21 years with ≥1 pediatric primary care visit from March 2018 to February 2020. Analyses were conducted in 2020-2022 using multivariable regression to examine patient-level demographic, clinical, and socioeconomic characteristics and systems-related factors associated with progression from screening positive for food insecurity risk to food pantry referral to completing ≥1 food pantry visit. RESULTS Of patients screened for food insecurity risk, 31.9% screened positive; 18.5% of food-insecure patients received an on-site food pantry referral. Among patients referred, 28.9% visited the food pantry. In multivariable models, higher odds of referral were found for patients living near the clinic (AOR=1.28; 95% CI=1.03, 1.59), for each additional health-related social need reported (AOR=1.23; 95% CI=1.16, 1.29), and when the index clinic encounter occurred during food pantry open hours (AOR=1.62; 95% CI=1.30, 2.02). Higher odds of food pantry visitation were found for patients with a preferred language of Haitian Creole (AOR=2.16; 95% CI=1.37, 3.39), for patients of Hispanic race/ethnicity (AOR=3.67; 95% CI=1.14, 11.78), when the index encounter occurred during food pantry open hours (AOR=1.96; 95% CI=1.25, 3.07), for patients with a clinician letter referral (AOR=6.74; 95% CI=3.94, 11.54), or for patients with a referral due to a screening-identified food emergency (AOR=2.27; 95% CI=1.30, 3.96). CONCLUSIONS There was substantial attrition along the pathway from screening positive for food insecurity risk to food pantry referral and utilization as well as patient-level characteristics and systems-related factors associated with successful referrals and utilization.
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Affiliation(s)
- Kelsey A Egan
- Division of Health Services Research, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Melissa Hofman
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Julio Ma Shum
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | - Lauren Fiechtner
- Division of General Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts; Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, Massachusetts; The Greater Boston Food Bank, Boston, Massachusetts
| | - Megan Sandel
- Division of Health Services Research, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Pablo Buitron de la Vega
- Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Caroline J Kistin
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
| | - Heather Hsu
- Division of Health Services Research, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Fakeye MK, Overman J, Bhatt J, O'Donnell MK, Burleson J. Public health and social entrepreneurs as activators of equitable health ecosystems. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2024; 12:100735. [PMID: 38401371 DOI: 10.1016/j.hjdsi.2024.100735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/28/2024] [Accepted: 02/06/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To describe approaches that public health and social entrepreneurs take to address health equity, and identify strategies for equitable collaborations with these entrepreneurs. METHODS We leveraged data from semi-structured interviews, conducted August to October 2022, with 20 public health and social entrepreneurs who focus on drivers of health and health equity. Two researchers employed content analysis, guided by a prior framework. RESULTS To support health equity, public health and social entrepreneurs: center equity, critique biases, innovate for inclusion, engage translational expertise, catalyze capacity, and activate equitable systems. Equitable collaborations are supported by re-examining roles, de-conflicting organizational barriers, prioritizing representation, mitigating bias in generating evidence, and employing equitable capital. CONCLUSIONS Public health and social entrepreneurs can uplift equity across health service design and delivery. More equitable collaborations can advance this work.
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Affiliation(s)
| | | | - Jay Bhatt
- Health Equity Institute, Deloitte, USA; Center for Health Solutions, Deloitte, USA.
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Rucker A, Watson A, Badolato G, Jarvis L, Patel SJ, Goyal MK. Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial. J Adolesc Health 2024; 74:292-300. [PMID: 37804303 DOI: 10.1016/j.jadohealth.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Adolescent emergency department (ED) patients have unmet social needs that contribute to ED use. This study aimed to evaluate the effect of social needs navigation for adolescents on subsequent ED visits and community resource use and to identify characteristics associated with elevated social risk. METHODS Between July 2017 and August 2019, we used a random date generator to establish intervention and control group enrollment dates. All adolescents completed a social needs survey. Adolescents enrolled on intervention dates received in-person, risk-tailored social needs navigation. Those enrolled on control dates received a preprinted resource guide. We used chart review and follow-up calls to assess 12-month ED revisits and community resource use. Logistic regression was used to compare these outcomes between groups. We measured the association between ≥3 reported unmet needs and characteristics hypothesized a priori to be associated with elevated social risk (nonurgent visits, obesity, or any of nine "socially sensitive" chief complaints) using logistic regression. RESULTS A total of 399 adolescents were randomized. There was no difference between groups in the number of ED revisits. There was increased community resource use in the intervention group (adjusted odds ratio [aOR]: 3.5 [95% confidence interval {CI}: 1.5, 8.2]). Adolescents with a socially sensitive chief complaint had increased odds of ≥3 unmet needs (aOR: 2.2 [95% CI: 1.3, 3.6]), as did those with food insecurity in a post hoc analysis (aOR: 9.9 [95% CI: 4.0, 24.6]). DISCUSSION Social needs navigation increased community resource use but not subsequent ED visits. Adolescents with socially sensitive chief complaints or food insecurity reported increased unmet needs.
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Affiliation(s)
- Alexandra Rucker
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C.
| | - Ar'Reon Watson
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C
| | - Gia Badolato
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C
| | - Lenore Jarvis
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
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16
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Garcia C, Doran K, Kushel M. Homelessness And Health: Factors, Evidence, Innovations That Work, And Policy Recommendations. Health Aff (Millwood) 2024; 43:164-171. [PMID: 38315930 DOI: 10.1377/hlthaff.2023.01049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, we highlight structural and individual risk factors that can lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations. Health system efforts to address homelessness and improve the health of homeless populations have included interventions such as screening for social needs and medical respite programs. Initiatives using the Housing First approach to permanent supportive housing have a strong track record of success. Health care financing innovations using Medicaid Section 1115 waivers offer promising new approaches to improving health and housing for people experiencing homelessness. To substantially reduce homelessness and its many adverse health impacts, changes are needed to increase the supply of affordable housing for households with very low incomes. Health care providers and systems should leverage their political power to advocate for policies that scale durable, evidence-based solutions to reduce homelessness, including increased funding to expand housing choice vouchers and greater investment in the creation and preservation of affordable housing.
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Affiliation(s)
- Cheyenne Garcia
- Cheyenne Garcia, University of California San Francisco, San Francisco, California
| | - Kelly Doran
- Kelly Doran, New York University, New York, New York
| | - Margot Kushel
- Margot Kushel , University of California San Francisco
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17
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Msw RET, Warner L, Shy BD, Manikowski C, Roosevelt GE. A descriptive study of screening and navigation on health-related social needs in a safety-net hospital emergency department. Am J Emerg Med 2023; 74:65-72. [PMID: 37778164 DOI: 10.1016/j.ajem.2023.09.007] [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: 06/22/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Health-related social needs (HRSN) have been associated with worse clinical outcomes, increased Emergency Department (ED) utilization and higher healthcare costs. The ED is uniquely positioned to bring HRSN screening to the bedside and develop effective interventions. We evaluated whether navigation services for high-risk patients led to the resolution of HRSN. METHODS Navigators screened a convenience sample of patients for HRSN with the Accountable Health Communities Screening Tool from October 2019 to January 2022. Patients with HRSN were considered high-risk if they had at least two ED visits in the previous 12 months. Patients who were high-risk were eligible for navigation including community referrals and one-on-one close follow-up. The HRSN status (resolved, in-progress, unable to resolve) was queried from the Centers for Medicare and Medicaid database. The state hospital association provided data on ED visits and inpatient hospitalizations within 6 months of the screening visit. RESULTS Of 185,470 ED visits, HRSN screening occurred in 4050 (2%). HRSN were self-reported in 48% (1944) of patient visits, with 71% of these (1379) considered high-risk. 15% of high-risk patients with HRSN opted out of navigation. Food insecurity was the most identified HRSN (35%) followed by housing instability (26%), transportation needs (24%) and utility assistance (15%). Food insecurity was the most resolved HRSN (39%, in-progress 32%) followed by utility assistance (37%, in-progress 26%), transportation needs (35%, in-progress 35%) and housing instability (28%, in-progress 36%). High-risk visits in which the patient or guardian accepted navigation were less likely to be associated with an ED visit within 6 months of the screening visit (51%) compared to high-risk patients in which the patient or guardian opted out of navigation (61%, p < 0.001), but there was no difference in inpatient hospitalizations (p = 0.427). CONCLUSIONS During the study period, one-third of HRSN were successfully resolved with another one-third in-progress. Navigation in high-risk patients was associated with fewer subsequent ED visits.
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Affiliation(s)
- Ruth Ellen Tubbs Msw
- Previous/Main: Denver Regional Council of Governments, 1001 17(th) Street, Suite 700, Denver, CO 80202, USA
| | - Leah Warner
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
| | - Bradley D Shy
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
| | - Christine Manikowski
- Previous/Main: Denver Regional Council of Governments, 1001 17(th) Street, Suite 700, Denver, CO 80202, USA
| | - Genie E Roosevelt
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
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Hempel S, Bolshakova M, Hochman M, Jimenez E, Thompson G, Motala A, Ganz DA, Gabrielian S, Edwards S, Zenner J, Dennis B, Chang E. Caring for high-need patients. BMC Health Serv Res 2023; 23:1289. [PMID: 37996845 PMCID: PMC10668484 DOI: 10.1186/s12913-023-10236-w] [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: 02/27/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE We aimed to explore the construct of "high need" and identify common need domains among high-need patients, their care professionals, and healthcare organizations; and to describe the interventions that health care systems use to address these needs, including exploring the potential unintended consequences of interventions. METHODS We conducted a modified Delphi panel informed by an environmental scan. Expert stakeholders included patients, interdisciplinary healthcare practitioners (physicians, social workers, peer navigators), implementation scientists, and policy makers. The environmental scan used a rapid literature review and semi-structured interviews with key informants who provide healthcare for high-need patients. We convened a day-long virtual panel meeting, preceded and followed by online surveys to establish consensus. RESULTS The environmental scan identified 46 systematic reviews on high-need patients, 19 empirical studies documenting needs, 14 intervention taxonomies, and 9 studies providing construct validity for the concept "high need." Panelists explored the construct and terminology and established that individual patients' needs are unique, but areas of commonality exist across all high-need patients. Panelists agreed on 11 domains describing patient (e.g., social circumstances), 5 care professional (e.g., communication), and 8 organizational (e.g., staffing arrangements) needs. Panelists developed a taxonomy of interventions with 15 categories (e.g., care navigation, care coordination, identification and monitoring) directed at patients, care professionals, or the organization. The project identified potentially unintended consequences of interventions for high-need patients, including high costs incurred for patients, increased time and effort for care professionals, and identification of needs without resources to respond appropriately. CONCLUSIONS Care for high-need patients requires a thoughtful approach; differentiating need domains provides multiple entry points for interventions directed at patients, care professionals, and organizations. Implementation efforts should consider outlined intended and unintended downstream effects on patients, care professionals, and organizations.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA.
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Michael Hochman
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gina Thompson
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - David A Ganz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | | | - James Zenner
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Ben Dennis
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Evelyn Chang
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Yeh SCJ, Wang WC, Yu HC, Wu TY, Lo YY, Shi HY, Chou HC. Relationship between using cancer resource center services and patient outcomes. Support Care Cancer 2023; 31:706. [PMID: 37975908 DOI: 10.1007/s00520-023-08169-5] [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: 04/28/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Psychological and social support are crucial in treating cancer. Cancer resource centers provide patients with cancer and their families with services that can help them through cancer treatment, ensure that patients receive adequate treatment, and reduce cancer-related stress. These centers offer various services, including medical guidance, health education, emotional assistance (e.g., consultations for cancer care), and access to resources such as financial aid and post recovery programs. In this study, we comprehensively analyzed how cancer resource centers assist patients with cancer and improve their clinical outcomes. METHODS The study participants comprised patients initially diagnosed with head and neck cancer or esophageal cancer. A total of 2442 patients from a medical center in Taiwan were included in the study. Data were analyzed through logistic regression and Cox proportional hazards regression. RESULTS The results indicate that unemployment, blue-collar work, and a lower education level were associated with higher utilization of cancer resource center services. The patients who were unemployed or engaged in blue-collar work had higher risks of mortality than did their white-collar counterparts. Patient education programs can significantly improve the survival probability of patients with cancer. On the basis of our evaluation of the utilization and benefits of services provided by cancer resource centers, we offer recommendations for improving the functioning of support systems for patients with cancer and provide suggestions for relevant future research. CONCLUSIONS We conclude that cancer resource centers provide substantial support for patients of low socioeconomic status and improve patients' survival.
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Institute of Health Care Management & Department of Business Management, National Sun Yat-Sen University, 70 Lian Hai Road, Kaohsiung, 80424, Taiwan.
| | - Wen Chun Wang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hsien-Chung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tzu-Yu Wu
- National Taiwan University Hospital Research Ethics Committee Office, Taipei, Taiwan
| | - Ying-Ying Lo
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsueh-Chih Chou
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Takada S, Shen Z, Bourgois P, Duru OK, Gelberg L, Han M, Javanbakht M, Shoptaw S, Wells K, Ryan G. A Qualitative Study of Perceptions and Preferences Regarding Social and Behavioral Risk Screening Among Primary Care Patients. J Gen Intern Med 2023; 38:3171-3179. [PMID: 37578623 PMCID: PMC10651619 DOI: 10.1007/s11606-023-08344-8] [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: 12/14/2022] [Accepted: 07/18/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Despite its relevance for healthcare settings, social and behavioral risk screening is not systematically performed by clinicians or healthcare systems. OBJECTIVE To address clinician concerns, such as social and behavioral risk screening disrupting the clinician-patient relationship and lack of resources to respond, we interviewed primary care patients at an academic medical center regarding their perceptions and preferences on social and behavioral risk screening. PARTICIPANTS Between September and December 2020, we recruited a convenience sample of 14 English-speaking primary care patients 18 years + from three clinics affiliated with an academic medical center. APPROACH Using a semi-structured interview guide, we asked about the importance of social and behavioral risk screening, whether or not and how to share social and behavioral risk factors, and how social and behavioral risk factors are addressed. We used a multi-step analytic process to identify the range and commonality of participants' responses thematically. KEY RESULTS Participants recognized that social and behavioral risk factor domains were relevant to primary care and important for treating the patient as a whole person. Participants preferred a conversation regarding social and behavioral risk factor with their primary care providers (PCPs), and suggested that, if surveys are used, they be followed with an open-ended, in-person discussion. Participants also suggested framing the discussion as something that is done routinely with all patients so that patients do not feel judged. Participants felt comfortable sharing social and behavioral risk factors when they trusted their PCPs, and felt that discussing social and behavioral risk factors with their PCPs built trust. Participants recognized that resources exist outside of the clinic, and suggested that PCPs distribute lists of relevant community resources to patients. CONCLUSION In our study of primary care patients on perceptions and preferences about screening and addressing social and behavioral risk factors, we found that patients were willing to share social and behavioral risk factors with their PCP, preferred an in-person discussions with or without a survey, and wanted a list of community resources to address their needs.
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Affiliation(s)
- Sae Takada
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- VA Greater Los Angeles Health System, Los Angeles, CA, USA.
| | - Zewei Shen
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Anthropology, University of California, Los Angeles, CA, USA
| | - O Kenrik Duru
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Office of Health Care Transformation and Innovation, VA Greater Los Angeles Health System, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Maria Han
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kenneth Wells
- VA Greater Los Angeles Health System, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Gery Ryan
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Russell LE, Cohen AJ, Chrzas S, Halladay CW, Kennedy MA, Mitchell K, Moy E, Lehmann LS. Implementing a Social Needs Screening and Referral Program Among Veterans: Assessing Circumstances & Offering Resources for Needs (ACORN). J Gen Intern Med 2023; 38:2906-2913. [PMID: 37165261 PMCID: PMC10171907 DOI: 10.1007/s11606-023-08181-9] [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: 11/18/2022] [Accepted: 03/17/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND The Department of Veterans Affairs (VA) healthcare system routinely screens Veterans for food insecurity, housing instability, and intimate partner violence, but does not systematically screen for other health-related social needs (HRSNs). OBJECTIVES To (1) develop a process for systematically identifying and addressing Veterans' HRSNs, (2) determine reported prevalence of HRSNs, and (3) assess the acceptability of HRSN screening among Veterans. DESIGN "Assessing Circumstances and Offering Resources for Needs" (ACORN) is a Veteran-tailored HRSN screening and referral quality improvement initiative. Veterans were screened via electronic tablet for nine HRSNs (food, housing, utilities, transportation, legal needs, social isolation, interpersonal violence, employment, and education) and provided geographically tailored resource guides for identified needs. Two-week follow-up interviews with a purposive sample of Veterans explored screening experiences. PARTICIPANTS Convenience sample of Veterans presenting for primary care at a VA urban women's health clinic and suburban community-based outpatient clinic (October 2019-May 2020). MAIN MEASURES Primary outcomes included prevalence of HRSNs, Veteran-reported acceptability of screening, and use of resources guides. Data were analyzed using descriptive statistics, chi-square tests, and rapid qualitative analysis. KEY RESULTS Of 268 Veterans screened, 50% reported one or more HRSNs. Social isolation was endorsed most frequently (29%), followed by educational needs (19%), interpersonal violence (12%), housing instability (9%), and utility concerns (7%). One in five Veterans reported at least one form of material hardship. In follow-up interviews (n = 15), Veterans found screening acceptable and felt VA should continue screening. No Veterans interviewed had contacted recommended resources at two-week follow-up, although several planned to use resource guides in the future. CONCLUSION In a VA HRSN screening and referral program, Veterans frequently reported HRSNs, felt screening was important, and thought VA should continue to screen for these needs. Screening for HRSNs is a critical step towards connecting patients with services, identifying gaps in service delivery, and informing future resource allocation.
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Affiliation(s)
- Lauren E Russell
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA.
| | - Alicia J Cohen
- VA Health Services Research & Development (HSR&D) Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, RI, USA
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Steven Chrzas
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher W Halladay
- VA Health Services Research & Development (HSR&D) Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, RI, USA
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kathleen Mitchell
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
| | - Ernest Moy
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA
| | - Lisa Soleymani Lehmann
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
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22
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Foster AA, Stoll J, Daly CJ, Clark CM, Sethi S, Jacobs DM. Patient and social factors related to nebulizer use in COPD patients at the transition of care: a qualitative study. BMC Pulm Med 2023; 23:358. [PMID: 37740178 PMCID: PMC10517547 DOI: 10.1186/s12890-023-02651-w] [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: 05/15/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Transition from hospital to home is a vulnerable period for patients with COPD exacerbations, with a high risk for readmission and mortality. Twenty percent of patients with an initial hospitalization for a COPD exacerbation are readmitted to a hospital within 30 days, costing the health care system over $15 billion annually. While nebulizer therapy directed at some high-risk COPD patients may improve the transition from hospital to home, patient and social factors are likely to contribute to difficulties with their use. Current literature describing the COPD patient's experience with utilizing nebulizer therapy, particularly during care transitions, is limited. Therefore, the objective of this study was to explore underlying COPD patient and social factors contributing to practical difficulties with nebulizer use at the care transition from hospital to home. METHODS This was a qualitative study conducted between September 2020 and June 2022. Patients were included if they were ≥ 40 years old, had a current diagnosis of COPD, had an inpatient admission at a hospital, and were discharged directly to home with nebulizer therapy. Semi-structured, one-on-one interviews with patients were conducted covering a broad range of patient and social factors and their relationships with nebulizer use and readmission. Interviews were recorded and transcribed verbatim. A thematic analysis was performed using a mixed inductive and deductive approach. RESULTS Twenty-one interviews were conducted, and subjects had a mean age of 64 ± 8.4 years, 62% were female, and 76% were White. The predominant interview themes were health care system interactions and medication management. The interviews highlighted that discharge counseling methods and depth of counseling from hospitals were inconsistent and were not always patient-friendly. They also suggested that patients could appropriately identify, set up, and utilize their nebulizer treatment without difficulties, but additional patient education is required for nebulizer clean up and maintenance. CONCLUSIONS Our interviews suggest that there is room for improvement within the health care system for providing consistent, effective discharge counseling. Also, COPD patients discharged from a hospital on nebulizer therapy can access and understand their treatment but require additional education for nebulizer clean up and maintenance.
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Affiliation(s)
- Amanda A Foster
- Department of Pharmacy Practice, Wegmans School of Pharmacy, St. John Fisher University, Rochester, NY, USA
| | - Jennifer Stoll
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Christopher J Daly
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 316 Pharmacy Building, Buffalo, NY, 14214, USA
| | - Collin M Clark
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 316 Pharmacy Building, Buffalo, NY, 14214, USA
| | - Sanjay Sethi
- Department of Pulmonary, Critical Care, and Sleep Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - David M Jacobs
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 316 Pharmacy Building, Buffalo, NY, 14214, USA.
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23
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Vanjani R, Reddy N, Giron N, Bai E, Martino S, Smith M, Harrington-Steppen S, Trimbur MC. The Social Determinants of Health - Moving Beyond Screen-and-Refer to Intervention. N Engl J Med 2023; 389:569-573. [PMID: 37590456 DOI: 10.1056/nejmms2211450] [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] [Indexed: 08/19/2023]
Affiliation(s)
- Rahul Vanjani
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Neha Reddy
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Nicole Giron
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Eric Bai
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Sarah Martino
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Megan Smith
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Suzanne Harrington-Steppen
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - M Catherine Trimbur
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
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24
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Patel MR, Anthony Tolentino D, Smith A, Heisler M. Economic burden, financial stress, and cost-related coping among people with uncontrolled diabetes in the U.S. Prev Med Rep 2023; 34:102246. [PMID: 37252071 PMCID: PMC10209691 DOI: 10.1016/j.pmedr.2023.102246] [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: 09/18/2022] [Revised: 01/02/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Granular information on material deprivation including financial and economic well-being among people with diabetes can better inform policy, practice and interventions to support diabetes management. The purpose of this study was to describe in-depth the state of economic burden, financial stress, and coping among people with high A1c. Data came from the 2019-2021 baseline assessment in an ongoing U.S. trial that addresses social determinants of health among people with diabetes and high A1c who report at least one financial burden or cost-related non-adherence (CRN) (n = 600). Mean age of participants was 53 years. Planning behaviors were the most common financial well-being behavior, while savings was least frequently endorsed. Nearly a quarter of participants report spending more than $300 per month out-of-pocket to manage all of their health conditions. Participants reported spending the most out-of-pocket on medications (52%), special foods (40%), doctor's visits (27%), and blood glucose supplies (22%). Along with health insurance, these were also the most cited as sources of financial stress and where assistance. Seventy-two percent reported high levels of financial stress. Maladaptive coping was evident through CRN, and less than half engaged in adaptive coping such as talking to a doctor about cost or using a resource to address their needs. Economic burden, financial stress, and cost-related coping are highly relevant constructs among people with diabetes and high A1cs. More evidence-generation is needed for diabetes self-management programs to address sources of financial stress, facilitate behaviors to enhance financial well-being, and address unmet social needs to alleviate economic burdens.
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Affiliation(s)
- Minal R. Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States
| | | | - Alyssa Smith
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States
| | - Michele Heisler
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States
- Department of Internal Medicine, Michigan Medicine, United States
- U.S. Department of Veterans Affairs VA Ann Arbor Healthcare System, United States
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25
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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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26
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Norris KC, Williams SF, Nee R. Flattening the Playing Field for Treatment of Diabetic Kidney Disease. Semin Nephrol 2023; 43:151428. [PMID: 37865981 DOI: 10.1016/j.semnephrol.2023.151428] [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: 10/24/2023]
Abstract
Diabetic kidney disease (DKD) remains a major health care issue and is beset with significant racial and ethnic disparities in regard to its incidence, progression, and complication rate. An individual's health is influenced strongly by an array of societal-level factors commonly called the social determinants of health. Among these, DKD is influenced highly by structured resources and opportunities, as well as an individual's socioeconomic status, health insurance status, access to care, education, health literacy, nutrition, green space exposure, level of trust in the medical community, and more. Health equity is considered a state in which everyone has a fair and just opportunity to attain his or her highest level of health. Conversely, health inequities are a consequence of a structured discriminatory system of inequitable allocation of social determinants of health. When this discriminatory system is race-based it is referred to as structural racism, which eventually leads to racial and ethnic health disparities. The further downstream sequela of structural racism, consciously or unconsciously, impacts health systems, providers, and patients, and can lead to disparities in DKD development, progression, and complications. In this article, we explore potential interventions at the societal, health system, and provider levels that can help flatten the playing field and reduce racial and ethnic disparities in DKD.
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Affiliation(s)
- Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
| | - Sandra F Williams
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Department of Medicine, Uniformed Services University, Bethesda, MD
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27
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Steeves-Reece AL, Davis MM, Hiebert Larson J, Major-McDowall Z, King AE, Nicolaidis C, Goldberg B, Richardson DM, Lindner S. Patients' Willingness to Accept Social Needs Navigation After In-Person versus Remote Screening. J Am Board Fam Med 2023; 36:229-239. [PMID: 36868871 PMCID: PMC10476619 DOI: 10.3122/jabfm.2022.220259r1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Social needs screening and referral interventions are increasingly common in health care settings. Although remote screening offers a potentially more practical alternative to traditional in-person screening, there is concern that screening patients remotely could adversely affect patient engagement, including interest in accepting social needs navigation. METHODS We conducted a cross-sectional study using a multivariable logistic regression analysis and data from the Accountable Health Communities (AHC) model in Oregon. Participants were Medicare and Medicaid beneficiaries in the AHC model from October 2018 through December 2020. The outcome variable was patients' willingness to accept social needs navigation assistance. We included an interaction term (total number of social needs + screening mode) to test whether in-person versus remote screening was an effect modifier. RESULTS The study included participants who screened positive for ≥1 social need(s); 43% were screened in person and 57% remotely. Overall, 71% of participants were willing to accept help with social needs. Neither screening mode nor interaction term were significantly associated with willingness to accept navigation assistance. CONCLUSIONS Among patients presenting with similar numbers of social needs, results indicate that type of screening mode may not adversely affect patients' willingness to accept health care-based navigation for social needs.
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Affiliation(s)
- Anna Louise Steeves-Reece
- From the Oregon Health & Science University-Portland State University School of Public Health, Portland, OR (ALS, MMD, DMR, SL); Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR (ALS, JHL, ZM, AEK, BG, MMD); Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (MMD); School of Social Work, Portland State University, Portland, OR (CN); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (CN); Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (SL).
| | - Melinda Marie Davis
- From the Oregon Health & Science University-Portland State University School of Public Health, Portland, OR (ALS, MMD, DMR, SL); Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR (ALS, JHL, ZM, AEK, BG, MMD); Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (MMD); School of Social Work, Portland State University, Portland, OR (CN); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (CN); Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (SL)
| | - Jean Hiebert Larson
- From the Oregon Health & Science University-Portland State University School of Public Health, Portland, OR (ALS, MMD, DMR, SL); Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR (ALS, JHL, ZM, AEK, BG, MMD); Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (MMD); School of Social Work, Portland State University, Portland, OR (CN); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (CN); Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (SL)
| | - Zoe Major-McDowall
- From the Oregon Health & Science University-Portland State University School of Public Health, Portland, OR (ALS, MMD, DMR, SL); Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR (ALS, JHL, ZM, AEK, BG, MMD); Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (MMD); School of Social Work, Portland State University, Portland, OR (CN); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (CN); Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (SL)
| | - Anne Elizabeth King
- From the Oregon Health & Science University-Portland State University School of Public Health, Portland, OR (ALS, MMD, DMR, SL); Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR (ALS, JHL, ZM, AEK, BG, MMD); Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (MMD); School of Social Work, Portland State University, Portland, OR (CN); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (CN); Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (SL)
| | - Christina Nicolaidis
- From the Oregon Health & Science University-Portland State University School of Public Health, Portland, OR (ALS, MMD, DMR, SL); Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR (ALS, JHL, ZM, AEK, BG, MMD); Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (MMD); School of Social Work, Portland State University, Portland, OR (CN); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (CN); Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (SL)
| | - Bruce Goldberg
- From the Oregon Health & Science University-Portland State University School of Public Health, Portland, OR (ALS, MMD, DMR, SL); Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR (ALS, JHL, ZM, AEK, BG, MMD); Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (MMD); School of Social Work, Portland State University, Portland, OR (CN); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (CN); Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (SL)
| | - Dawn Michele Richardson
- From the Oregon Health & Science University-Portland State University School of Public Health, Portland, OR (ALS, MMD, DMR, SL); Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR (ALS, JHL, ZM, AEK, BG, MMD); Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (MMD); School of Social Work, Portland State University, Portland, OR (CN); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (CN); Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (SL)
| | - Stephan Lindner
- From the Oregon Health & Science University-Portland State University School of Public Health, Portland, OR (ALS, MMD, DMR, SL); Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR (ALS, JHL, ZM, AEK, BG, MMD); Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (MMD); School of Social Work, Portland State University, Portland, OR (CN); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (CN); Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR (SL)
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28
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Chang AY, Bowers S. The Social Determinants of Health and Their Impact on Dermatologic Health, Part 2: Taking Action to Address the Social Determinants of Health. Dermatol Clin 2023; 41:317-324. [PMID: 36933921 DOI: 10.1016/j.det.2022.10.010] [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: 02/05/2023]
Abstract
The social determinants of health (SDoH) impact health and lead to health disparities in a variety of complex and intersecting ways. They are the nonmedical factors that must be addressed to improve health outcomes and achieve greater health equity. The SDoH contribute to dermatologic health disparities and decreasing these disparities requires multilevel action. Part 2 of this 2-part review offers a framework that dermatologists can use to help address the SDoH both at the point of care and in the health care system at large.
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Affiliation(s)
- Aileen Y Chang
- Department of Dermatology, University of California San Francisco, Zuckerberg San Francisco General Hospital, 995 Potrero Avenue, Building 90, Ward 92, San Francisco, CA 94110, USA.
| | - Sacharitha Bowers
- Division of Dermatology, Department of Internal Medicine, Southern Illinois University School of Medicine, 751 North Rutledge Suite 2300, Springfield, IL 62702, USA
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29
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Kraynov L, Quarles A, Kerrigan A, Mayes KD, Mahmoud-Werthmann S, Fockele CE, Duber HC, Doran KM, Lin MP, Cooper RJ, Wang NE. Proceedings from the 2021 SAEM Consensus Conference: Research Priorities for Interventions to Address Social Risks and Needs Identified in Emergency Department Patients. West J Emerg Med 2023; 24:295-301. [PMID: 36976612 PMCID: PMC10047718 DOI: 10.5811/westjem.2022.11.57293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/21/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Emergency departments (ED) function as a health and social safety net, regularly taking care of patients with high social risk and need. Few studies have examined ED-based interventions for social risk and need. METHODS Focusing on ED-based interventions, we identified initial research gaps and priorities in the ED using a literature review, topic expert feedback, and consensus-building. Research gaps and priorities were further refined based on moderated, scripted discussions and survey feedback during the 2021 SAEM Consensus Conference. Using these methods, we derived six priorities based on three identified gaps in ED-based social risks and needs interventions: 1) assessment of ED-based interventions; 2) intervention implementation in the ED environment; and 3) intercommunication between patients, EDs, and medical and social systems. RESULTS Using these methods, we derived six priorities based on three identified gaps in ED-based social risks and needs interventions: 1) assessment of ED-based interventions, 2) intervention implementation in the ED environment, and 3) intercommunication between patients, EDs, and medical and social systems. Assessing intervention effectiveness through patient-centered outcome and risk reduction measures should be high priorities in the future. Also noted was the need to study methods of integrating interventions into the ED environment and to increase collaboration between EDs and their larger health systems, community partners, social services, and local government. CONCLUSION The identified research gaps and priorities offer guidance for future work to establish effective interventions and build relationships with community health and social systems to address social risks and needs, thereby improving the health of our patients.
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Affiliation(s)
- Liliya Kraynov
- Valleywise Health, Department of Emergency Medicine, Phoenix, Arizona
| | - Aaron Quarles
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Andrew Kerrigan
- University of Southern California, Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California
| | | | | | - Callan E Fockele
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Herbert C Duber
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Kelly M Doran
- NYU School of Medicine, Departments of Emergency Medicine and Population Health, New York, New York
| | - Michelle P Lin
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Richelle J Cooper
- David Geffen School of Medicine at UCLA, UCLA Department of Emergency Medicine, Los Angeles
| | - Nancy Ewen Wang
- Stanford University, Department of Emergency Medicine, Stanford, California
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Davis VH, Rodger L, Pinto AD. Collection and Use of Social Determinants of Health Data in Inpatient General Internal Medicine Wards: A Scoping Review. J Gen Intern Med 2023; 38:480-489. [PMID: 36471193 PMCID: PMC9905340 DOI: 10.1007/s11606-022-07937-z] [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: 03/11/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is growing interest in incorporating social determinants of health (SDoH) data collection in inpatient hospital settings to inform patient care. However, there is limited information on this data collection and its use in inpatient general internal medicine (GIM). This scoping review sought to describe the current state of the literature on SDoH data collection and its application to patient care in inpatient GIM settings. METHODS English-language searches on MedLine, Embase, Web of Science, CINAHL, Cochrane, and PsycINFO were conducted from 2000 to April 2021. Studies reporting systematic data collection or use of at least three SDoH, sociodemographic, or social needs variables in inpatient hospital GIM settings were included. Four independent reviewers screened abstracts, and two reviewers screened full-text articles. RESULTS A total of 8190 articles underwent abstract screening and eight were included. A range of SDoH tools were used, such as THRIVE, PRAPARE, WHO-Quality of Life, Measuring Health Equity, and a biopsychosocial framework. The most common SDoH were food security or malnutrition (n=7), followed by housing, transportation, employment, education, income, functional status and disability, and social support (n=5 each). Four of the eight studies applied the data to inform patient care, and three provided community resource referrals. DISCUSSION There is limited evidence to guide the collection and use of SDoH data in inpatient GIM settings. This review highlights the need for integrated care, the role of the electronic health record, and social history taking, all of which may benefit from more robust SDoH data collection. Future research should examine the feasibility and acceptability of SDoH integration in inpatient GIM settings.
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Affiliation(s)
- Victoria H Davis
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Laura Rodger
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
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Peahl AF, Rubin-Miller L, Paterson V, Jahnke HR, Plough A, Henrich N, Moss C, Shah N. Understanding social needs in pregnancy: Prospective validation of a digital short-form screening tool and patient survey. AJOG GLOBAL REPORTS 2023; 3:100158. [PMID: 36922957 PMCID: PMC10009524 DOI: 10.1016/j.xagr.2022.100158] [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: 01/07/2023] Open
Abstract
BACKGROUND Social determinants of health significantly affect health outcomes, yet are infrequently addressed in prenatal care. OBJECTIVE This study aimed to improve the efficiency and experience of addressing social needs in pregnancy through: (1) testing a digital short-form screening tool; and (2) characterizing pregnant people's preferences for social needs screening and management. STUDY DESIGN We developed a digital short-form social determinants of health screening tool from PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences), and a survey to query patients' preferences for addressing social needs. Instruments were administered online to peripartum participants, with equal representation of patients with public and private insurance. We calculated the sensitivity and specificity of the short-form tool vs PRAPARE. Quantitative responses were characterized using descriptive statistics. Free-text responses were analyzed with matrix and thematic coding. Survey data were analyzed by subgroups of historically marginalized populations. RESULTS A total of 215 people completed the survey. Participants were predominantly White (167; 77.7%) and multiparous (145; 67.4%). Unmet social needs were prevalent with both the short-form tool (77.7%) and PRAPARE (96.7%). The sensitivity (79.3%) and specificity (71.4%) of the short-form screener were high for detecting any social need. Most participants believed that it was important for their pregnancy care team to know their social needs (material: 173, 80.5%; support: 200, 93.0%), and over half felt comfortable sharing their needs through in-person or digital modalities if assistance was or was not available (material: 117, 54.4%; support: 122, 56.7%). Free-text themes reflected considerations for integrating social needs in routine prenatal care. Acceptability of addressing social needs in pregnancy was high among all groups. CONCLUSION A digital short-form social determinants of health screening tool performs well when compared with the gold standard. Pregnant people accept social needs as a part of routine pregnancy care. Future work is needed to operationalize efficient, effective, patient-centered approaches to addressing social needs in pregnancy.
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Affiliation(s)
- Alex F Peahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Peahl).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (Dr Peahl).,Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Lily Rubin-Miller
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Victoria Paterson
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (Paterson)
| | - Hannah R Jahnke
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Avery Plough
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Natalie Henrich
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Christa Moss
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Neel Shah
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah).,Harvard Medical School Department of Obstetrics and Gynecology, Boston, MA (Dr Shah)
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Almodóvar AS, Ross E, Nahata MC, Bingham JM. Social needs of dual-enrolled Medicare-Medicaid patients with medication nonadherence in a telehealth medication therapy management program. J Manag Care Spec Pharm 2023; 29:210-215. [PMID: 36705284 PMCID: PMC10387950 DOI: 10.18553/jmcp.2023.29.2.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND: Telehealth services that identify and address the social needs of patients can improve access to health care and social services. The social needs of medication therapy management (MTM)-eligible Medicare-Medicaid dual-enrolled patients are unknown. OBJECTIVE: To describe the social needs of Medicare-Medicaid dual-enrolled patients participating in a telephonic MTM program. METHODS: This study evaluated the findings of a social needs survey implemented within a telehealth MTM program. Surveys were offered telephonically to eligible Medicare-Medicaid patients of one insurance plan who were identified with medication nonadherence between July 13, 2020, and December 31, 2020. This study described patients who completed the survey during provision of a comprehensive medication review (CMR). Questions screened for social needs in the following social determinant of health domains: community and social context, economic stability, and neighborhood and physical environment. Descriptive statistics were used to describe results. RESULTS: Among 461 patients who completed CMRs, 358 completed the social needs survey. The most prevalent needs and concerns identified included lacking support to perform daily activities (165 [47%]), lacking companionship (81 [23%]), feeling left out (71 [20%]), feeling isolated (81 [23%]), not having enough money to pay bills (177 [49%]), worrying about running out of food (77 [22%]), or having run out of food within the last 12 months (81 [23%]). In this sample, 54 (15%) patients reported avoiding a provider visit because of transportation barriers. Certain individuals were without a steady place to live or were worried about losing their home (40 [11%]) and 35 (10%) reported struggling to keep a job. CONCLUSIONS: The identification of social needs among patient populations is necessary to reduce barriers to medication adherence and optimize health care utilization. This study described important social needs identified during the provision of a telehealth CMR among MTM-eligible Medicare-Medicaid dual-enrolled patients. DISCLOSURES: Dr Nahata was supported in part by the Avatar Foundation. Dr Silva Almodóvar works as a research pharmacist within a medication management program, which provides medication therapy management services.
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Affiliation(s)
| | - Emily Ross
- El Rio Community Health Center, Tucson, AZ
| | - Milap C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy, Columbus, OH.,Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine Columbus, OH
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Cené CW, Viswanathan M, Fichtenberg CM, Sathe NA, Kennedy SM, Gottlieb LM, Cartier Y, Peek ME. Racial Health Equity and Social Needs Interventions: A Review of a Scoping Review. JAMA Netw Open 2023; 6:e2250654. [PMID: 36656582 PMCID: PMC9857687 DOI: 10.1001/jamanetworkopen.2022.50654] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Social needs interventions aim to improve health outcomes and mitigate inequities by addressing health-related social needs, such as lack of transportation or food insecurity. However, it is not clear whether these studies are reducing racial or ethnic inequities. OBJECTIVE To understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity. EVIDENCE REVIEW Sources included a scoping review of systematic searches of PubMed and the Cochrane Library from January 1, 1995, through November 29, 2021, expert suggestions, and hand searches of key citations. Eligible studies evaluated interventions addressing social needs; reported behavioral, health, or utilization outcomes or harms; and were conducted in multiracial or multiethnic populations. Two reviewers independently assessed titles, abstracts, and full text for inclusion. The team developed a framework to assess whether the study was "conceptually thoughtful" for understanding root causes of racial health inequities (ie, noted that race or ethnicity are markers of exposure to racism) and whether analyses were "analytically informative" for advancing racial health equity research (ie, examined differential intervention impacts by race or ethnicity). FINDINGS Of 152 studies conducted in multiracial or multiethnic populations, 44 studies included race or ethnicity in their analyses; of these, only 4 (9%) were conceptually thoughtful. Twenty-one studies (14%) were analytically informative. Seven of 21 analytically informative studies reported differences in outcomes by race or ethnicity, whereas 14 found no differences. Among the 7 that found differential outcomes, 4 found the interventions were associated with improved outcomes for minoritized racial or ethnic populations or reduced inequities between minoritized and White populations. No studies were powered to detect differences. CONCLUSIONS AND RELEVANCE In this review of a scoping review, studies of social needs interventions in multiracial or multiethnic populations were rarely conceptually thoughtful for understanding root causes of racial health inequities and infrequently conducted informative analyses on intervention effectiveness by race or ethnicity. Future work should use a theoretically sound conceptualization of how race (as a proxy for racism) affects social drivers of health and use this understanding to ensure social needs interventions benefit minoritized racial and ethnic groups facing social and structural barriers to health.
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Affiliation(s)
- Crystal W. Cené
- Department of Medicine, University of California, San Diego Health, San Diego
- School of Medicine, University of California, San Diego
| | - Meera Viswanathan
- RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, RTI International, Research Triangle Park
| | - Caroline M. Fichtenberg
- University of California, San Francisco Social Intervention Research and Evaluation Network, San Francisco
- School of Medicine, Department of Family and Community Medicine, Center for Health and Community, University of California, San Francisco
| | - Nila A. Sathe
- RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, RTI International, Research Triangle Park
| | - Sara M. Kennedy
- RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, RTI International, Research Triangle Park
| | - Laura M. Gottlieb
- School of Medicine, Department of Family and Community Medicine, Center for Health and Community, University of California, San Francisco
| | - Yuri Cartier
- University of California, San Francisco Social Intervention Research and Evaluation Network, San Francisco
| | - Monica E. Peek
- Section of General Internal Medicine, MacLean Center for Clinical Medical Ethics, Center for the Study of Race, Politics and Culture, The University of Chicago, Chicago, Illinois
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Sakata T, Thomas S, Dailey C, Fritz N, Carmichael H, Srivastava R, Moore M. How Health Systems Can Address Social Determinants of Health (SDOH): An Update to Improve the Health of Communities. Qual Manag Health Care 2023; 32:65-67. [PMID: 36579688 DOI: 10.1097/qmh.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Theadora Sakata
- Healthcare Delivery Institute (Drs Sakata, Thomas, Carmichael, and Srivastava), Intermountain Healthcare, Salt Lake City, Utah (Mr Fritz and Ms Moore); and Multiplier Advisors, Park City, Utah (Ms Dailey)
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Fleming MD, Safaeinili N, Knox M, Hernandez E, Esteban EE, Sarkar U, Brewster AL. Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study. BMC Health Serv Res 2022; 22:1585. [PMID: 36572882 PMCID: PMC9791730 DOI: 10.1186/s12913-022-08979-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Social needs case management programs are a strategy to coordinate social and medical care for high-risk patients. Despite widespread interest in social needs case management, not all interventions have shown effectiveness. A lack of evidence about the mechanisms through which these complex interventions benefit patients inhibits effective translation to new settings. The CommunityConnect social needs case management program in Contra Costa County, California recently demonstrated an ability to reduce inpatient hospital admissions by 11% in a randomized study. We sought to characterize the mechanisms through which the Community Connect social needs case management program was effective in helping patients access needed medical and social services and avoid hospitalization. An in-depth understanding of how this intervention worked can support effective replication elsewhere. METHODS Using a case study design, we conducted semi-structured, qualitative interviews with case managers (n = 30) and patients enrolled in social needs case management (n = 31), along with field observations of patient visits (n = 31). Two researchers coded all interview transcripts and observation fieldnotes. Analysis focused on program elements identified by patients and staff as important to effectiveness. RESULTS Our analyses uncovered three primary mechanisms through which case management impacted patient access to needed medical and social services: [1] Psychosocial work, defined as interpersonal and emotional support provided through the case manager-patient relationship, [2] System mediation work to navigate systems, coordinate resources, and communicate information and [3] Addressing social needs, or working to directly mitigate the impact of social conditions on patient health. CONCLUSIONS These findings highlight that the system mediation tasks which are the focus of many social needs assistance interventions offered by health care systems may be necessary but insufficient. Psychosocial support and direct assistance with social needs, enabled by a relationship-focused program, may also be necessary for effectiveness.
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Affiliation(s)
- Mark D. Fleming
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Nadia Safaeinili
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Margae Knox
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Elizabeth Hernandez
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Emily E. Esteban
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Urmimala Sarkar
- grid.267103.10000 0004 0461 8879Department of Medicine—San Francisco, University of California, San Francisco, California, USA
| | - Amanda L. Brewster
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
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Patel MR, Smith A, Torby M, Isaacson N, Cohen AJ. Predictors of Interest in Offered Social Care Assistance Among People with Uncontrolled Diabetes. Popul Health Manag 2022; 25:744-752. [PMID: 36315180 PMCID: PMC10024070 DOI: 10.1089/pop.2022.0186] [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: 12/29/2022] Open
Abstract
Despite increasing resources dedicated to identifying and addressing social risks in health care settings, many patients screening positive for social risks either decline assistance or do not follow up with offered resources. This study assessed predictors of engagement with offered social care assistance through guided self-navigation or in-person assistance. Data came from a cross-sectional analysis of 6-month follow-up survey data from an ongoing trial of participants with poorly controlled diabetes and a positive social risk screen randomized to guided online self-navigation or in-person social care assistance. Multivariable logistic regression models estimated participant characteristics associated with engagement with offered assistance. Mean age was 55 years (standard deviation = 12). Of 407 participants, 41% (n = 165) engaged with offered assistance: 76% (n = 137) of those in the guided self-navigation arm and 13% (n = 28) of those in the in-person assistance arm. A sizable proportion of participants endorsed already using assistance for medications (30%), food (26%), and employment (22%). Female gender [OR 1.57, 95% CI (1.03-2.40), P < 0.05] and being out of the workforce [OR 1.71, 95% CI (1.07-2.73), P < 0.05] predicted engagement with social care assistance. Those already using assistance for medications [OR 4.71, 95% CI (1.69-13.15), P < 0.05] and blood glucose supplies [OR 6.25, 95% CI (1.45-26.78) P < 0.05] were also more likely to engage with offered assistance. Fewer than half of individuals engaged with offered social assistance through either guided online self-navigation or in-person assistance; limited demographic and clinical factors predicted uptake. More investments are needed to understand how best to support uptake of offered assistance.
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Affiliation(s)
- Minal R. Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alyssa Smith
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Michelle Torby
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Nicole Isaacson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alicia J. Cohen
- Department of Family Medicine, VA Providence Healthcare System, Providence, Rhode Island, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Testa A, Jackson DB, Vaughn MG, Ganson KT, Nagata JM. Adverse Childhood Experiences, health insurance status, and health care utilization in middle adulthood. Soc Sci Med 2022; 314:115194. [PMID: 36283330 DOI: 10.1016/j.socscimed.2022.115194] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 07/01/2022] [Indexed: 01/26/2023]
Abstract
RATIONALE Adverse childhood experiences (ACEs) negatively impact health over the life-course. Yet, compared to the robust literature on the consequences for ACEs for health, substantially fewer studies assess the implications of exposure to ACEs for health insurance status and health care utilization in adulthood. OBJECTIVE To assess the association between accumulating ACEs and (1) an individual's health insurance status, and (2) usual source of care, as well as examine the mediating role of adult socioeconomic status. METHODS Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 8,757). Multinomial logistic regression is used to assess the relationship between ACEs and health insurance status and the usual source of care. RESULTS Net of control and mediating variables, accumulating exposure to ACEs -particularly four or more ACEs- is associated with a higher likelihood of being uninsured and utilizing the emergency room as the usual source of care. Adult socioeconomic status including educational attainment, household income, employment status, and being uninsured-in the case of usual source of care-substantially mediates these associations. CONCLUSION ACEs carry negative repercussions for health insurance and patterns of healthcare utilization that spans into adulthood, and this is largely driven by poor adult socioeconomic status.
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Affiliation(s)
- Alexander Testa
- Department of Management, Policy and Community Health University of Texas Health Science Center at Houston, USA.
| | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health Johns Hopkins University, USA
| | - Michael G Vaughn
- College for Public Health and Social Justice Saint Louis University, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work University of Toronto, Canada
| | - Jason M Nagata
- Department of Pediatrics University of California, San Francisco, USA
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Graber E, Rouhani S, Khidir H, De Luca M, Noyes E, Hernandez C, Tulip J, Hasdiana MA, Jambaulikar G, Marsh R, Wilson M. Reducing COVID-19 Health Inequities by Identifying Social Needs and Clinical Deterioration of Discharged Emergency Department Patients. West J Emerg Med 2022; 23:794-801. [PMID: 36409948 PMCID: PMC9683770 DOI: 10.5811/westjem.2022.8.55253] [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: 10/31/2021] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The decision to discharge a patient from the hospital with confirmed or suspected coronavirus 2019 (COVID-19) is fraught with challenges. Patients who are discharged home must be both medically stable and able to safely isolate to prevent disease spread. Socioeconomically disadvantaged patient populations in particular may lack resources to safely quarantine and are at high risk for COVID-19 morbidity. METHODS We developed a telehealth follow-up program for emergency department (ED) patients who received testing for COVID-19 from April 24-June 29, 2020 and were discharged home. Patients who were discharged with a pending COVID-19 test received follow-up calls on Days 1, 4, and 8. The objective of our program was to screen and provide referrals for health-related social needs (HRSN), conduct clinical screening for worsening symptoms, and deliver risk-reduction strategies for vulnerable individuals. We conducted retrospective chart reviews on all patients in this cohort to collect demographic information, testing results, and outcomes of clinical symptom and HRSN screening. Our primary outcome measurement was the need for clinical reassessment and referral for an unmet HRSN. RESULTS From April 24-June 29, 2020, we made calls to 1,468 patients tested for COVID-19 and discharged home. On Day 4, we reached 67.0% of the 1,468 patients called. Of these, 15.9% were referred to a physician's assistant (PA) out of concern for clinical worsening and 12.4% were referred to an emergency department (ED) patient navigator for HRSNs. On Day 8, we reached 81.8% of the 122 patients called. Of these, 19.7% were referred to a PA for clinical reassessment and 14.0% were referred to an ED patient navigator for HRSNs. Our intervention reached 1,069 patients, of whom 12.6% required referral for HRSNs and 1.3% (n = 14) were referred to the ED or Respiratory Illness Clinic due to concern for worsening clinical symptoms. CONCLUSION In this patient population, the demand for interventions to address social needs was as high as the need for clinical reassessment. Similar ED-based programs should be considered to help support patients' interdependent social and health needs beyond those related to COVID-19.
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Affiliation(s)
- Eleanor Graber
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Shada Rouhani
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Hazar Khidir
- Yale National Clinician Scholars Program, New Haven, Connecticut
| | - Michael De Luca
- George Washington University School of Medicine, Department of Emergency Medicine, Washington, DC
| | - Elizabeth Noyes
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Carlos Hernandez
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Joe Tulip
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - M Adrian Hasdiana
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Regan Marsh
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Michael Wilson
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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Molina M, Evans J, Montoy JC, Cawley C, Graham-Squire D, Perez K, Raven M, Kanzaria HK. Analysis of Emergency Department Encounters Among High Users of Health Care and Social Service Systems Before and During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2239076. [PMID: 36306131 PMCID: PMC9617170 DOI: 10.1001/jamanetworkopen.2022.39076] [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: 11/14/2022] Open
Abstract
IMPORTANCE Although the general US population had fewer emergency department (ED) visits during the COVID-19 pandemic, patterns of use among high users are unknown. OBJECTIVES To examine natural trends in ED visits among high users of health and social services during an extended period and assess whether these trends differed during COVID-19. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study combined data from 9 unique cohorts, 1 for each fiscal year (July 1 to June 30) from 2012 to 2021, and used mixed-effects, negative binomial regression to model ED visits over time and assess ED use among the top 5% of high users of multiple systems during COVID-19. Data were obtained from the Coordinated Care Management System, a San Francisco Department of Public Health platform that integrates medical and social information with service use. EXPOSURES Fiscal year 2020 was defined as the COVID-19 year. MAIN OUTCOMES AND MEASURES Measured variables were age, gender, language, race and ethnicity, homelessness, insurance status, jail health encounters, mental health and substance use diagnoses, and mortality. The main outcome was annual mean ED visit counts. Incidence rate ratios (IRRs) were used to describe changes in ED visit rates both over time and in COVID-19 vs non-COVID-19 years. RESULTS Of the 8967 participants, 3289 (36.7%) identified as White, 3005 (33.5%) as Black, and 1513 (16.9%) as Latinx; and 7932 (88.5%) preferred English. The mean (SD) age was 46.7 (14.2) years, 6071 (67.7%) identified as men, and 7042 (78.5%) had experienced homelessness. A statistically significant decrease was found in annual mean ED visits among high users for every year of follow-up until year 8, with the largest decrease occurring in the first year of follow-up (IRR, 0.41; 95% CI, 0.40-0.43). However, during the pandemic, ED visits decreased 25% beyond the mean reduction seen in prepandemic years (IRR, 0.75; 95% CI, 0.72-0.79). CONCLUSIONS AND RELEVANCE In this study, multiple cohorts of the top 5% of high users of multiple health care systems in San Francisco had sustained annual decreases in ED visits from 2012 to 2021, with significantly greater decreases during COVID-19. Further research is needed to elucidate pandemic-specific factors associated with these findings and understand how this change in use was associated with health outcomes.
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Affiliation(s)
- Melanie Molina
- Department of Emergency Medicine, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jennifer Evans
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
| | - Juan Carlos Montoy
- Department of Emergency Medicine, University of California, San Francisco
| | - Caroline Cawley
- Department of Emergency Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Dave Graham-Squire
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
| | - Kenneth Perez
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
| | - Maria Raven
- Department of Emergency Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Hemal K. Kanzaria
- Department of Emergency Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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Schneberk T, Bolshakova M, Sloan K, Chang E, Stal J, Dinalo J, Jimenez E, Motala A, Hempel S. Quality Indicators for High-Need Patients: a Systematic Review. J Gen Intern Med 2022; 37:3147-3161. [PMID: 35260956 PMCID: PMC9485370 DOI: 10.1007/s11606-022-07454-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Healthcare systems are increasingly implementing programs for high-need patients, who often have multiple chronic conditions and complex social situations. Little, however, is known about quality indicators that might guide healthcare organizations and providers in improving care for high-need patients. We sought to conduct a systematic review to identify potential quality indicators for high-need patients. METHODS This systematic review (CRD42020215917) searched PubMed, CINAHL, and EMBASE; guideline clearing houses ECRI and GIN; and Google scholar. We included publications suggesting, evaluating, and utilizing indicators to assess quality of care for high-need patients. Critical appraisal of the indicators addressed the development process, endorsement and adoption, and characteristics, such as feasibility. We standardized indicators by patient population subgroups to facilitate comparisons across different indicator groups. RESULTS The search identified 6964 citations. Of these, 1382 publications were obtained as full text, and 53 studies met inclusion criteria. We identified over 1700 quality indicators across studies. Quality indicator characteristics varied widely. The scope of the selected indicators ranged from detailed criterion (e.g., "annual eye exam") to very broad categories (e.g., "care coordination"). Some publications suggested disease condition-specific indicators (e.g., diabetes), some used condition-independent criteria (e.g., "documentation of the medication list in the medical record available to all care agencies"), and some publications used a mixture of indicator types. DISCUSSION We identified and evaluated existing quality indicators for a complex, heterogeneous patient group. Although some quality indicators were not disease-specific, we found very few that accounted for social determinants of health and behavioral factors. More research is needed to develop quality indicators that address patient risk factors.
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Affiliation(s)
- Todd Schneberk
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA.
| | - Maria Bolshakova
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kylie Sloan
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Evelyn Chang
- VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Julia Stal
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Dinalo
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Aneesa Motala
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Susanne Hempel
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Hill S, Topel K, Li X, Solomon BS. Engagement in a Social Needs Navigation Program and Health Care Utilization in Pediatric Primary Care. Acad Pediatr 2022; 22:1221-1227. [PMID: 35597440 DOI: 10.1016/j.acap.2022.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Evidence for social needs interventions on resource linkage has grown over the past decade. Though social and economic needs predict health care utilization, few studies have assessed social needs interventions on these outcomes. The objective of this study was to examine the association between enrollment in a clinic-based social needs program on subsequent well-child visit (WCV) attendance and emergency department (ED) use in 2 primary care clinics. METHODS A retrospective cohort study was conducted of patients in 2 clinics referred to a social risk screening and navigation program between June and August 2018. We compared health care utilization over the subsequent 12 months for those who completed a full intake and received resource navigation (enrolled) to those referred (not enrolled). Logistic regression was used to assess the association between enrollment with WCV attendance and ED visits. RESULTS During the study period, of the 969 patients referred to the program, 761 were enrolled across the 2 clinics. At both sites, the majority of enrolled patients had high WCV attendance postintervention (Site A: 81.6%, Site B: 71.4%). High WCV attendance for nonenrolled but referred patients was significantly lower (Site A: 52.7%, Site B: 35.0%). Enrolled participants were significantly more likely to have high WCV attendance than nonenrolled patients, adjusting for preintervention utilization (Site A adjusted odds ratio [aOR]: 5.83, Site B aOR : 4.20). There were no significant differences in ED use at either clinic. CONCLUSIONS Addressing families' social needs through resource linkage and navigation can improve WCV attendance.
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Affiliation(s)
- Sarah Hill
- Johns Hopkins University School of Medicine (S Hill, K Topel, and BS Solomon), Baltimore, Md
| | - Kristin Topel
- Johns Hopkins University School of Medicine (S Hill, K Topel, and BS Solomon), Baltimore, Md
| | - Ximin Li
- Johns Hopkins Berman Institute of Bioethics (X Li), Baltimore, Md
| | - Barry S Solomon
- Johns Hopkins University School of Medicine (S Hill, K Topel, and BS Solomon), Baltimore, Md.
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Nederveld AL, Duarte KF, Rice JD, Richie A, Broaddus-Shea ET. IMAGINE: A Trial of Messaging Strategies for Social Needs Screening and Referral. Am J Prev Med 2022; 63:S164-S172. [PMID: 35987528 DOI: 10.1016/j.amepre.2022.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Health-related social needs are associated with poor health outcomes. Many primary care practices now screen and refer patients with health-related social needs to assistance organizations, but some patients decline screening or assistance. Improving communication about health-related social needs screening and referral could increase screening response and assistance acceptance rates. STUDY DESIGN This is a pragmatic, nonrandomized 3-stage trial of messages and communication strategies for health-related social needs screening and referral. Messages and strategies were informed by qualitative analysis of stakeholder interviews and were developed through an iterative, patient-, and stakeholder-engaged process. SETTING/PARTICIPANTS Settings included 3 primary care clinics serving primarily low-income patients in western Colorado. INTERVENTION Stage 1 includes usual clinic processes for health-related social needs screening (form given to patients at the front desk without additional explanation), Stage 2 includes adding written patient-friendly messages regarding the purpose of health-related social needs screening and referral to usual clinic processes, and Stage 3 includes adding verbal messages delivered by a medical assistant (form given to patients by a medical assistant during the rooming process). MAIN OUTCOME MEASURES Primary outcomes include (1) screening form response rate and (2) acceptance of referral for assistance rate among patients with health-related social needs. Secondary outcomes include (1) comfort with screening, (2) perceived helpfulness of screening, and (3) receipt of explanation about screening. RESULTS All data collection and analysis occurred in 2021. Study Stage 2 was not associated with significant changes in any outcomes. Stage 3 was associated with decreased odds of screening form response at 2 of the 3 clinics relative to those of Stage 1 (OR=0.1, 95% CI=0.1, 0.3; OR=0.4, 95% CI=0.2, 0.7) but with increased odds of assistance acceptance (OR=2.1, 95% CI=1.1, 4.0) among patients with needs who responded to the screening form. Stage 3 was also associated with higher odds of patients perceiving screening as helpful and receiving an explanation about screening. CONCLUSIONS Altering practice workflows to provide verbal explanations of health-related social needs screening may reduce response rates but may encourage responders to accept assistance referrals. Optimal communication strategies and workflows will likely differ depending on the intended goals of health-related social needs screening and referral.
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Affiliation(s)
- Andrea L Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado.
| | - Kelsey Fife Duarte
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - John D Rice
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ashlyn Richie
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; School of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Elena T Broaddus-Shea
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Cohen AJ, Isaacson N, Torby M, Smith A, Zhang G, Patel MR. Motivators, Barriers, and Preferences to Engagement With Offered Social Care Assistance Among People With Diabetes: A Mixed Methods Study. Am J Prev Med 2022; 63:S152-S163. [PMID: 35987527 PMCID: PMC10615322 DOI: 10.1016/j.amepre.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A substantial proportion of patients screening positive for social risks either decline assistance or do not follow-up with offered resources. This study examined patient interest in and engagement with offered social care assistance among adults with poorly controlled diabetes at an academic medical center. METHODS Surveys (n=307) and purposively sampled follow-up interviews (n=40) were conducted 6 months after randomization to receive guided online self-navigation or in-person assistance to address unmet social needs. Integrated mixed methods (data collected in 2019-2021) explored the motivators, barriers, and preferences regarding the uptake of offered assistance. Results were analyzed in 2021 using descriptive statistics, rapid qualitative analysis, and joint display models. RESULTS A total of 77% of people randomized to online self-navigation and 14% randomized to in-person assistance engaged with offered assistance. Motivators for engagement were similar across groups and included ease of use, anticipating assistance that could address 1 or more needs, and interest in learning more about available resources. Barriers to engagement included not needing or desiring assistance, participants perceiving that offered assistance was not relevant to their needs or that they would not qualify, competing priorities/forgetting, previous negative experiences or stigma, and technology or access challenges (online self-navigation group). Preferences around offered assistance that directly addressed barriers to uptake included changing messaging and framing around offered help and the ability to tailor modalities. CONCLUSIONS There are key barriers to the use of social care assistance that may directly reflect the process by which individuals are screened and offered assistance. Strategies to increase uptake should be patient centered and ideally provide multiple options for type of assistance and mode of engagement.
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Affiliation(s)
- Alicia J Cohen
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, Rhode Island; Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Department of Health Services, Policy, & Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Nicole Isaacson
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Michelle Torby
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Alyssa Smith
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Guanghao Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Minal R Patel
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
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Brown DM, Hernandez EA, Levin S, De Vaan M, Kim MO, Lynch C, Roth A, Brewster AL. Effect of Social Needs Case Management on Hospital Use Among Adult Medicaid Beneficiaries : A Randomized Study. Ann Intern Med 2022; 175:1109-1117. [PMID: 35785543 DOI: 10.7326/m22-0074] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Case management programs assisting patients with social needs may improve health and avoid unnecessary health care use, but little is known about their effectiveness. OBJECTIVE This large-scale study assessed the population-level impact of a case management program designed to address patients' social needs. DESIGN Single-site randomized encouragement design with administrative enrollment from an eligible population and intention-to-treat analysis. Study participants were enrolled between August 2017 and December 2018 and followed for 1 year. (ClinicalTrials.gov: NCT04000074). SETTING Contra Costa County, an economically and culturally diverse community in the San Francisco Bay Area. PARTICIPANTS 57 972 randomized enrollments of adult Medicaid patients at elevated risk for health care use (top 15%) to the intervention or control group. INTERVENTION Enrollees were offered 12 months of social needs case management, which provided more intensive services to patients with higher demonstrated needs. MEASUREMENTS Medical use was measured via emergency department (ED) visits and inpatient admissions, some of which were classified as avoidable. RESULTS Participants in the intervention group visited the ED at ratios of 0.96 (95% CI, 0.91 to 1.00) for all visits and 0.97 (CI, 0.92 to 1.03) for avoidable visits relative to the control group. The intervention group was hospitalized at ratios of 0.89 (CI, 0.81 to 0.98) for all admissions and 0.72 (CI, 0.55 to 0.88) for avoidable admissions. LIMITATIONS Only 40% of the intervention group engaged with the program. The program was in continual development during the trial period. CONCLUSION Although social needs case management programs may reduce health care use, these savings may not cover full program costs. More work is needed to identify ways to increase patient uptake and define characteristics of successful programs. PRIMARY FUNDING SOURCE Contra Costa Health Services via the Medicaid waiver program.
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Affiliation(s)
- Daniel M Brown
- Contra Costa Health Services, Martinez, California (D.M.B., E.A.H., S.L., C.L., A.R.)
| | - Elizabeth A Hernandez
- Contra Costa Health Services, Martinez, California (D.M.B., E.A.H., S.L., C.L., A.R.)
| | - Sara Levin
- Contra Costa Health Services, Martinez, California (D.M.B., E.A.H., S.L., C.L., A.R.)
| | - Mathijs De Vaan
- University of California, Berkeley, Berkeley, California (M.D., A.L.B.)
| | - Mi-Ok Kim
- University of California, San Francisco, San Francisco, California (M.K.)
| | - Chris Lynch
- Contra Costa Health Services, Martinez, California (D.M.B., E.A.H., S.L., C.L., A.R.)
| | - Anna Roth
- Contra Costa Health Services, Martinez, California (D.M.B., E.A.H., S.L., C.L., A.R.)
| | - Amanda L Brewster
- University of California, Berkeley, Berkeley, California (M.D., A.L.B.)
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Knox M, Esteban EE, Hernandez EA, Fleming MD, Safaeinilli N, Brewster AL. Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program. BMJ Open Qual 2022; 11:bmjoq-2021-001807. [PMID: 35667706 PMCID: PMC9171266 DOI: 10.1136/bmjoq-2021-001807] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Health systems are expanding efforts to address health and social risks, although the heterogeneity of early evidence indicates need for more nuanced exploration of how such programs work and how to holistically assess program success. This qualitative study aims to identify characteristics of success in a large-scale, health and social needs case management program from the perspective of interdisciplinary case managers. Setting Case management program for high-risk, complex patients run by an integrated, county-based public health system. Participants 30 out of 70 case managers, purposively sampled to represent their interdisciplinary health and social work backgrounds. Interviews took place in March–November 2019. Primary and secondary outcome measures The analysis intended to identify characteristics of success working with patients. Results Case managers described three characteristics of success working with patients: (1) establishing trust; (2) observing change in patients’ mindset or initiative and (3) promoting stability and independence. Cross-cutting these characteristics, case managers emphasised the importance of patients defining their own success, often demonstrated through individualised, incremental progress. Thus, moments of success commonly contrasted with external perceptions and operational or productivity metrics. Conclusions Themes emphasise the importance of compassion for complexity in patients’ lives, and success as a step-by-step process that is built over longitudinal relationships.
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Affiliation(s)
- Margae Knox
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | | | | | - Mark D Fleming
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Nadia Safaeinilli
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Amanda L Brewster
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Garg R, McQueen A, Wolff JM, Skinner KE, Kegler MC, Kreuter MW. Low housing quality, unmet social needs, stress and depression among low-income smokers. Prev Med Rep 2022; 27:101767. [PMID: 35321214 PMCID: PMC8935510 DOI: 10.1016/j.pmedr.2022.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 11/25/2022] Open
Abstract
Over 60% of low-income smokers reported housing quality problems. Problems with housing quality were among the most common social needs. Housing quality problems were associated with worse measures of health. Poor housing quality may exacerbate health disparities for low-income smokers.
Smokers are at greater risk of multiple health conditions that are exacerbated by environmental hazards associated with low housing quality. However, little is known about the prevalence of low housing quality among low-income smokers. Using correlations and logistic regression, we examined associations among eight housing quality indicators – pests, water leaks, mold, lead paint, and working smoke detectors, appliances, heating, and air conditioning – and between housing quality and social needs, depressive symptoms, perceived stress, sleep problems, and self-rated health in a community-based sample of 786 low-income smokers from 6 states. Most participants were female (68%), and White (45%) or African-American (43%). One in four (27%) completed less than high school education, and 41% reported annual pre-tax household income of less than $10,000. Housing quality problems were common. Most participants (64%) reported at least one problem in their home, and 41% reported two or more problems, most commonly pest infestations (40%), water leaks (22%), lack of air conditioning (22%) and mold (18%). Lack of heat and air conditioning were correlated, as were water leaks and mold. Using logistic regression analyses controlling for participant demographic characteristics, we found that reporting more housing quality problems was associated with greater odds of worse mental and physical health outcomes. Multiple health threats, including housing quality, depressive symptoms, stress, poor sleep, and financial strain may be mutually reinforcing and compound the health consequence of smoking. Future research should seek to replicate these findings in other samples, and examine associations longitudinally to better understand causality.
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Yan AF, Chen Z, Wang Y, Campbell JA, Xue QL, Williams MY, Weinhardt LS, Egede LE. Effectiveness of Social Needs Screening and Interventions in Clinical Settings on Utilization, Cost, and Clinical Outcomes: A Systematic Review. Health Equity 2022; 6:454-475. [PMID: 35801145 PMCID: PMC9257553 DOI: 10.1089/heq.2022.0010] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: This systematic review examined and synthesized peer-reviewed research studies that reported the process of integrating social determinants of health (SDOH) or social needs screening into electronic health records (EHRs) and the intervention effects in the United States. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, a systematic search of Scopus, Web of Science Core Collection, MEDLINE, and Cochrane Central Register of Clinical Trials was performed. English language peer-reviewed studies that reported the process of integrating SDOH or social needs screening into EHRs within the U.S. health systems and published between January 2015 and December 2021 were included. The review focused on process measures, social needs changes, health outcomes, and health care cost and utilization. Results: In total, 28 studies were included, and half were randomized controlled trials. The majority of the studies targeted multiple SDOH domains. The interventions vary by the levels of intensity of their approaches and heterogeneities in outcome measures. Most studies (82%, n=23) reported the findings related to the process measures, and nearly half (43%, n=12) reported outcomes related to social needs. By contrast, only 39% (n=11) and 32% (n=9) of the studies reported health outcomes and impact on health care cost and utilization, respectively. Findings on patients' social needs change demonstrated improved access to resources. However, findings were mixed on intervention effects on health and health care cost and utilization. We also identified gaps in implementation challenges to be overcome. Conclusion: Our review supports the current policy efforts to increase U.S. health systems' investment toward directly addressing SDOH. While effective interventions can be more complex or resource intensive than an online referral, health care organizations hoping to achieve health equity and improve population health must commit the effort and investment required to achieve this goal.
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Affiliation(s)
- Alice F. Yan
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Yang Wang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jennifer A. Campbell
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine and the Center on Aging and Health, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle Y. Williams
- Division of Research, Nursing and Patient Care Services, Stanford Health Care, Palo Alto, California, USA
| | - Lance S. Weinhardt
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Leonard E. Egede
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
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Brewster AL, Wilson TL, Kunkel SR, Curry LA, Rubeo C. Factors Associated With Contracting Between Area Agencies on Aging and Health Care Entities. J Appl Gerontol 2022; 41:1878-1886. [PMID: 35505592 DOI: 10.1177/07334648221096137] [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: 11/17/2022] Open
Abstract
Contracting with health care entities offers an avenue for Area Agencies on Aging (AAAs) to be reimbursed for providing services that improve health and avoid the need for expensive health care among older adults. However, we have little systematic evidence about the organizational characteristics and policy environments that facilitate these contractual relationships. Using survey data on AAAs from 2017-18, we found that contracting with health insurers was significantly more likely if AAAs had strong business capabilities and access to a state CBO contracting network. AAA contracting with health care delivery organizations trended with different factors, becoming more likely if states had implemented more integrated health care delivery programs, and becoming less likely if states had managed long-term services and supports. Contracting could be facilitated by supports for AAA business capabilities, as well as state policies that increase demand for their services among health insurers and health care delivery organizations.
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Affiliation(s)
- Amanda L Brewster
- Health Policy and Management, 1439University of California, Berkeley, CA, USA
| | | | | | | | - Chris Rubeo
- 1439University of California, Berkeley, CA, USA
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McQueen A, Kreuter MW, Herrick CJ, Li L, Brown DS, Haire-Joshu D. Associations among social needs, health and healthcare utilization, and desire for navigation services among US Medicaid beneficiaries with type 2 diabetes. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1035-1044. [PMID: 33704849 PMCID: PMC8433262 DOI: 10.1111/hsc.13296] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/14/2020] [Accepted: 01/07/2021] [Indexed: 05/03/2023]
Abstract
The purpose of this study was to better understand the number and types of social needs experienced by Medicaid beneficiaries with type 2 diabetes, and how their social needs are associated with key health indicators. Also examined were factors that influence patients' interest in navigation services for health and social needs to inform future interventions and service delivery. The study expands upon prior research, much of which has focused on only one social need (e.g., food insecurity) or one health outcome. The hypothesis was that among individuals with type 2 diabetes, those with a greater number of social needs would report more health-related problems and be more interested in receiving social needs navigation services. Participants completed a cross-sectional survey by phone (n = 95) or online (n = 14). Most (85%) reported having at least one social need (M = 2.5, SD = 2.2), most commonly not having enough money for unexpected expenses (68%) or necessities like food, shelter and clothing (31%), medical costs (24%), and utilities (23%). Results supported our comprehensive conceptual model. Having more social needs was associated with greater perceived stress, diabetes distress, problems with sleep and executive and cognitive functioning, less frequent diabetes self-care activities, more days of poor mental health and activity limitations, worse self-reported health and more hospitalisations. Number of social needs also was positively associated with interest in having a social needs navigator. Social needs were not associated with days of poor physical health, BMI, self-reported A1C or smoking status. Social needs were associated with a wide range of indicators of poor health and well-being. Participants with the greatest social need burden were most open to intervention.
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Affiliation(s)
- Amy McQueen
- Department of Internal Medicine, School of Medicine, Washington University in St. Louis, MO
- Brown School of Social Work, Washington University in St. Louis, MO
| | | | - Cynthia J. Herrick
- Department of Internal Medicine, School of Medicine, Washington University in St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, MO
| | - Linda Li
- Brown School of Social Work, Washington University in St. Louis, MO
| | - Derek S. Brown
- Brown School of Social Work, Washington University in St. Louis, MO
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Steeves-Reece AL, Totten AM, Broadwell KD, Richardson DM, Nicolaidis C, Davis MM. Social Needs Resource Connections: A Systematic Review of Barriers, Facilitators, and Evaluation. Am J Prev Med 2022; 62:e303-e315. [PMID: 35078672 PMCID: PMC9850790 DOI: 10.1016/j.amepre.2021.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/20/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Healthcare organizations increasingly are screening patients for social needs (e.g., food, housing) and referring them to community resources. This systematic mixed studies review assesses how studies evaluate social needs resource connections and identifies patient- and caregiver-reported factors that may inhibit or facilitate resource connections. METHODS Investigators searched PubMed and CINAHL for articles published from October 2015 to December 2020 and used dual review to determine inclusion based on a priori selection criteria. Data related to study design, setting, population of interest, intervention, and outcomes were abstracted. Articles' quality was assessed using the Mixed Methods Appraisal Tool. Data analysis was conducted in 2021. RESULTS The search identified 34 articles from 32 studies. The authors created a taxonomy of quantitative resource connection measures with 4 categories: whether participants made contact with resources, received resources, had their social needs addressed, or rated some aspect of their experience with resources. Barriers to resource connections were inadequacy, irrelevancy, or restrictiveness; inaccessibility; fears surrounding stigma or discrimination; and factors related to staff training and resource information sharing. Facilitators were referrals' relevancy, the degree of support and simplicity embedded within the interventions, and interventions being comprehensive and inclusive. DISCUSSION This synthesis of barriers and facilitators indicates areas where healthcare organizations may have agency to improve the efficacy of social needs screening and referral interventions. The authors also recommend that resource connection measures be explicitly defined and focus on whether participants received new resources and whether their social needs were addressed.
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Affiliation(s)
- Anna Louise Steeves-Reece
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Annette Marie Totten
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon; Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; Department of Medical Informatics & Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Katherine DuBose Broadwell
- Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Dawn Michele Richardson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, Oregon; Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Melinda Marie Davis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon; Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
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