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Meacock SS, Khan IA, Hohmann AL, Cohen-Rosenblum A, Krueger CA, Purtill JJ, Fillingham YA. What Are Social Determinants of Health and Why Should They Matter to an Orthopaedic Surgeon? J Bone Joint Surg Am 2024:00004623-990000000-01071. [PMID: 38635723 DOI: 10.2106/jbjs.23.01114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Samantha S Meacock
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Irfan A Khan
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, Louisiana
| | - Alexandra L Hohmann
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anna Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, Louisiana
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James J Purtill
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yale A Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Alegría M, Cruz-Gonzalez M, Markle SL, Falgas-Bague I, Poindexter C, Stein GL, Eddington K, Martinez Vargas AE, Fuentes L, Cheng M, Shrout PE. Referrals to Community and State Agencies to Address Social Determinants of Health for Improving Mental Health, Functioning, and Quality of Care Outcomes for Diverse Adults. Am J Public Health 2024; 114:S278-S288. [PMID: 37948053 PMCID: PMC10976451 DOI: 10.2105/ajph.2023.307442] [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] [Accepted: 09/01/2023] [Indexed: 11/12/2023]
Abstract
Objectives. To examine whether referral for social determinants of health (SDH) needs decreases psychological distress and posttraumatic stress disorder (PTSD) symptoms and improves level of functioning and quality of care among diverse adults. Methods. Data are from control participants (n = 503 adults) in a randomized controlled trial testing a mental health intervention in North Carolina and Massachusetts. We fitted multilevel mixed-effects models to repeated assessments (baseline, 3, 6, and 12 months) collected between September 2019 and January 2023. Results. After referral to services for trouble paying utility bills, participants reported lower PTSD symptoms. Participants reported better quality of care when receiving referrals to mental health care. After adjusting for income and employment status, we found that participants who were referred more often also had lower PTSD symptoms and better levels of functioning. Conclusions. Referrals for certain SDH needs might decrease PTSD symptoms and improve self-reported quality of care and functioning. However, referrals alone, without ensuring receipt of services, might be insufficient to affect other mental health outcomes. Research is needed on training and providing care managers time for offering interpersonal support, securing services, and understanding agencies' contexts for addressing high SDH needs. (Am J Public Health. 2024;114(S3):S278-S288. https://doi.org/10.2105/AJPH.2023.307442).
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Affiliation(s)
- Margarita Alegría
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Mario Cruz-Gonzalez
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Sheri Lapatin Markle
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Irene Falgas-Bague
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Claire Poindexter
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Gabriela Livas Stein
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Kari Eddington
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Abraham Ezequiel Martinez Vargas
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Larimar Fuentes
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Michelle Cheng
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Patrick E Shrout
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
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Stark K, Mathur M, Fok C, Le YC, Hunt ET, McCoy J, Mansoori S, Ukoh N, Keatts S, Fanous E, Eisenhauer R, McKay S. Evaluation of a Clinic-Based, Electronic Social Determinants of Health Screening and Intervention in Primary Care Pediatrics. Acad Pediatr 2024; 24:302-308. [PMID: 38160752 DOI: 10.1016/j.acap.2023.12.010] [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: 06/12/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Social determinants of health (SDOH) significantly affect individuals' health outcomes, yet universal electronic SDOH screening is not standard in primary care. Our study explores the implementation of an electronic SDOH screening in the electronic health record (EHR) and follow-up intervention among primary care pediatric patients within an academic clinic. METHODS Beginning in August of 2022, patients and their families determined to have at least one SDOH need qualified for an in-clinic referral to a coordinated care team member. We assessed the overall efficacy and feasibility of the implementation. RESULTS Over the 4-month pilot, 1473 of 2064 (71.4%) eligible patients were screened, with 472 (32%) patients screening positive on at least one SDOH domain. Of the 472 screened positive, 48 (10.2%) declined a referral. Two hundred and forty-seven of the 424 (58.3%) received a referral to a care coordination team member. CONCLUSIONS This study demonstrates the feasibility of a universal electronic SDOH screening tool within the EHR within an urban, academic-based clinic.
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Affiliation(s)
- Kaitlyn Stark
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Mallika Mathur
- School of Public Health at UTHealth Houston (M Mathur), Houston, Tex.
| | - Christina Fok
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Yen-Chi Le
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Ethan T Hunt
- School of Public Health at UTHealth Houston at Austin (ET Hunt), Austin, Tex.
| | - Jacee McCoy
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Shadhi Mansoori
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Nancy Ukoh
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Sydney Keatts
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Erika Fanous
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Rachel Eisenhauer
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
| | - Sandra McKay
- McGovern Medical School at UTHealth Houston (K Stark, C Fok, Y-C Le, J McCoy, S Mansoori, N Ukoh, S Keatts, E Fanous, R Eisenhauer, and S McKay), Houston, Tex.
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Ronis SD, Masotya M, Birkby G, Stange KC. Social Needs Screening and Intervention in Pediatric Primary Care: Impact on Families' Experience of Care. J Prim Care Community Health 2024; 15:21501319241255917. [PMID: 38761365 PMCID: PMC11102682 DOI: 10.1177/21501319241255917] [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: 03/06/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/20/2024] Open
Abstract
INTRODUCTION/OBJECTIVES Social determinants of health (SDoH) screening and intervention in pediatric primary care depends upon caregiver disclosure of adverse household or social conditions and thus may be influenced by perceived bias or stigma. This paper examines to what extent parents' experience of their child's medical home is associated with their perceptions of a practice-based social needs intervention. METHODS We conducted a cohort study of data reported by 73 parents of children obtaining care in a medical home with an embedded SDoH navigation program. Using survey data collected in October 2021 and October 2022, we calculated descriptive statistics and non-parametric bivariate analyses of the association between engagement with the SDoH navigation program and parent-reported social needs, stress, and perception of care quality as measured by the Person-Centered Primary Care Measure (PCPCM). RESULTS Initial ratings of care quality were high (mean baseline PCPCM score = 3.63) and remained high on second interview (mean change in PCPCM score = -0.04, 95%CI -0.16, 0.09, P = .58) despite significant reductions in parents' ratings of access to care over time. Parents reported substantial stress, unmet social needs, and unmet healthcare needs, with 41 families (56%) ever using the practice-based SDoH program, including 16 (22%) who were new users in 2022. There was no association observed between PCPCM score and parent stress, unmet social needs, or use of SDoH services. CONCLUSIONS Parents' perceptions of care delivered in their child's medical home appears to be stable on repeat measurement, and independent of family context or interactions with social needs navigation services offered in the practice.
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Affiliation(s)
- Sarah D. Ronis
- UH Rainbow Center for Child Health & Policy, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Marie Masotya
- UH Rainbow Center for Child Health & Policy, Cleveland, OH, USA
| | - Genevieve Birkby
- UH Rainbow Babies and Children’s Ahuja Center for Women & Children, Cleveland, OH, USA
| | - Kurt C. Stange
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Luo H, Luo D, Tang Q, Niu Z, Xu J, Li J. The combined impact of social networks and connectedness on anxiety, stress, and depression during COVID-19 quarantine: a retrospective observational study. Front Public Health 2023; 11:1298693. [PMID: 38169600 PMCID: PMC10758457 DOI: 10.3389/fpubh.2023.1298693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction The COVID-19 pandemic and associated quarantine measures have precipitated a surge in mental health disorders, particularly depression and anxiety. Government policies and restrictions on physical activity have contributed to this phenomenon, as well as diminished subjective social connectedness and exacerbated objective social isolation. As two dimensions of social isolation, it is worth noting that subjectively perceived social connectedness serves as a protective factor for mental health, whereas the decline in the size of objectively evaluated social networks poses a significant risk. However, research investigating the combined influence of these two dimensions remains limited. Methods This study used an online survey to collect data to investigate the effects of objective social connectedness and objective social networks on anxiety, stress, and depression during COVID-19 quarantine. A total of 485 participants were analyzed using statistical methods, including paired t-test, Pearson correlation analysis, linear regression, cluster analysis, ANOVA, and moderated mediated. Results The study found that anxiety and depression scores increased during the quarantine, with age, education, and social connectedness scores associated with the increase. Pre-quarantine anxiety and depression levels were strongly correlated with mental health status during quarantine. Cluster analysis, respectively, revealed three clusters for those without increasing anxiety and depression scores. The study also found that objective social network influences the impact of subjective social connectedness on pre-quarantine mental health, which in turn affects anxiety and depression levels during quarantine. Conclusion The study identified that quarantine increased anxiety and depression, with age being protective, and education and subjective social connectedness as risk factors. The study also emphasizes the comprehensive impact of objective and subjective social isolation. Although individuals perceive the same degree of social connectedness, those with smaller social networks are more prone to developing symptoms of anxiety and depression, which are also more likely to worsen during quarantine.
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Affiliation(s)
| | | | | | | | - Jiajun Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Cacioppo AM, Winslow V, Abramsohn EM, Jagai JS, Makelarski JA, Waxman E, Wroblewski K, Tessler Lindau S. Food Insecurity and Experiences of Discrimination Among Caregivers of Hospitalized Children. Pediatrics 2023; 152:e2023061750. [PMID: 37986582 PMCID: PMC10657777 DOI: 10.1542/peds.2023-061750] [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] [Accepted: 09/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric hospitals are adopting strategies to address food insecurity (FI), a stigmatizing condition, among families with children. We hypothesized that parents and other caregivers ("caregivers") from households with FI or marginal food security (MFS) are more likely to experience discrimination during their child's hospitalization. METHODS We analyzed data from 319 caregivers of children admitted to an urban, academic children's hospital and randomly assigned to the control arm of the double-blind randomized controlled CommunityRx-Hunger trial (November 2020 to June 2022, NCT R01MD012630). Household food security in the 30 days before admission and discrimination during hospitalization were measured with the US Household Food Security Survey and the Discrimination in Medical Settings Scale, respectively. We used logistic regression to model the relationship between food security status and discrimination, adjusting for gender, race, ethnicity, income, and partner status. RESULTS Most participants were African American or Black (81.5%), female (94.7%), and the parent of the hospitalized child (93.7%). FI and MFS were prevalent (25.1% and 15.1%, respectively). Experiences of discrimination during a child's hospitalization were prevalent (51.9%). Caregivers with FI had higher odds than caregivers with food security of experiencing discrimination (adjusted odds ratio = 2.0, 95% confidence interval 1.1-3.6, P = .03); MFS was not significantly associated with discrimination (P = .25). Compared with food secure caregivers, those with FI had higher odds of 5 of 7 experiences of discrimination assessed. CONCLUSIONS Among parents and other caregivers, household FI is associated with experiences of discrimination during a child's hospitalization.
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Affiliation(s)
| | | | | | | | | | - Elaine Waxman
- The Urban Institute, Washington, District of Columbia
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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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Langevin R, Berry ABL, Zhang J, Fockele CE, Anderson L, Hsieh D, Hartzler A, Duber HC, Hsieh G. Implementation Fidelity of Chatbot Screening for Social Needs: Acceptability, Feasibility, Appropriateness. Appl Clin Inform 2023; 14:374-391. [PMID: 36787882 PMCID: PMC10191737 DOI: 10.1055/a-2035-5342] [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: 09/02/2022] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES Patient and provider-facing screening tools for social determinants of health have been explored in a variety of contexts; however, effective screening and resource referral remain challenging, and less is known about how patients perceive chatbots as potential social needs screening tools. We investigated patient perceptions of a chatbot for social needs screening using three implementation outcome measures: acceptability, feasibility, and appropriateness. METHODS We implemented a chatbot for social needs screening at one large public hospital emergency department (ED) and used concurrent triangulation to assess perceptions of the chatbot use for screening. A total of 350 ED visitors completed the social needs screening and rated the chatbot on implementation outcome measures, and 22 participants engaged in follow-up phone interviews. RESULTS The screened participants ranged in age from 18 to 90 years old and were diverse in race/ethnicity, education, and insurance status. Participants (n = 350) rated the chatbot as an acceptable, feasible, and appropriate way of screening. Through interviews (n = 22), participants explained that the chatbot was a responsive, private, easy to use, efficient, and comfortable channel to report social needs in the ED, but wanted more information on data use and more support in accessing resources. CONCLUSION In this study, we deployed a chatbot for social needs screening in a real-world context and found patients perceived the chatbot to be an acceptable, feasible, and appropriate modality for social needs screening. Findings suggest that chatbots are a promising modality for social needs screening and can successfully engage a large, diverse patient population in the ED. This is significant, as it suggests that chatbots could facilitate a screening process that ultimately connects patients to care for social needs, improving health and well-being for members of vulnerable patient populations.
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Affiliation(s)
- Raina Langevin
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, United States
| | - Andrew B. L. Berry
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Jinyang Zhang
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, Washington, United States
| | - Callan E. Fockele
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Layla Anderson
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Dennis Hsieh
- Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Torrance, California, United States
| | - Andrea Hartzler
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
| | - Herbert C. Duber
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Office of Health and Science, Washington State Department of Health, Seattle, Washington, United States
| | - Gary Hsieh
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, United States
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Beidler LB, Razon N, Lang H, Fraze TK. "More than just giving them a piece of paper": Interviews with Primary Care on Social Needs Referrals to Community-Based Organizations. J Gen Intern Med 2022; 37:4160-4167. [PMID: 35426010 PMCID: PMC9708990 DOI: 10.1007/s11606-022-07531-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary care practices are responding to calls to incorporate patients' social risk factors, such as housing, food, and economic insecurity, into clinical care. Healthcare likely relies on the expertise and resources of community-based organizations to improve patients' social conditions, yet little is known about the referral process. OBJECTIVE To characterize referrals to community-based organizations by primary care practices. DESIGN Qualitative study using semi-structured interviews with healthcare administrators responsible for social care efforts in their organization. PARTICIPANTS Administrators at 50 diverse US healthcare organizations with efforts to address patients' social risks. MAIN MEASURES Approaches used in primary care to implement social needs referral to community-based organizations. RESULTS Interviewed administrators reported that social needs referrals were an essential element in their social care activities. Administrators described the ideal referral programs as placing limited burden on care teams, providing patients with customized referrals, and facilitating closed-loop referrals. We identified three key challenges organizations experience when trying to implement the ideal referrals program: (1) developing and maintaining resources lists; (2) aligning referrals with patient needs; and (3) measuring the efficacy of referrals. Collectively, these challenges led to organizations relying on staff to manually develop and update resource lists and, in most cases, provide patients with generic referrals. Administrators not only hoped that referral platforms may help overcome some of these barriers, but also reported implementation challenges with platforms including inconsistent buy-in and use across staff; integration with electronic health records; management and prioritization of resources; and alignment with other organizations in their market. CONCLUSION AND RELEVANCE Referrals to community-based organizations were used in primary care to improve patients' social conditions, but despite strong motivations, interviewees reported challenges providing tailored and up-to-date information to patients.
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Affiliation(s)
- Laura B Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, USA
| | - Na'amah Razon
- Family and Community Medicine, University of California, Davis, Davis, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA
| | | | - Taressa K Fraze
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA.
- Family and Community Medicine, University of California, San Francisco, 3333 California Street, Suite 465, San Francisco, CA, 94118, USA.
- Healthforce Center, University of California, San Francisco, San Francisco, USA.
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10
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Sharareh N, Wallace AS, Brintz BJ, Wan N, Guo JW, Wong B. Associated factors with patient-reported unmet food needs among emergency department adult patients - A social need perspective. Prev Med Rep 2022; 29:101974. [PMID: 36161133 PMCID: PMC9502286 DOI: 10.1016/j.pmedr.2022.101974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 10/25/2022] Open
Abstract
Food insecurity is a complex problem affected by a number of factors from individual to societal. While individual-level demographic information and population-level social determinants of health (SDoH) are commonly used to identify patients at risk of food insecurity and to direct resources, a more comprehensive understanding of food insecurity requires integrating multi-level data. Our goal is to identify factors associated with food insecurity using patient, health system, and population level data. Between January 2019 and April 2020, we screened adult patients visiting an academic health sciences emergency department in Utah using a 10-item social needs screener. Patients' demographic data were linked to their screener responses. ZIP Code-level food-related SDoH such as accessibility to food providers, measured by geographic information systems methods, were assigned to patients. We then applied multilevel logistic regression modeling to identify factors associated with unmet food needs at two different levels-individual and ZIP Code. Unmet food needs were identified by asking patients if they felt there was not enough money for food in the last month, which grossly represents food insecurity. On a sample of 2,290 patients, 21.61% reported unmet food needs. Patient-reported housing, medical care, and utility needs along with Supplemental Nutrition Assistance Program participation and primary care provider utilization were highly associated with unmet food needs. Our efforts to identify the population at risk of food insecurity should be centered around patient-reported social needs. Our results suggest that addressing food insecurity in health care settings should include assessing social needs in primary care.
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Affiliation(s)
- Nasser Sharareh
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
| | - Andrea S Wallace
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA.,College of Nursing, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
| | - Ben J Brintz
- Internal Medicine, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
| | - Neng Wan
- Geography Department, University of Utah, Salt Lake City, UT, USA
| | - Jia-Wen Guo
- College of Nursing, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
| | - Bob Wong
- College of Nursing, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
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11
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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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Kim EJ, Nam IC, Koo YR. Reframing Patient Experience Approaches and Methods to Achieve Patient-Centeredness in Healthcare: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159163. [PMID: 35954517 PMCID: PMC9367952 DOI: 10.3390/ijerph19159163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
(1) There has been growing attention among healthcare researchers on new and innovative methodologies for improving patient experience. This study reviewed the approaches and methods used in current patient experience research by applying the perspective of design thinking to discuss practical methodologies for a patient-centered approach and creative problem-solving. (2) A scoping review was performed to identify research trends in healthcare. A four-stage design thinking process (“Discover”, “Define”, “Develop”, and “Deliver”) and five themes (“User focus”, “Problem-framing”, “Visualization”, “Experimentation”, and “Diversity”), characterizing the concept, were used for the analysis framework. (3) After reviewing 67 studies, the current studies show that the iterative process of divergent and convergent thinking is lacking, which is a core concept of design thinking, and it is necessary to employ an integrative methodology to actively apply collaborative, multidisciplinary, and creative attributes for a specific and tangible solution. (4) For creative problem-solving to improve patient experience, we should explore the possibilities of various solutions by an iterative process of divergent and convergent thinking. A concrete and visualized solution should be sought through active user interactions from various fields. For this, a specific methodology that allows users to collaborate by applying the integrative viewpoint of design thinking should be introduced.
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Affiliation(s)
- Eun-Jeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic Medical Center, The Catholic University of Korea, Seoul 06591, Korea;
| | - Inn-Chul Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea
- Correspondence: (I.-C.N.); (Y.-R.K.)
| | - Yoo-Ri Koo
- Department of Service Design, Graduate School of Industrial Arts, Hongik University, Seoul 04066, Korea
- Correspondence: (I.-C.N.); (Y.-R.K.)
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13
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Wagner J, Henderson S, Hoeft TJ, Gosdin M, Hinton L. Moving beyond referrals to strengthen late-life depression care: a qualitative examination of primary care clinic and community-based organization partnerships. BMC Health Serv Res 2022; 22:605. [PMID: 35524300 PMCID: PMC9074362 DOI: 10.1186/s12913-022-07997-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND National guidelines have called for greater integration of primary care and behavioral health services, with more recent attention to social care and community-based services. Under growing resource constraints healthcare organizations have tended to rely on referrals to external entities to address social care needs. Traditional referral models, however, may not be equipped to provide for the complex needs of older adults with depression. The Care Partners Project was designed to strengthen late-life depression care through integrated partnerships between primary care clinics and community-based organizations. We sought to understand how these integrated partnerships, with shared tasks and accountability across organizations, changed the nature of depression care for older adults. METHODS We conducted 65 in-depth, semi-structured interviews and six focus groups with service providers involved in the project, including care managers, primary care providers, and psychiatric consultants, and applied inductive and deductive qualitative thematic analysis to develop themes around participants' experiences with the partnered initiative. RESULTS We found the partnerships established by the Care Partners Project reshaped late-life depression care in two ways: (1) bidirectional communication across organizations facilitated greater recognition among providers of intersecting medical and social needs associated with late-life depression; and (2) depression care became more coordinated and effective as care teams established or strengthened relationships across organizations. CONCLUSIONS These findings highlight the ways cross-organizational health and social care partnerships that move beyond traditional referrals can strengthen late-life depression care and enhance organizational capacities.
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Affiliation(s)
- Jenny Wagner
- Evaluation Specialist, School of Medicine Office of Research, University of California, Davis, 2921 Stockton Blvd. Suite 1400, Sacramento, CA, 95817, USA.
| | - Stuart Henderson
- Director, Evaluation, School of Medicine Office of Research, University of California, Davis, 2921 Stockton Blvd. Suite 1400, Sacramento, CA, 95817, USA
| | - Theresa J Hoeft
- Research Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-6560, USA
| | - Melissa Gosdin
- Qualitative Research Analyst, Center for Healthcare Policy and Research, University of California, Davis, 2103 Stockton Blvd., Suite 2224, Sacramento, CA, 95817, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2230 Stockton Blvd, Sacramento, CA, 95817, USA
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Kelly A, Fazio D, Padgett D, Ran Z, Castelblanco DG, Kumar D, Doran KM. Patient views on emergency department screening and interventions related to housing. Acad Emerg Med 2022; 29:589-597. [PMID: 35064727 DOI: 10.1111/acem.14442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/15/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
Objectives Emergency departments (EDs) serve as a health care "safety net" and may be uniquely suited to screening for and addressing patients' unmet social needs. We aimed to better understand patient perspectives on ED-based screening and interventions related to housing instability, as a step toward improving future efforts. Methods We present findings from a qualitative study using in-depth, one-on-one interviews with ED patients who had become homeless in the past 6 months. Qualitative interviewees were asked their thoughts on ED staff asking about and helping to address homelessness and housing issues. Interviews were professionally transcribed verbatim. Multiple coders identified interview text segments focused on ED-based housing screening and intervention, which were then independently analyzed thematically and discussed to reach consensus. Researchers also categorized each participant's overall opinion on ED housing screening and interventions as positive, neutral, or negative. Results Qualitative interviews were conducted with 31 patients. Four themes related to ED-based housing screening and interventions emerged: (1) patients generally welcome ED staff/providers asking about and assisting with their housing situation, with caveats around privacy and respect; (2) ED conversations about housing have potential benefits beyond addressing unmet housing needs; (3) patients may not consider the ED as a site to obtain help with housing; (4) patients' experiences navigating existing housing services can inform best approaches for the ED. Most participants expressed overall positive views of ED staff/providers asking patients about their housing situation. Conclusions Study participants generally felt positively about screening and interventions for housing in the ED. Insights from this study can inform future ED-based housing instability screening and interventions.
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Affiliation(s)
- Audrey Kelly
- Department of Emergency Medicine NYU School of Medicine New York New York USA
| | - Daniela Fazio
- Department of Emergency Medicine NYU School of Medicine New York New York USA
| | | | - Ziwei Ran
- NYU Silver School of Social Work New York New York USA
| | | | - Diana Kumar
- Department of Emergency Medicine NYU School of Medicine New York New York USA
| | - Kelly M. Doran
- Department of Emergency Medicine NYU School of Medicine New York New York USA
- Department of Population Health NYU School of Medicine New York New York USA
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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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16
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Johnson CB, Luther B, Wallace AS, Kulesa MG. Social Determinants of Health: What Are They and How Do We Screen. Orthop Nurs 2022; 41:88-100. [PMID: 35358126 DOI: 10.1097/nor.0000000000000829] [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: 11/25/2022] Open
Abstract
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report recognizes nurses' impact on the medical and social factors that drive health outcomes (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021). The report calls for nursing to take bold steps to address individual and structural level social determinants of health (SDoH)-or social and environmental factors contributing to poor health, poor health outcomes, and health disparities (NASEM, 2021, p. 5). Nurses must recognize the significance of SDoH on patient health outcomes in order to advance health equity and employ nursing interventions to affect positive change for our patients. SDoH are part of our patients' stories, and holistic nursing means we know the whole patient story. Although it is now widely recognized that SDoH affect health outcomes, a key challenge for nurses is that they represent an enormous range of factors-from food and housing insecurity to personal safety and environmental exposures-that may be more or less able to change with interventions in clinical settings. Furthermore, concerns have been raised that screening for SDoH-especially when not done with sensitivity, cultural competence, or ready intervention-may compromise therapeutic relationships and marginalize patients (Wallace et al., 2020). However, despite these concerns, healthcare systems are widely adopting SDoH assessments, generally through electronic health record screening questions, and attempting to implement associated workflows and interventions. Given this landscape, the purpose of this article, within this special issue of Orthopaedic Nursing, is to provide an overview of SDoH factors, identify best practices related to screening and referral, and highlight nurse-directed interventions in clinical settings.
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Affiliation(s)
- Charla B Johnson
- Charla B. Johnson, DNP, RN-BC, ONC, System Director, Nursing Informatics, Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA
- Brenda Luther, PhD, RN, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Andrea S. Wallace, PhD, RN, Assistant Dean of Research, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Marjorie Gibson Kulesa, RN, BS, ONC, CNOR-E, Retired Nurse Coordinator, Department of Orthopaedic Surgery, NYU Langone Long Island, NY
| | - Brenda Luther
- Charla B. Johnson, DNP, RN-BC, ONC, System Director, Nursing Informatics, Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA
- Brenda Luther, PhD, RN, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Andrea S. Wallace, PhD, RN, Assistant Dean of Research, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Marjorie Gibson Kulesa, RN, BS, ONC, CNOR-E, Retired Nurse Coordinator, Department of Orthopaedic Surgery, NYU Langone Long Island, NY
| | - Andrea S Wallace
- Charla B. Johnson, DNP, RN-BC, ONC, System Director, Nursing Informatics, Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA
- Brenda Luther, PhD, RN, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Andrea S. Wallace, PhD, RN, Assistant Dean of Research, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Marjorie Gibson Kulesa, RN, BS, ONC, CNOR-E, Retired Nurse Coordinator, Department of Orthopaedic Surgery, NYU Langone Long Island, NY
| | - Marjorie Gibson Kulesa
- Charla B. Johnson, DNP, RN-BC, ONC, System Director, Nursing Informatics, Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA
- Brenda Luther, PhD, RN, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Andrea S. Wallace, PhD, RN, Assistant Dean of Research, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Marjorie Gibson Kulesa, RN, BS, ONC, CNOR-E, Retired Nurse Coordinator, Department of Orthopaedic Surgery, NYU Langone Long Island, NY
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O'Loughlin K, Shadowen HM, Haley AD, Gilbert J, Lail Kashiri P, Webel B, Huebschmann AG, Krist AH. Patient Preferences for Discussing and Acting on Health-Related Needs in Primary Care. J Prim Care Community Health 2022; 13:21501319221115946. [PMID: 35920033 PMCID: PMC9358340 DOI: 10.1177/21501319221115946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Addressing social needs, health behaviors, and mental health may help
patients more than traditional medical care. However, these root causes of
poor health are difficult to address and the role of primary care is
unclear. This qualitative study assesses patient’s willingness and
motivations to discuss and accept assistance for these needs from their
primary care team. Methods: In July and August of 2020, semi-structured virtual interviews were conducted
with family medicine patients (n = 6) and residents of low resource
neighborhoods (n = 11) in Richmond, Virginia. Interviews were conducted over
Zoom. We conducted a qualitative analysis of patient and resident interview
transcripts. A rapid qualitative analysis approach and
immersion-crystallization processes were used to identify themes and
categories. Results: Interviewees reported varying degrees of comfort discussing topics with their
health care team. They were less comfortable discussing needs they
considered outside the realm of “traditional primary care” including
finances, transportation, and housing, but interviewees expressed
willingness to discuss these needs under certain conditions. Important
factors were a strong patient-clinician relationship to create a trusted and
safe space for discussion, adequate time for discussion during visits,
communication of practices’ ability to provide resources to help patients,
and ensuring appropriate high quality referrals. Conclusions: Primary care provides opportunity for identifying and addressing needs that
adversely impact health. Some needs are more sensitive for patients to work
with their care team on, though, there was willingness to work on
any need when a strong provider relationship and clinic
structure for providing support were in place. This study highlights
critical care delivery factors which may be used to enhance patient comfort
accepting support for their needs and ultimately improve clinical care and
chronic disease management.
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Affiliation(s)
| | | | - Amber D Haley
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | | | - Ben Webel
- Virginia Commonwealth University, Richmond, USA
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Nohria R, Xiao N, Guardado R, Drainoni ML, Smith C, Nokes K, Byhoff E. Implementing Health Related Social Needs Screening in an Outpatient Clinic. J Prim Care Community Health 2022; 13:21501319221118809. [PMID: 35978539 PMCID: PMC9393584 DOI: 10.1177/21501319221118809] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Health-related social needs (HRSN) screening efforts have reported high rates of identified social needs. Little is known if efforts to conduct HRSN screening in resource-constrained federally-qualified health centers (FQHC) successfully captures a representative patient population. METHODS This cross-sectional study extracted EMR data from 2016 to 2020 for 4731 screened patients from 7 affiliated clinics of a FQHC. Unscreened patients were pulled as a random sample from the study period. A multivariable logistic regression was used to identify sociodemographic traits, chronic disease diagnoses and burden, and clinic visit type and frequency associated with being screened for HRSN. RESULTS BHC screened 4731 unique patients or <1% of the total clinic population. Screened patients had a median of 3.3 (±2.5) unmet HRSN. Medicaid patients had higher odds of being screened (aOR = 1.38, CI 1.19-1.61) relative to Medicare patients. The odds of being screened for social needs increased with more provider visits per year: compared to fewer than 1 visit per year, patients with 1 to 3 provider visits (aOR = 2.06, CI 1.73-2.32), 4 to 6 provider visits (aOR = 3.34, CI 2.89-3.87), and more than 6 provider visits (aOR = 5.16, CI 4.35-6.12) all had higher odds of social needs screening. Patients with a higher comorbid disease burden (>2 conditions, aOR = 2.80, CI 2.07-3.79) had higher odds of screening. CONCLUSIONS Our findings demonstrate an increased likelihood to screen patients who visit outpatient services more often and have a higher comorbid disease burden. To meet state-level Medicaid requirements, resource-constrained FQHCs that implement clinic wide HRSN screening may be well served to identify a priori strategies to ensure representative and equitable screening across the patient population.
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Affiliation(s)
- Raman Nohria
- Duke University School of Medicine, Durham, NC, USA
| | - Nan Xiao
- Greater Lawrence Family Health Center, Lawrence, MA, USA
| | | | - Mari-Lynn Drainoni
- Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.,Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
| | - Cara Smith
- Greater Lawrence Family Health Center, Lawrence, MA, USA
| | - Keith Nokes
- Greater Lawrence Family Health Center, Lawrence, MA, USA.,Department of Family Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Elena Byhoff
- Tufts University School of Medicine, Boston, MA, USA.,Department of Medicine, Tufts Medical Center, Boston, MA, USA
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Fraze TK, Beidler LB, Savitz LA. "It's Not Just the Right Thing . . . It's a Survival Tactic": Disentangling Leaders' Motivations and Worries on Social Care. Med Care Res Rev 2021; 79:701-716. [PMID: 34906013 PMCID: PMC9397397 DOI: 10.1177/10775587211057673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health care organizations face growing pressure to improve their patients’ social conditions, such as housing, food, and economic insecurity. Little is known about the motivations and concerns of health care organizations when implementing activities aimed at improving patients’ social conditions. We used semi-structured interviews with 29 health care organizations to explore their motivations and tensions around social care. Administrators described an interwoven set of motivations for delivering social care: (a) doing the right thing for their patients, (b) improving health outcomes, and (c) making the business case. Administrators expressed tensions around the optimal role for health care in social care including uncertainty around (a) who should be responsible, (b) whether health care has the needed capacity/skills, and (c) sustainability of social care activities. Health care administrators could use guidance and support from policy makers on how to effectively prioritize social care activities, partner with other sectors, and build the needed workforce.
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Affiliation(s)
| | | | - Lucy A Savitz
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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Placzek H, Cruz S, Chapdelaine M, Carl M, Levin S, Hsu C. Intersecting systemic and personal barriers to accessing social services: qualitative interviews in northern California. BMC Public Health 2021; 21:1933. [PMID: 34689735 PMCID: PMC8542412 DOI: 10.1186/s12889-021-11981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background Addressing social risks in the clinical setting can increase patient confidence in the availability of community resources and may contribute to the development of a therapeutic alliance which has been correlated with treatment adherence and improved quality of life in mental health contexts. It is not well understood what barriers patients face when trying to connect to community resources that help address social risks. This paper aims to describe patient-reported barriers to accessing and using social needs-related resources to which they are referred by a program embedded in a safety net primary care clinic. Methods This is a qualitative assessment of patient-reported barriers to accessing and using social needs assistance programs. We conducted over 100 in-depth interviews with individuals in Northern California who participated in a navigation and referral program to help address their social needs and describe a unique framework for understanding how policies and systems intersect with an individual’s personal life circumstances. Results Individuals described two distinct domains of barriers: 1) systems-level barriers that were linked to the inequitable distribution of and access to resources, and 2) personal-level barriers that focused on unique limitations experienced by each patient and impacted the way that they accessed services in their communities. While these barriers often overlapped or manifested in similar outcomes, this distinction was key because the systems barriers were not things that individuals could control or overcome through their own initiative or by increasing individual capacity. Conclusions Respondents describe intersecting systemic and personal barriers that compound patients’ challenges to getting their social needs met; this includes both a picture of the inequitable distribution of and access to social services and a profile of the limitations created by individual life histories. These results speak to the need for structural changes to improve adequacy, availability, and accessibility of social needs resources. These findings highlight the need for advocacy to address systems barriers, especially the stigma that is faced by people who struggle with a variety of health and social issues, and investment in incentives to strengthen relationships between health care settings and social service agencies.
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Affiliation(s)
- Hilary Placzek
- Health Leads, San Francisco, CA, USA. .,Ariadne Labs, Boston, MA, USA. .,Ontrak, Inc., San Francisco, CA, USA.
| | - Stephanie Cruz
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Mary Carl
- Health Leads, San Francisco, CA, USA
| | - Sara Levin
- Contra Costa Public Health Clinical Services, Martinez, CA, USA
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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21
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Wallace AS, Luther BL, Sisler SM, Wong B, Guo JW. Integrating social determinants of health screening and referral during routine emergency department care: evaluation of reach and implementation challenges. Implement Sci Commun 2021; 2:114. [PMID: 34620248 PMCID: PMC8499465 DOI: 10.1186/s43058-021-00212-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background Despite the importance of social determinants in health outcomes, little is known about the best practices for screening and referral during clinical encounters. This study aimed to implement universal social needs screening and community service referrals in an academic emergency department (ED), evaluating for feasibility, reach, and stakeholder perspectives. Methods Between January 2019 and February 2020, ED registration staff screened patients for social needs using a 10-item, low-literacy, English-Spanish screener on touchscreens that generated automatic referrals to community service outreach specialists and data linkages. The RE-AIM framework, specifically the constructs of reach and adoption, guided the evaluation. Reach was estimated through a number of approaches, completed screenings, and receipt of community service referrals. Adoption was addressed qualitatively via content analysis and qualitative coding techniques from (1) meetings, clinical interactions, and semi-structured interviews with ED staff and (2) an iterative “engagement studio” with an advisory group composed of ED patients representing diverse communities. Results Overall, 4608 participants were approached, and 61% completed the screener. The most common reason for non-completion was patient refusal (43%). Forty-seven percent of patients with completed screeners communicated one or more needs, 34% of whom agreed to follow-up by resource specialists. Of the 482 participants referred, 20% were reached by outreach specialists and referred to community agencies. Only 7% of patients completed the full process from screening to community service referral; older, male, non-White, and Hispanic patients were more likely to complete the referral process. Iterative staff (n = 8) observations and interviews demonstrated that, despite instruction for universal screening, patient presentation (e.g., appearance, insurance status) drove screening decisions. The staff communicated discomfort with, and questioned the usefulness of, screening. Patients (n = 10) communicated a desire for improved understanding of their unmet needs, but had concerns about stigmatization and privacy, and communicated how receptivity of screenings and outreach are influenced by the perceived sincerity of screening staff. Conclusions Despite the limited time and technical barriers, few patients with social needs ultimately received service referrals. Perspectives of staff and patients suggest that social needs screening during clinical encounters should incorporate structure for facilitating patient-staff relatedness and competence, and address patient vulnerability by ensuring universal, private screenings with clear intent. Trial registration ClinicalTrials.gov, NCT04630041. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00212-y.
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Affiliation(s)
- Andrea S Wallace
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA. .,Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, USA.
| | - Brenda L Luther
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA
| | - Shawna M Sisler
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA
| | - Bob Wong
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA
| | - Jia-Wen Guo
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA
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22
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Parry J, Vanstone M, Grignon M, Dunn JR. Primary care-based interventions to address the financial needs of patients experiencing poverty: a scoping review of the literature. Int J Equity Health 2021; 20:219. [PMID: 34620188 PMCID: PMC8496150 DOI: 10.1186/s12939-021-01546-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is broadly accepted that poverty is associated with poor health, and the health impact of poverty has been explored in numerous high-income country settings. There is a large and growing body of evidence of the role that primary care practitioners can play in identifying poverty as a health determinant, and in interventions to address it. PURPOSE OF STUDY This study maps the published peer-reviewed and grey literature on primary care setting interventions to address poverty in high-income countries in order to identify key concepts and gaps in the research. This scoping review seeks to map the tools in use to identify and address patients' economic needs; describe the key types of primary care-based interventions; and examine barriers and facilitators to successful implementation. METHODS Using a scoping review methodology, we searched five databases, the grey literature and the reference lists of relevant studies to identify studies on interventions to address the economic needs-related social determinants of health that occur in primary health care delivery settings, in high-income countries. Findings were synthesized narratively, and examined using thematic analysis, according to iteratively identified themes. RESULTS Two hundred and fourteen papers were included in the review and fell into two broad categories of description and evaluation: screening tools, and economic needs-specific interventions. Primary care-based interventions that aim to address patients' financial needs operate at all levels, from passive sociodemographic data collection upon patient registration, through referral to external services, to direct intervention in addressing patients' income needs. CONCLUSION Tools and processes to identify and address patients' economic social needs range from those tailored to individual health practices, or addressing one specific dimension of need, to wide-ranging protocols. Primary care-based interventions to address income needs operate at all levels, from passive sociodemographic data collection, through referral to external services, to direct intervention. Measuring success has proven challenging. The decision to undertake this work requires courage on the part of health care providers because it can be difficult, time-consuming and complex. However, it is often appreciated by patients, even when the scope of action available to health care providers is quite narrow.
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Affiliation(s)
- Jane Parry
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Michel Grignon
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - James R. Dunn
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
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23
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Ruiz Escobar E, Pathak S, Blanchard CM. Screening and Referral Care Delivery Services and Unmet Health-Related Social Needs: A Systematic Review. Prev Chronic Dis 2021; 18:E78. [PMID: 34387188 PMCID: PMC8388203 DOI: 10.5888/pcd18.200569] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction Unmet health-related social needs contribute to high patient morbidity and poor population health. A potential solution to improve population health includes the adoption of care delivery models that alleviate unmet needs through screening, referral, and tracking of patients in health care settings, yet the overall impact of such models has remained unexplored. This review addresses an existing gap in the literature regarding the effectiveness of these models and assesses their overall impact on outcomes related to experience of care, population health, and costs. Methods In March 2020, we searched for peer-reviewed articles published in PubMed over the past 10 years. Studies were included if they 1) used a screening tool for identifying unmet health-related social needs in a health care setting, 2) referred patients with positive screens to appropriate resources for addressing identified unmet health-related social needs, and 3) reported any outcomes related to patient experience of care, population health, or cost. Results Of 1,821 articles identified, 35 met the inclusion criteria. All but 1 study demonstrated a tendency toward high risk of bias. Improved outcomes related to experience of care (eg, change in social needs, patient satisfaction, n = 34), population health (eg, diet quality, blood cholesterol levels, n = 7), and cost (eg, program costs, cost-effectiveness, n = 3) were reported. In some studies (n = 5), improved outcomes were found among participants who received direct referrals or additional assistance with indirect referrals compared with those who received indirect referrals only. Conclusion Effective collaborations between health care organizations and community-based organizations are essential to facilitate necessary patient connection to resources for addressing their unmet needs. Although evidence indicated a positive influence of screening and referral programs on outcomes related to experience of care and population health, no definitive conclusions can be made on overall impact because of the potentially high risk of bias in the included studies.
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Affiliation(s)
- Emily Ruiz Escobar
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Shweta Pathak
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina.,UNC Eshelman School of Pharmacy, Center for Medication Optimization, 2400 Kerr Hall, 301 Pharmacy Ln, Chapel Hill, NC 27599-7574.
| | - Carrie M Blanchard
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
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24
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Greenwood-Ericksen M, DeJonckheere M, Syed F, Choudhury N, Cohen AJ, Tipirneni R. Implementation of Health-Related Social Needs Screening at Michigan Health Centers: A Qualitative Study. Ann Fam Med 2021; 19:310-317. [PMID: 34264836 PMCID: PMC8282295 DOI: 10.1370/afm.2690] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Federally qualified health centers (FQHCs) are leaders in screening for and addressing patient's health-related social needs but variation exists in screening practices. This variation is relatively unexplored, particularly the influences of organizational and state policies. We employed a qualitative descriptive approach to study social needs screening practices at Michigan FQHCs to characterize screening processes and identify drivers of variation in screening implementation. METHODS Site visits and semistructured interviews were conducted from October 2016 through March 2017, to explore implementation of social needs screening in clinical practice. Five FQHCs were selected through maximum variation sampling. Within each site, snowball sampling identified care team members highly knowledgeable about social needs screening. We conducted 4 to 5 interviews per site. Transcripts were analyzed using a thematic approach. RESULTS We interviewed 23 participants from 5 sites; these sites varied by geography, age distribution, and race/ethnicity. We identified 4 themes: (1) statewide initiatives and local leadership drove variation in screening practices; (2) as community health workers (CHWs) played an integral role in identifying patients' needs, their roles often shifted from that of screener to implementer; (3) social needs screening data was variably integrated into electronic health records and infrequently used for population health management; and (4) sites experienced barriers to social needs screening that limited the perceived impact and sustainability. CONCLUSIONS FQHCs placed value on the role of CHWs, on sustainable initiatives, and on funding to support continued social needs screening in primary care settings.
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Affiliation(s)
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - Faiyaz Syed
- Michigan Primary Care Association, Lansing, Michigan
| | | | - Alicia J Cohen
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.,Center of Innovation in Long Term Services and Supports for Vulnerable Populations, Providence VA Medical Center, Providence, Rhode Island.,Departments of Family Medicine and Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Renuka Tipirneni
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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25
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Sandhu S, Xu J, Eisenson H, Prvu Bettger J. Workforce Models to Screen for and Address Patients' Unmet Social Needs in the Clinic Setting: A Scoping Review. J Prim Care Community Health 2021; 12:21501327211021021. [PMID: 34053370 PMCID: PMC8772357 DOI: 10.1177/21501327211021021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objectives While healthcare organizations increasingly aim to address the social determinants of health (SDOH) in the clinic setting, there is little guidance on which staff are best equipped to assume this role. The present study is a scoping review of the peer-reviewed literature to characterize workforce models used to screen for and respond to patients’ unmet social needs in ambulatory settings. Methods Four online databases were used to identify papers published until February 2021. Eligible articles were original research studies or systematic reviews that described the implementation of a standardized assessment for multiple SDOH domains and resulting activities to respond to individual patient needs (eg, referral to community resources) in ambulatory care settings. Results Of the 1569 articles identified, 65 met study eligibility criteria. Majority of studies had observational study designs (11% were randomized control trials). For screening-related activities, more articles reported using traditional healthcare staff (51%), such as medical providers, medical assistants, and front-desk staff, than social care staff (32%), such as social workers and student volunteers. In contrast, for response-related activities, more articles reported using social care staff (88%) than traditional healthcare staff (60%). While we found wide variations in specific team configurations and training for the roles, social care staff generally provided more intensive forms of assistance than traditional healthcare staff. Conclusion While this review demonstrates the breadth of models for building or deploying a workforce to integrate health and social care, it also identifies the need for rigorous research on workforce development, implementation, and effectiveness.
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Affiliation(s)
- Sahil Sandhu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Jacqueline Xu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | | | - Janet Prvu Bettger
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham NC, USA
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26
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Lian T, Kutzer K, Gautam D, Eisenson H, Crowder JC, Esmaili E, Sandhu S, Trachtman L, Prvu Bettger J, Drake C. Factors Associated with Patients' Connection to Referred Social Needs Resources at a Federally Qualified Health Center. J Prim Care Community Health 2021; 12:21501327211024390. [PMID: 34120507 PMCID: PMC8202269 DOI: 10.1177/21501327211024390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study aimed to identify factors associated with the successful connection (ie, services started) to social needs resources, as well as factors associated with an attempt to connect as a secondary, intermediate outcome. Methods: This retrospective cohort study included patients who had been screened, referred, and subsequently reached for follow-up navigation from March 2019 to December 2020, as part of a social needs intervention at a federally qualified health center (FQHC). Measures included demographic and social needs covariates collected during screening, as well as resource-related covariates that characterized the referred resources, including service domain (area of need addressed), service site (integration relative to the FQHC), and access modality (means of accessing services). Results: Of the 501 patients in the analytic sample, 32.7% had started services with 1 or more of their referred resources within 4 weeks of the initial referral, and 63.3% had at least attempted to contact 1 referred resource, whether or not they were able to start services. Receiving a referral to resources that patients could access via phone call or drop-in visit, as opposed to resources that required additional appointments or applications prior to accessing services, was associated with increased odds (aOR 1.95, 95% CI 1.05, 3.61) of connection success, after adjusting for age, sex, race, ethnicity, education, number of social needs, and resource-related characteristics. This study did not find statistically significant associations between connection attempt and any variable included in adjusted analyses. Conclusion: These findings suggest that referral pathways may influence the success of patients’ connection to social needs resources, highlighting opportunities for more accessible solutions to addressing patients’ unmet social needs.
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Affiliation(s)
- Tyler Lian
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kate Kutzer
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | - Diwas Gautam
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | | | | | | | - Sahil Sandhu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | | | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.,Duke Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Connor Drake
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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27
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Nguyen KH, Trivedi AN, Cole MB. Receipt of Social Needs Assistance and Health Center Patient Experience of Care. Am J Prev Med 2021; 60:e139-e147. [PMID: 33309453 PMCID: PMC7931986 DOI: 10.1016/j.amepre.2020.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/04/2020] [Accepted: 08/25/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Community health centers often screen for and address patients' unmet social needs. This study examines the degree to which community health center patients report receiving social needs assistance and compares measures of access and quality between patients who received assistance versus similar patients who did not. METHODS A nationally representative sample of 4,699 nonelderly adults receiving care at community health centers from the 2014-2015 Health Resources and Services Administration Health Center Patient Survey was used, representing 12.6 million patients. The exposure-having "received social needs assistance"-was based on whether a patient received any community health center assistance accessing social programs (e.g., applying for government benefits) or basic needs (e.g., obtaining transportation, housing, food). Using logistic regression models with inverse probability of treatment weights, outcomes for patients who received social needs assistance with similar patients who did not were compared. Study outcomes, reported as absolute adjusted differences, included reporting a community health center as a usual source of care, reporting the emergency department as a usual source of care, perceived quality of care, and willingness to recommend the community health center to others. Data were analyzed in 2020. RESULTS Of the sample, 36% reported receiving social needs assistance, where the most common form of assistance was applying for government benefits. Relative to similar patients who did not receive social needs assistance, patients receiving assistance were significantly more likely to report a community health center as their usual source of care (adjusted difference=7.2 percentage points, 95% CI=2.2, 12.1) and to report perceived quality of care as "the best" (adjusted difference=11.1, 95% CI=5.4, 16.9). They were significantly less likely to report the emergency department as their usual source of care (adjusted difference= -4.2, 95% CI= -7.0, -1.3). CONCLUSIONS As community health centers and other providers consider providing social needs assistance to patients, these results suggest that doing so may be associated with improved access to and quality of care.
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Affiliation(s)
- Kevin H Nguyen
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island; Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Megan B Cole
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
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28
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Browne J, Mccurley JL, Fung V, Levy DE, Clark CR, Thorndike AN. Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study. J Prim Care Community Health 2021; 12:2150132721993651. [PMID: 33576286 PMCID: PMC7883146 DOI: 10.1177/2150132721993651] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/15/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Systematic screening for social determinants of health (SDOH), such as food and housing insecurity, is increasingly implemented in primary care, particularly in the context of Accountable Care Organizations (ACO). Despite the importance of developing effective systems for SDOH resource linkage, there is limited research examining these processes. The objective of the study was to explore facilitators and barriers to addressing SDOH identified by systematic screening in a healthcare system participating in a Medicaid ACO. METHODS This qualitative case study took place between January and March 2020. Semi-structured interviews were conducted with fifteen staff (8 community resource staff and 7 managers) from community health centers and hospitals affiliated with a large healthcare system. Interviews were transcribed, coded, and analyzed using the Framework Method. RESULTS Facilitators for addressing SDOH included maintaining updated resource lists, collaborating with community organizations, having leadership buy-in, and developing a trusting relationship with patients. Barriers to addressing SDOH included high caseloads, time constraints, inefficiencies in tracking, lack of community resources, and several specific patient characteristics. Further, resource staff expressed distress associated with having to communicate to patients that they were unable to address certain needs. CONCLUSIONS Health system, community, and individual-level facilitators and barriers should be considered when developing programs for addressing SDOH. Specifically, the psychological burden on resource staff is an important and underappreciated factor that could impact patient care and lead to staff burnout.
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Affiliation(s)
- Julia Browne
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Durham VA Health Care System, Durham, NC, USA
| | - Jessica L. Mccurley
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Vicki Fung
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Douglas E. Levy
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cheryl R. Clark
- Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Anne N. Thorndike
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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29
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Hunleth J, Spray J, Ruiz S, Maki J, Fedele DA, Prabhakaran S, Forsyth RB, Sykes C, Crepps K, Shepperd J, Bowen D, Waters EA. Situating household management of children's asthma in the context of social, economic, and environmental injustice. J Asthma 2020; 59:70-78. [PMID: 33107771 DOI: 10.1080/02770903.2020.1837159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Structural determinants of health are social, economic, and environmental forces that generate unequal opportunities for resources and unequally distribute exposure to risk. For example, economic constraint, racial discrimination and segregation, and environmental injustice shape population-level asthma prevalence and severity. Structural determinants are especially relevant to consider in clinical settings because they affect everyday household asthma management. OBJECTIVE To examine how structural determinants shape everyday household management of pediatric asthma and offer a framework for providers to understand asthma management in social context. DESIGN Qualitative interviews of caregivers for children with asthma. PARTICIPANTS Participants included 41 caregivers in two U.S. cities: St. Louis, Missouri (n = 25) and Gainesville, Florida (n = 16). Most caregivers were women (83%), Black (73%) and/or had low socioeconomic status (SES; 78%). Caregivers cared for children with asthma aged 0-4 (32%), 5-11 (68%) and 12-17 (54%). APPROACH We carried out narrative interviews with caregivers using an adapted McGill Illness Narrative Interview and using qualitative analysis techniques (e.g. inductive and deductive coding, constant comparison). KEY RESULTS Caregivers highlighted three ways that structural determinants complicated asthma management at home: 1) housing situations, 2) competing household illnesses and issues, and 3) multi-household care. CONCLUSIONS By connecting social, economic, and environmental injustices to the everyday circumstances of asthma management, our study can help providers understand how social contexts challenge asthma management and can open conversations about barriers to adherence and strategies for supporting asthma management at home. We offer recommendations for medical system reform, clinical interactions, and policy advocacy.
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Affiliation(s)
- Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sienna Ruiz
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Julia Maki
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | | | - Rachel B Forsyth
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Cassidy Sykes
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kaylah Crepps
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - James Shepperd
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Deb Bowen
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Erika A Waters
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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