1
|
Pruitt Z, Emechebe N, Quast T, Taylor P, Bryant K. Expenditure Reductions Associated with a Social Service Referral Program. Popul Health Manag 2018; 21:469-476. [PMID: 29664702 PMCID: PMC6276598 DOI: 10.1089/pop.2017.0199] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Recent health system innovations provide encouraging evidence that greater coordination of medical and social services can improve health outcomes and reduce health care expenditures. This study evaluated the savings associated with a managed care organization's call center-based social service referral program that aimed to assist participants address their social needs, such as homelessness, transportation barriers, and food insecurity. The program evaluation linked social service referral data with health care claims to analyze expenditures in 2 annual periods, before and after the first social service referral. Secondary data analysis estimated the change in mean expenditures over 2 annual periods using generalized estimating equations regression analysis with the identity link. The study compared the change in mean health care expenditures for the second year for those reporting social needs met versus the group whose needs remained unmet. By comparing the difference between the first and second year mean expenditures for both groups, the study estimated the associated savings of social services, after controlling for group differences. These results showed that the decrease in second year mean expenditures for the group of participants who reported all of their social needs met was $2443 (10%) greater than the decrease in second year mean expenditures for the group who reported none of their social needs met, after controlling for group differences. Organizations that integrate medical and social services may thrive under policy initiatives that require financial accountability for the total well-being of patients.
Collapse
Affiliation(s)
- Zachary Pruitt
- Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, Florida
| | - Nnadozie Emechebe
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | - Troy Quast
- Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, Florida
| | - Pamme Taylor
- Center for CommUnity Impact, WellCare Health Plans, Inc., Tampa, Florida
| | | |
Collapse
|
2
|
Mullen PD, Savas LS, Bundy ŁT, Haardörfer R, Hovell M, Fernández ME, Monroy JAA, Williams RS, Kreuter MW, Jobe D, Kegler MC. Minimal intervention delivered by 2-1-1 information and referral specialists promotes smoke-free homes among 2-1-1 callers: a Texas generalisation trial. Tob Control 2018; 25:i10-i18. [PMID: 27697943 PMCID: PMC5099226 DOI: 10.1136/tobaccocontrol-2016-053045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/02/2016] [Indexed: 01/15/2023]
Abstract
Background Replication of intervention research is reported infrequently, limiting what we know about external validity and generalisability. The Smoke Free Homes Program, a minimal intervention, increased home smoking bans by United Way 2-1-1 callers in randomised controlled trials in Atlanta, Georgia and North Carolina. Objective Test the programme's generalisability-external validity in a different context. Methods A randomised controlled trial (n=508) of English-speaking callers from smoking-discordant households (≥1 smoker and ≥1 non-smoker). 2-1-1 Texas/United Way HELPLINE call specialists serving the Texas Gulf Coast recruited callers and delivered three mailings and one coaching call, supported by an online tracking system. Data collectors, blind to study assignment, conducted telephone interviews 3 and 6 months postbaseline. Results At 3 months, more intervention households reported a smoke-free home (46.6% vs 25.4%, p<0.0001; growth model intent-to-treat OR=1.48, 95% CI 1.241 to 1.772, p<0.0001). At 6 months, self-reported full bans were 62.9% for intervention participants and 38.4% for controls (OR=2.19). Texas trial participants were predominantly women (83%), single-smoker households (76%) and African-American (65%); half had incomes ≤US$10 000/year (50%). Texas recruitment was <50% of the other sites. Fewer callers reported having a smoker in the household. Almost twice the callers with a household smoker declined interest in the programme/study. Conclusions Our findings in a region with lower smoking rates and more diverse callers, including English-speaking Latinos, support programme generalisability and convey evidence of external validity. Our recruitment experience indicates that site-specific adjustments might improve recruitment efficiency and reach. Trial registration number NCT02097914, Results.
Collapse
Affiliation(s)
- Patricia Dolan Mullen
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, USA
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, USA
| | - Łucja T Bundy
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mel Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Maria E Fernández
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, USA
| | - Jo Ann A Monroy
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention and Lineberger Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Washington University, St. Louis, Missouri, USA
| | - David Jobe
- 2-1-1 Texas/United Way HELPLINE, United Way of Greater Houston, Houston, Texas, USA
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Klein WMP, Grenen EG, O'Connell M, Blanch-Hartigan D, Chou WYS, Hall KL, Taber JM, Vogel AL. Integrating knowledge across domains to advance the science of health behavior: overcoming challenges and facilitating success. Transl Behav Med 2017; 7:98-105. [PMID: 27520313 DOI: 10.1007/s13142-016-0433-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Health behaviors often co-occur and have common determinants at multiple levels (e.g., individual, relational, environmental). Nevertheless, research programs often examine single health behaviors without a systematic attempt to integrate knowledge across behaviors. This paper highlights the significant potential of cross-cutting behavioral research to advance our understanding of the mechanisms and causal factors that shape health behaviors. It also offers suggestions for how researchers could develop more effective interventions. We highlight barriers to such an integrative science along with potential steps that can be taken to address these barriers. With a more nuanced understanding of health behavior, redundancies in research can be minimized, and a stronger evidence base for the development of health behavior interventions can be realized.
Collapse
Affiliation(s)
- William M P Klein
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 3E140, MSC 9761, Bethesda, MD, 20892-9761, USA.
| | - Emily G Grenen
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 3E140, MSC 9761, Bethesda, MD, 20892-9761, USA
| | - Mary O'Connell
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 3E140, MSC 9761, Bethesda, MD, 20892-9761, USA
| | | | - Wen-Ying Sylvia Chou
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 3E140, MSC 9761, Bethesda, MD, 20892-9761, USA
| | - Kara L Hall
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 3E140, MSC 9761, Bethesda, MD, 20892-9761, USA
| | - Jennifer M Taber
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 3E140, MSC 9761, Bethesda, MD, 20892-9761, USA
| | - Amanda L Vogel
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, 21702, USA
| |
Collapse
|
4
|
Springer AE, Evans AE. Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners. Health Promot Perspect 2016; 6:111-8. [PMID: 27579254 PMCID: PMC5002877 DOI: 10.15171/hpp.2016.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/24/2016] [Indexed: 11/25/2022] Open
Abstract
Conducting a health needs assessment is an important if not essential first step for health promotion planning. This paper explores how health needs assessments may be further strengthened for health promotion planning via an assessment of environmental assets rooted in the multiple environments (policy, information, social and physical environments) that shape health and behavior. Guided by a behavioral-ecological perspective- one that seeks to identify environmental assets that can influence health behavior, and an implementation science perspective- one that seeks to interweave health promotion strategies into existing environmental assets, we present a basic framework for assessing environmental assets and review examples from the literature to illustrate the incorporation of environmental assets into health program design. Health promotion practitioners and researchers implicitly identify and apply environmental assets in the design and implementation of health promotion interventions;this paper provides foundation for greater intentionality in assessing environmental assets for health promotion planning.
Collapse
Affiliation(s)
- Andrew E Springer
- Assistant Professor of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
| | - Alexandra E Evans
- Associate Professor of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
| |
Collapse
|
5
|
Thompson T, Kreuter MW, Boyum S. Promoting Health by Addressing Basic Needs: Effect of Problem Resolution on Contacting Health Referrals. HEALTH EDUCATION & BEHAVIOR 2016; 43:201-7. [PMID: 26293458 PMCID: PMC5029788 DOI: 10.1177/1090198115599396] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Members of vulnerable populations have heightened needs for health services. One advantage of integrating health risk assessment and referrals into social service assistance systems such as 2-1-1 is that such systems help callers resolve problems in other areas (e.g., housing). Callers to 2-1-1 in Missouri (N= 1,090) with at least one behavioral risk factor or cancer screening need were randomly assigned to one of three health referral interventions: verbal referrals only, verbal referrals + a tailored mailed reminder, or verbal referrals + telephone health navigator. After 1 month, we assessed whether the nonhealth problems that prompted the 2-1-1 call had been resolved. Logistic regression estimated effects of having the problem resolved on calling a health referral. Callers were predominantly female (85%) and had a high school education or less (61%); nearly half (47%) had incomes under $10,000. The most common service requests were for utility assistance (35%), home/family problems (23%), and rent/mortgage assistance (12%). At follow-up, 38% of callers reported that all problems prompting their 2-1-1 call had been resolved, and 24% reported calling a health referral. Resolving all problems prompting the 2-1-1 call was associated with a higher odds of contacting a health referral (odds ratio = 1.44, 95% confidence interval [1.02, 2.05]) compared to people whose problems were not resolved. Multifaceted interventions that help meet non-health-related needs and provide support in reaching health-related goals may promote health in vulnerable populations.
Collapse
Affiliation(s)
- Tess Thompson
- Washington University in St. Louis, St. Louis, MO, USA
| | | | - Sonia Boyum
- Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
6
|
Corbin JH, Fernandez ME, Mullen PD. Evaluation of a community-academic partnership: lessons from Latinos in a network for cancer control. Health Promot Pract 2014; 16:345-53. [PMID: 25395057 DOI: 10.1177/1524839914558514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Established in 2002, Latinos in a Network for Cancer Control is a community-academic network supported by the Centers for Disease Control and Prevention and the National Cancer Institute. The network includes >130 individuals from 65 community and academic organizations committed to reducing cancer-related health disparities. Using an empirically derived systems model--the Bergen Model of Collaborative Functioning--as the analytic frame, we interviewed 19 partners to identify challenges and successful processes. Findings indicated that sustained partner interaction created "meaningful relationships" that were routinely called on for collaboration. The leadership was regarded positively on vision, charisma, and capacity. Limitations included overreliance on a single leader. Suggestions supported more delegation of decision making, consistent communication, and more equitable resource distribution. The study highlighted new insights into dynamics of collaboration: Greater inclusiveness of inputs (partners, finances, mission) and loosely defined roles and structure produced strong connections but less network-wide productivity (output). Still, this profile enabled the creation of more tightly defined and highly productive subgroups, with clear goals and roles but less inclusive of inputs than the larger network. Important network outputs included practice-based research publications, cancer control intervention materials, and training to enhance the use of evidence-based interventions, as well as continued and diversified funding.
Collapse
Affiliation(s)
| | - Maria E Fernandez
- University of Texas-Houston, School of Public Health, Houston, TX, USA
| | - Patricia D Mullen
- University of Texas-Houston, School of Public Health, Houston, TX, USA
| |
Collapse
|
7
|
Linnan LA. Research collaboration with 2-1-1 to eliminate health disparities: an introduction. Am J Prev Med 2012; 43:S415-9. [PMID: 23157758 PMCID: PMC7135801 DOI: 10.1016/j.amepre.2012.09.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 09/08/2012] [Accepted: 09/14/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Laura A Linnan
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina 27599, USA.
| |
Collapse
|
8
|
Daily LS. Health research and surveillance potential to partner with 2-1-1. Am J Prev Med 2012; 43:S422-4. [PMID: 23157760 PMCID: PMC7135616 DOI: 10.1016/j.amepre.2012.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 09/07/2012] [Accepted: 09/13/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Linda S Daily
- United Way Worldwide, Alexandria, Virginia 22314-2045, USA.
| |
Collapse
|
9
|
Bennett GG. Connecting eHealth with 2-1-1 to reduce health disparities. Am J Prev Med 2012; 43:S509-11. [PMID: 23157773 DOI: 10.1016/j.amepre.2012.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 09/04/2012] [Accepted: 09/13/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Gary G Bennett
- Department of Psychology and Neuroscience, Duke Global Health Institute, Duke Obesity Prevention Program, Duke University, Durham, North Carolina, USA.
| |
Collapse
|
10
|
Eddens KS. Guiding principles for collaborative research with 2-1-1. Am J Prev Med 2012; 43:S512-7. [PMID: 23157774 DOI: 10.1016/j.amepre.2012.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 09/11/2012] [Accepted: 09/13/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine S Eddens
- Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, Kentucky 40536, USA. .
| |
Collapse
|
11
|
Reach, effectiveness, and connections: the case for partnering with 2-1-1 to eliminate health disparities. Am J Prev Med 2012; 43:S420-1. [PMID: 23157759 PMCID: PMC3960992 DOI: 10.1016/j.amepre.2012.09.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 08/27/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022]
|