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Grant RW, McCloskey JK, Uratsu CS, Ranatunga D, Ralston JD, Bayliss EA, Sofrygin O. Predicting Self-Reported Social Risk in Medically Complex Adults Using Electronic Health Data. Med Care 2024; 62:590-598. [PMID: 38833715 DOI: 10.1097/mlr.0000000000002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Social barriers to health care, such as food insecurity, financial distress, and housing instability, may impede effective clinical management for individuals with chronic illness. Systematic strategies are needed to more efficiently identify at-risk individuals who may benefit from proactive outreach by health care systems for screening and referral to available social resources. OBJECTIVE To create a predictive model to identify a higher likelihood of food insecurity, financial distress, and/or housing instability among adults with multiple chronic medical conditions. RESEARCH DESIGN AND SUBJECTS We developed and validated a predictive model in adults with 2 or more chronic conditions who were receiving care within Kaiser Permanente Northern California (KPNC) between January 2017 and February 2020. The model was developed to predict the likelihood of a "yes" response to any of 3 validated self-reported survey questions related to current concerns about food insecurity, financial distress, and/or housing instability. External model validation was conducted in a separate cohort of adult non-Medicaid KPNC members aged 35-85 who completed a survey administered to a random sample of health plan members between April and June 2021 (n = 2820). MEASURES We examined the performance of multiple model iterations by comparing areas under the receiver operating characteristic curves (AUCs). We also assessed algorithmic bias related to race/ethnicity and calculated model performance at defined risk thresholds for screening implementation. RESULTS Patients in the primary modeling cohort (n = 11,999) had a mean age of 53.8 (±19.3) years, 64.7% were women, and 63.9% were of non-White race/ethnicity. The final, simplified model with 30 predictors (including utilization, diagnosis, behavior, insurance, neighborhood, and pharmacy-based variables) had an AUC of 0.68. The model remained robust within different race/ethnic strata. CONCLUSIONS Our results demonstrated that a predictive model developed using information gleaned from the medical record and from public census tract data can be used to identify patients who may benefit from proactive social needs assessment. Depending on the prevalence of social needs in the target population, different risk output thresholds could be set to optimize positive predictive value for successful outreach. This predictive model-based strategy provides a pathway for prioritizing more intensive social risk outreach and screening efforts to the patients who may be in greatest need.
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Affiliation(s)
- Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jodi K McCloskey
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Connie S Uratsu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Dilrini Ranatunga
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle WA
| | | | - Oleg Sofrygin
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Saelee R, Bullard KM, Wittman JT, Alexander DS, Hudson D. State-Level Household Energy Insecurity and Diabetes Prevalence Among US Adults, 2020. Prev Chronic Dis 2024; 21:E65. [PMID: 39208386 PMCID: PMC11364296 DOI: 10.5888/pcd21.240087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
The objective of this study was to examine the state-level association between household energy insecurity and diabetes prevalence in 2020. We obtained 1) state-level data on household energy characteristics from the 2020 Residential Energy Consumption Survey and 2) diagnosed diabetes prevalence from the US Diabetes Surveillance System. We found states with a higher percentage of household energy insecurity had greater diabetes prevalence compared with states with lower percentages of energy insecurity. Interventions related to energy assistance may help reduce household energy insecurity, mitigate the risk of diabetes-related complications, and alleviate some of the burden of diabetes management during extreme temperatures.
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Affiliation(s)
- Ryan Saelee
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS S107-3, Atlanta, GA, 30341
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacob T Wittman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dayna S Alexander
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Darrell Hudson
- Center for the Study of Race, Ethnicity & Equity, Brown School at Washington University, St. Louis, Missouri
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April-Sanders AK. Integrating Social Determinants of Health in the Management of Cardiovascular-Kidney-Metabolic Syndrome. J Am Heart Assoc 2024; 13:e036518. [PMID: 39136349 DOI: 10.1161/jaha.124.036518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
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Lyles C, Berrean B, Buenaventura A, Milter S, Hernandez DD, Sarkar U, Gutierrez C, Palmer N, Brown III W. Building a Client Resource and Communication Platform for Community-Based Organizations to Address Health and Social Needs: Co-Design Study. JMIR Hum Factors 2024; 11:e53939. [PMID: 39157908 PMCID: PMC11342060 DOI: 10.2196/53939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 08/20/2024] Open
Abstract
Background Connecting individuals to existing community resources is critical to addressing social needs and improving population health. While there is much ongoing informatics work embedding social needs screening and referrals into health care systems and their electronic health records, there has been less focus on the digital ecosystem and needs of community-based organizations (CBOs) providing or connecting individuals to these resources. Objective We used human-centered design to develop a digital platform for CBOs, focused on identification of health and social resources and communication with their clients. Methods Centered in the Develop phase of the design process, we conducted in-depth interviews in 2 phases with community-based organizational leadership and staff to create and iterate on the platform. We elicited and mapped participant feedback to theory-informed domains from the Technology Acceptance Model, such as Usefulness and Ease of Use, to build the final product and summarized all major design decisions as the platform development proceeded. Results Overall, we completed 22 interviews with 18 community-based organizational leadership and staff in 2 consecutive Develop phases. After coding of the interview transcripts, there were 4 major themes related to usability, relevance, and external factors impacting use. Specifically, CBOs expressed an interest in a customer relationship management software to manage their client interactions and communications, and they needed specific additional features to address the scope of their everyday work, namely (1) digital and SMS text messaging communication with clients and (2) easy ways to identify relevant community resources based on diverse client needs and various program eligibility criteria. Finally, clear implementation needs emerged, such as digital training and support for staff using new platforms. The final platform, titled "Mapping to Enhance the Vitality of Engaged Neighborhoods (MAVEN)," was completed in the Salesforce environment in 2022, and it included features and functions directly mapped to the design process. Conclusions Engaging community organizations in user-centered design of a health and social resource platform was essential to tapping into their deep expertise in serving local communities and neighborhoods. Design methods informed by behavioral theory can be similarly employed in other informatics research. Moving forward, much more work will be necessary to support the implementation of platforms specific to CBOs' needs, especially given the resources, training, and customization needed in these settings.
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Affiliation(s)
- Courtney Lyles
- UC Davis Center for Healthcare Policy and Research, UC Davis School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Beth Berrean
- Technology Services Unit, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ana Buenaventura
- Technology Services Unit, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Svetlana Milter
- Technology Services Unit, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Dayana Daniel Hernandez
- Technology Services Unit, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Urmimala Sarkar
- Department of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Christian Gutierrez
- Department of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Nynikka Palmer
- Department of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - William Brown III
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Walker RJ, Williams JS, Linde S, Egede LE. Social Risk and Clinical Outcomes Among Adults With Type 2 Diabetes. JAMA Netw Open 2024; 7:e2425996. [PMID: 39207760 PMCID: PMC11362860 DOI: 10.1001/jamanetworkopen.2024.25996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/28/2024] [Indexed: 09/04/2024] Open
Abstract
Importance No clear process exists for categorizing social risks in a way that informs effective social risk screening and intervention development. Objective To investigate social risk profiles and associations of those profiles with clinical outcomes in adults with diabetes using latent profile analysis. Design, Setting, and Participants For this cross-sectional study, a latent profile analysis was conducted using data for adults with type 2 diabetes collected at 2 primary care clinics in the Southeastern US from 2013 to 2014. Data were analyzed from November to December 2023. Main Outcomes and Measures Participants completed validated questionnaires for 26 social risk factors within 5 domains of social determinants of health: socioeconomic, neighborhood, education, food, and social and community context. In addition, participants completed questions that assessed psychological risk and behavioral risk. A 3-step latent profile analysis was used to identify different subgroups within the sample. Profiles were then regressed on outcomes of hemoglobin A1c (HbA1c), blood pressure, and quality of life. Results A total of 615 participants (mean [SD] age, 61.3 [10.9] years; 379 men [61.6%]) were included. Five latent class profiles were identified. The lowest risk group had significantly higher mental health-related quality of life compared with a group with higher neighborhood risk (β, 1.11; 95% CI, 0.67 to 1.55). The second group had low economic risk but high neighborhood risk and served as the reference group. The third group had high economic and neighborhood risk and had significantly higher blood pressure (β, 8.08; 95% CI, 2.16 to 14.01) compared with the reference. The fourth group had high psychological and behavioral risks but low socioeconomic and neighborhood risks. This group had significantly higher HbA1c (β, 0.47; 95% CI, 0.01 to 0.92) and lower mental health-related quality of life (β, -1.83; 95% CI, -2.41 to -1.24) compared with the reference. The highest risk group indicated high risk in all domains, had significantly higher HbA1c (β, 1.07; 95% CI, 0.50 to 1.63), and had lower mental health-related quality of life (β, -2.15; 95% CI, -2.87 to -1.42) compared with the reference. Conclusions and Relevance These findings suggest that social risk profiles can be identified according to social, psychological, and behavioral risk domains and the health outcome of concern among adults with diabetes. Future work should consider the use of social risk profiles in intervention development and testing.
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Affiliation(s)
- Rebekah J. Walker
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Joni S. Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Sebastian Linde
- Department of Health Policy & Management, Texas A&M School of Public Health, College Station
| | - Leonard E. Egede
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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McQueen A, von Nordheim D, Caburnay C, Li L, Herrick C, Grimes L, Broussard D, Smith RE, Lawson D, Yan Y, Kreuter M. A Randomized Controlled Trial Testing the Effects of a Social Needs Navigation Intervention on Health Outcomes and Healthcare Utilization among Medicaid Members with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:936. [PMID: 39063512 PMCID: PMC11277523 DOI: 10.3390/ijerph21070936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
Health systems are increasingly assessing and addressing social needs with referrals to community resources. The objective of this randomized controlled trial was to randomize adult Medicaid members with type 2 diabetes to receive usual care (n = 239) or social needs navigation (n = 234) for 6 months and compare HbA1c (primary outcome), quality of life (secondary outcome), and other exploratory outcomes with t-tests and mixed-effects regression. Eligible participants had an HbA1c test in claims in the past 120 days and reported 1+ social needs. Data were collected from November 2019 to July 2023. Surveys were completed at baseline and at 3-, 6-, and 12-month follow-up. Health plan data included care management records and medical and pharmacy claims. The sample was from Louisiana, USA, M = 51.6 (SD = 9.5) years old, 76.1% female, 66.5% Black, 29.4% White, and 3.0% Hispanic. By design, more navigation (91.5%) vs. usual care (6.7%) participants had a care plan. Social needs persisted for both groups. No group differences in HbA1c tests and values were observed, though the large amount of missing HbA1c lab values reduced statistical power. No group differences were observed for other outcomes. Proactively eliciting and attempting to provide referrals and resources for social needs did not demonstrate significant health benefits or decrease healthcare utilization in this sample.
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Affiliation(s)
- Amy McQueen
- School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA; (C.H.); (Y.Y.)
- Health Communication Research Lab, Brown School, Washington University in St. Louis, 1 Brookings Hall, St. Louis, MO 63130, USA; (D.v.N.); (C.C.); (L.L.); (L.G.); (M.K.)
| | - David von Nordheim
- Health Communication Research Lab, Brown School, Washington University in St. Louis, 1 Brookings Hall, St. Louis, MO 63130, USA; (D.v.N.); (C.C.); (L.L.); (L.G.); (M.K.)
| | - Charlene Caburnay
- Health Communication Research Lab, Brown School, Washington University in St. Louis, 1 Brookings Hall, St. Louis, MO 63130, USA; (D.v.N.); (C.C.); (L.L.); (L.G.); (M.K.)
| | - Linda Li
- Health Communication Research Lab, Brown School, Washington University in St. Louis, 1 Brookings Hall, St. Louis, MO 63130, USA; (D.v.N.); (C.C.); (L.L.); (L.G.); (M.K.)
| | - Cynthia Herrick
- School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA; (C.H.); (Y.Y.)
| | - Lauren Grimes
- Health Communication Research Lab, Brown School, Washington University in St. Louis, 1 Brookings Hall, St. Louis, MO 63130, USA; (D.v.N.); (C.C.); (L.L.); (L.G.); (M.K.)
| | - Darrell Broussard
- Louisiana Healthcare Connections, 4171 Essen Ln, 2nd floor, Baton Rouge, LA 70809, USA; (D.B.); (R.E.S.); (D.L.)
- CGI Federal, 538 Cajundome Boulevard, Lafayette, LA 70506, USA
| | - Rachel E. Smith
- Louisiana Healthcare Connections, 4171 Essen Ln, 2nd floor, Baton Rouge, LA 70809, USA; (D.B.); (R.E.S.); (D.L.)
| | - Dana Lawson
- Louisiana Healthcare Connections, 4171 Essen Ln, 2nd floor, Baton Rouge, LA 70809, USA; (D.B.); (R.E.S.); (D.L.)
| | - Yan Yan
- School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA; (C.H.); (Y.Y.)
| | - Matthew Kreuter
- Health Communication Research Lab, Brown School, Washington University in St. Louis, 1 Brookings Hall, St. Louis, MO 63130, USA; (D.v.N.); (C.C.); (L.L.); (L.G.); (M.K.)
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Chino F, Narayan AK, Sadigh G. Identifying and Addressing Health-Related Social Risks and Needs: What Is Our Role? J Am Coll Radiol 2024:S1546-1440(24)00599-4. [PMID: 38971412 DOI: 10.1016/j.jacr.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Affiliation(s)
- Fumiko Chino
- Affordability Working Group and the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; leadership roles at American Society for Radiation Oncology as a member of the Health Equity, Diversity and Inclusion Counsel, Member, the Steering Committee of American Society of Clinical Oncology Quality; Director the Costs of Care Group; Consulting Editor for JCO Oncology Practice; Associate Editor for Advances in Radiation Oncology.
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Vice Chair, ACR Patient- and Family-Centered Care Outreach Committee; Treasurer, Wisconsin Radiological Society; Treasurer, Assistant Editor, Journal of the American College of Radiology; Associate Editor, Radiology
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California Irvine, Irvine, California; associate Editor at Journal of American College of Radiology; Director of Health Services and Comparative Effectiveness Outcome Research; Associate Chair for Faculty Development at University of California Irvine
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Kim J, Hwang S. Separating the Effects of Transitions Into and Out of Social Isolation and Loneliness on Cognitive Function in Later Life. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae082. [PMID: 38742600 DOI: 10.1093/geronb/gbae082] [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: 10/27/2023] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES This study investigates the effects of social isolation and loneliness on cognitive function, distinguishing between the effects of transitioning into and out of these states. METHODS This study analyzed data from 6,663 adults aged 65 or older collected over the course of 7 waves (12 years) of the Korean Longitudinal Study of Aging from 2006 to 2018. A novel asymmetric fixed effects model was utilized to separately estimate the effects of transitions into and out of social isolation or loneliness. RESULTS The association of transitions into social isolation due to a lack of informal social contact or loneliness with cognitive function (b = -1.387, p < .001 and b = -0.601, p < .001, respectively) was stronger than the association of transitions out of these states (b = 0.345, p < .05 and b = 0.353, p < .001, respectively). The magnitude of the negative and positive coefficients was statistically different (F-statistic = 45.29, p < .001 and F-statistic = 5.12, p < .05, respectively). In contrast, no such asymmetric effects were observed for social isolation due to a lack of formal activity (F-statistic = 0.06, p = .800). DISCUSSION The detrimental effects of transitioning into social isolation due to a lack of informal social contact (but not formal activity) or loneliness on cognitive function outweigh the beneficial effects of transitioning out of these states. Preventing the onset of social disconnection should be prioritized as an intervention to improve the cognitive function of older adults.
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Affiliation(s)
- Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
| | - Sungsik Hwang
- Department of Sociology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Colon M, Goodman JM. Screening tools for employment in clinical healthcare delivery systems: a content analysis. BMC Health Serv Res 2024; 24:720. [PMID: 38862954 PMCID: PMC11167741 DOI: 10.1186/s12913-024-10976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/10/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The relationship between work and health is complex and bidirectional, where work can have both health-harming and health-enhancing effects. Though employment is recognized as a social determinant of health, and clinical healthcare delivery systems are increasingly using screening tools to ask patients about social needs, little research has explored the extent to which employment-related social risk is captured in these screening tools. This study aimed to identify and characterize employment- and work-related questions in social risk screening tools that have been implemented in clinical healthcare delivery systems. METHODS We conducted a qualitative content analysis of employment-related items in screening tools that have been implemented in clinical healthcare service delivery systems. Three content areas guided data extraction and analysis: Setting, Domain, and Level of Contextualization. RESULTS Screening tools that asked employment-related questions were implemented in settings that were diverse in the populations served and the scope of care provided. The intent of employment-related items focused on four domains: Social Risk Factor, Social Need, Employment Exposure, and Legal Need. Most questions were found to have a low Level of Contextualization and were largely focused on identifying an individual's employment status. CONCLUSIONS Several existing screening tools include measures of employment-related social risk, but these items do not have a clear purpose and range widely depending on the setting in which they are implemented. In order to maximize the utility of these tools, clinical healthcare delivery systems should carefully consider what domain(s) they aim to capture and how they anticipate using the screening tools to address social determinants of health.
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Affiliation(s)
- Mina Colon
- OHSU-PSU School of Public Health, Portland, OR, USA.
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Viswanathan M, Kennedy SM, Sathe N, Eder ML, Ng V, Kugley S, Lewis MA, Gottlieb LM. Evaluating Intensity, Complexity, and Potential for Causal Inference in Social Needs Interventions: A Review of a Scoping Review. JAMA Netw Open 2024; 7:e2417994. [PMID: 38904959 PMCID: PMC11193129 DOI: 10.1001/jamanetworkopen.2024.17994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/19/2024] [Indexed: 06/22/2024] Open
Abstract
Importance Interventions that address needs such as low income, housing instability, and safety are increasingly appearing in the health care sector as part of multifaceted efforts to improve health and health equity, but evidence relevant to scaling these social needs interventions is limited. Objective To summarize the intensity and complexity of social needs interventions included in randomized clinical trials (RCTs) and assess whether these RCTs were designed to measure the causal effects of intervention components on behavioral, health, or health care utilization outcomes. Evidence Review This review of a scoping review was based on a Patient-Centered Outcomes Research Institute-funded evidence map of English-language US-based RCTs of social needs interventions published between January 1, 1995, and April 6, 2023. Studies were assessed for features related to intensity (defined using modal values as providing as-needed interaction, 8 participant contacts or more, contacts occurring every 2 weeks or more often, encounters of 30 minutes or longer, contacts over 6 months or longer, or home visits), complexity (defined as addressing multiple social needs, having dedicated staff, involving multiple intervention components or practitioners, aiming to change multiple participant behaviors [knowledge, action, or practice], requiring or providing resources or active assistance with resources, and permitting tailoring), and the ability to assess causal inferences of components (assessing interventions, comparators, and context). Findings This review of a scoping review of social needs interventions identified 77 RCTs in 93 publications with a total of 135 690 participants. Most articles (68 RCTs [88%]) reported 1 or more features of high intensity. All studies reported 1 or more features indicative of high complexity. Because most studies compared usual care with multicomponent interventions that were moderately or highly dependent on context and individual factors, their designs permitted causal inferences about overall effectiveness but not about individual components. Conclusions and Relevance Social needs interventions are complex, intense, and include multiple components. Our findings suggest that RCTs of these interventions address overall intervention effectiveness but are rarely designed to distinguish the causal effects of specific components despite being resource intensive. Future studies with hybrid effectiveness-implementation and sequential designs, and more standardized reporting of intervention intensity and complexity could help stakeholders assess the return on investment of these interventions.
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Affiliation(s)
| | | | - Nila Sathe
- RTI International, Research Triangle Park, North Carolina
| | | | - Valerie Ng
- RTI International, Research Triangle Park, North Carolina
| | - Shannon Kugley
- RTI International, Research Triangle Park, North Carolina
| | - Megan A. Lewis
- RTI International, Research Triangle Park, North Carolina
| | - Laura M. Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco
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Seiber EE, Garrity K, Moon KJ, Jankowski E, Nawaz S, Garner JA, Headings A, Jonas DE, Clark A, Bose-Brill S, Shrodes JC, Hoseus J, Baker C, McAlearney AS, Hefner JL, Joseph JJ, Vallangeon D, Walker DM. Sustainability of Social Needs Resolution Interventions: A Call to Consider Cost. Am J Prev Med 2024; 66:1100-1104. [PMID: 38272244 PMCID: PMC11102842 DOI: 10.1016/j.amepre.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
| | - Katharine Garrity
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH, USA
| | - Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Emma Jankowski
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Jennifer A Garner
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH, USA; John Glenn College of Public Affairs, Ohio State University, Columbus, OH, USA
| | - Amy Headings
- The Mid-Ohio Food Collective, Columbus, Ohio, USA
| | - Daniel E Jonas
- Division of General Internal Medicine, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Aaron Clark
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer C Shrodes
- Division of General Internal Medicine, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Jenelle Hoseus
- Health Impact Ohio, Columbus, Ohio, United States of America
| | - Carrie Baker
- Health Impact Ohio, Columbus, Ohio, United States of America
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer L Hefner
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dana Vallangeon
- Ohio Association of Community Health Centers, Columbus, OH, USA
| | - Daniel M Walker
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University College of Medicine, Columbus, OH, USA
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Bennett CL, Saxena M, Boothroyd D, Mahmoud-Werthmann S, Lin MP. Association Between Social Vulnerability and US HIV Priority Jurisdictions. J Acquir Immune Defic Syndr 2024; 96:e4-e6. [PMID: 38771755 DOI: 10.1097/qai.0000000000003415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
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Painter H, Parry E, McCann L, Dehn Lunn A, Ford J. Social needs screening in primary care: A tool in the fight for health equity? PUBLIC HEALTH IN PRACTICE 2024; 7:100466. [PMID: 38323126 PMCID: PMC10844637 DOI: 10.1016/j.puhip.2024.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Progress on addressing health inequalities is slow and in many places around the world the gap between the privileged and the disadvantaged is widening. This is driven largely by an unfair and unequal distribution of the social determinants of health. While upstream policy and agenda commitment is needed to improve social determinants of health at a population level, healthcare also has a role. Currently social information is sporadically collected and used in healthcare. Improving our understanding of social problems is crucial in targeting services and to reduce the overreliance on area-level measures of deprivation. This has the potential to improve patient care as well as more accurately capture socio-economic disadvantage. Here we argue that there is a role for primary care in screening for social needs to help address inequalities. Social needs screening, more commonly used in North America than Europe, aims to systematically collect social information in health and care settings. Healthcare professionals ask patients about social issues including employment, finances, housing, education and social isolation and this information is used to prompt referral to community services to address any need identified. Social needs screening has potential to address negative impacts of social determinants of health at an individual and population level. Providing a reliable measure of social need, screening gives healthcare professionals an opportunity to tailor and improve quality of care for patients and offer individualised support. It has been shown to improve individual social and health outcomes and positively impact healthcare utilisation. At a population level, social needs screening can improve the data on social determinants of health and therefore support policy makers and service delivery leaders to target resources and services more effectively to the communities most in need. Implementing social needs screening must take account of local healthcare service capacity and available community resources but where sustainable, effective programmes can be introduced, the potential benefits are manifold. While primary care alone cannot solve the root causes of health inequalities, we argue it could be a powerful actor in the fight for health equity.
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Affiliation(s)
- H. Painter
- Wolfson Institute for Population Health, Queen Mary University of London, UK
| | - E. Parry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - L. McCann
- Wolfson Institute for Population Health, Queen Mary University of London, UK
| | - A. Dehn Lunn
- Wolfson Institute for Population Health, Queen Mary University of London, UK
| | - J. Ford
- Wolfson Institute for Population Health, Queen Mary University of London, UK
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GOTTLIEB LAURAM, HESSLER DANIELLE, WING HOLLY, GONZALEZ‐ROCHA ALEJANDRA, CARTIER YURI, FICHTENBERG CAROLINE. Revising the Logic Model Behind Health Care's Social Care Investments. Milbank Q 2024; 102:325-335. [PMID: 38273221 PMCID: PMC11176407 DOI: 10.1111/1468-0009.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
Policy Points This article summarizes recent evidence on how increased awareness of patients' social conditions in the health care sector may influence health and health care utilization outcomes. Using this evidence, we propose a more expansive logic model to explain the impacts of social care programs and inform future social care program investments and evaluations.
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Affiliation(s)
- LAURA M. GOTTLIEB
- University of CaliforniaSan Francisco
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - DANIELLE HESSLER
- University of CaliforniaSan Francisco
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - HOLLY WING
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - ALEJANDRA GONZALEZ‐ROCHA
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - YURI CARTIER
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - CAROLINE FICHTENBERG
- University of CaliforniaSan Francisco
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
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Kuklina EV, Merritt RK, Wright JS, Vaughan AS, Coronado F. Hypertension in Pregnancy: Current Challenges and Future Opportunities for Surveillance and Research. J Womens Health (Larchmt) 2024; 33:553-562. [PMID: 38529887 PMCID: PMC11260429 DOI: 10.1089/jwh.2023.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Hypertension in pregnancy (HP) includes eclampsia/preeclampsia, chronic hypertension, superimposed preeclampsia, and gestational hypertension. In the United States, HP prevalence doubled over the last three decades, based on birth certificate data. In 2019, the estimated percent of births with a history of HP varied from 10.1% to 15.9% for birth certificate data and hospital discharge records, respectively. The use of electronic medical records may result in identifying an additional third to half of undiagnosed cases of HP. Individuals with gestational hypertension or preeclampsia are at 3.5 times higher risk of progressing to chronic hypertension and from 1.7 to 2.8 times higher risk of developing cardiovascular disease (CVD) after childbirth compared with individuals without these conditions. Interventions to identify and address CVD risk factors among individuals with HP are most effective if started during the first 6 weeks postpartum and implemented during the first year after childbirth. Providing access to affordable health care during the first 12 months after delivery may ensure healthy longevity for individuals with HP. Average attendance rates for postpartum visits in the United States are 72.1%, but the rates vary significantly (from 24.9% to 96.5%). Moreover, even among individuals with CVD risk factors who attend postpartum visits, approximately 40% do not receive counseling on a healthy lifestyle. In the United States, as of the end of September 2023, 38 states and the District of Columbia have extended Medicaid coverage eligibility, eight states plan to implement it, and two states proposed a limited coverage extension from 2 to 12 months after childbirth. Currently, data gaps exist in national health surveillance and health systems to identify and monitor HP. Using multiple data sources, incorporating electronic medical record data algorithms, and standardizing data definitions can improve surveillance, provide opportunities to better track progress, and may help in developing targeted policy recommendations.
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Affiliation(s)
- Elena V Kuklina
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert K Merritt
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet S Wright
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fátima Coronado
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Miller J, Doucas A, Karra H, Thareja SK, Bowie O, Dong X, Terrell J, Hernandez S, Corujo-Ramirez AM, Xia N, Qi S, Huang CC, Lundh R, Young SA. Social determinants of health correlations and resource usefulness at a Milwaukee free clinic for uninsured individuals: A cross-sectional study. J Clin Transl Sci 2024; 8:e71. [PMID: 38690226 PMCID: PMC11058579 DOI: 10.1017/cts.2024.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/16/2024] [Accepted: 03/14/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Addressing social determinants of health (SDOH) is fundamental to improving health outcomes. At a student-run free clinic, we developed a screening process to understand the SDOH needs and resource utilization of Milwaukee's uninsured population. Methods In this cross-sectional study, we screened adult patients without health insurance (N = 238) for nine traditional SDOH needs as well as their access to dental and mental health care between October 2021 and October 2022. Patients were surveyed at intervals greater than or equal to 30 days. We assessed correlations between SDOH needs and trends in patient-reported resource usefulness. Results Access to dental care (64.7%) and health insurance (51.3%) were the most frequently endorsed needs. We found significant correlations (P ≤ 0.05) between various SDOH needs. Notably, mental health access needs significantly correlated with dental (r = 0.41; 95% CI = 0.19, 0.63), medications (r = 0.51; 95% CI = 0.30, 0.72), utilities (r = 0.39; 95% CI = 0.17, 0.61), and food insecurity (r = 0.42; 95% CI = 0.19, 0.64). Food-housing (r = 0.55; 95% CI = 0.32, 0.78), housing-medications (r = 0.58; 95% CI = 0.35, 0.81), and medications-food (r = 0.53; 95% CI = 0.32, 0.74) were significantly correlated with each other. Longitudinal assessment of patient-reported usefulness informed changes in the resources offered. Conclusions Understanding prominent SDOH needs can inform resource offerings and interventions, addressing root causes that burden under-resourced patients. In this study, patient-reported data about resource usefulness prompted the curation of new resources and volunteer roles. This proof-of-concept study shows how longitudinally tracking SDOH needs at low-resource clinics can inform psychosocial resources.
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Affiliation(s)
- Jessica Miller
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adrianna Doucas
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hamsitha Karra
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Suma K. Thareja
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Owen Bowie
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Xiaowei Dong
- Medical College of Wisconsin, Milwaukee, WI, USA
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jennifer Terrell
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Samuel Hernandez
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ana Mia Corujo-Ramirez
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nicole Xia
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sabrina Qi
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chiang-Ching Huang
- Medical College of Wisconsin, Milwaukee, WI, USA
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rebecca Lundh
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Staci A. Young
- Medical College of Wisconsin, Milwaukee, WI, USA
- Saturday Clinic for the Uninsured, Medical College of Wisconsin, Milwaukee, WI, USA
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Astorino JA, Pratt-Chapman ML, Schubel L, Lee Smith J, White A, Sabatino SA, Littlejohn R, Buckley BO, Taylor T, Arem H. Contextual Factors Relevant to Implementing Social Risk Factor Screening and Referrals in Cancer Survivorship: A Qualitative Study. Prev Chronic Dis 2024; 21:E22. [PMID: 38573795 PMCID: PMC10996388 DOI: 10.5888/pcd21.230352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Introduction Social risk factors such as food insecurity and lack of transportation can negatively affect health outcomes, yet implementation of screening and referral for social risk factors is limited in medical settings, particularly in cancer survivorship. Methods We conducted 18 qualitative, semistructured interviews among oncology teams in 3 health systems in Washington, DC, during February and March 2022. We applied the Exploration, Preparation, Implementation, Sustainment Framework to develop a deductive codebook, performed thematic analysis on the interview transcripts, and summarized our results descriptively. Results Health systems varied in clinical and support staff roles and capacity. None of the participating clinics had an electronic health record (EHR)-based process for identifying patients who completed their cancer treatment ("survivors") or a standardized cancer survivorship program. Their capacities also differed for documenting social risk factors and referrals in the EHR. Interviewees expressed awareness of the prevalence and effect of social risk factors on cancer survivors, but none employed a systematic process for identifying and addressing social risk factors. Recommendations for increasing screening for social risk factors included designating a person to fulfill this role, improving data tracking tools in the EHR, and creating systems to maintain up-to-date information and contacts for community-based organizations. Conclusion The complexity of cancer care workflows and lack of reimbursement results in a limited ability for clinic staff members to screen and make referrals for social risk factors. Creating clinical workflows that are flexible and tailored to staffing realities may contribute to successful implementation of a screening and referral program. Improving ongoing communication with community-based organizations to address needs was deemed important by interviewees.
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Affiliation(s)
- Joseph A Astorino
- The George Washington Cancer Center, The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Mandi L Pratt-Chapman
- The George Washington Cancer Center, The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Laura Schubel
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia
| | - Judith Lee Smith
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robin Littlejohn
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia
| | - Bryan O Buckley
- Department of General Medicine, Georgetown University, Washington, District of Columbia
| | | | - Hannah Arem
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia
- Department of Oncology, Georgetown University, Washington, District of Columbia
- MedStar Health Research Institute, 3007 Tilden St NW, Ste 6N, Washington, DC 20008
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18
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Yoon J. Reexamining Differences Between Black and White Veterans in Hospital Mortality and Other Outcomes in Veterans Affairs and Other Hospitals. Med Care 2024; 62:243-249. [PMID: 38315886 PMCID: PMC11168193 DOI: 10.1097/mlr.0000000000001979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To examine Black-White patient differences in mortality and other hospital outcomes among Veterans treated in Veterans Affairs (VA) and non-VA hospitals. BACKGROUND Lower hospital mortality has been documented in older Black patients relative to White patients, yet the mechanisms have not been determined. Comparing other hospital outcomes and multiple hospital systems may help inform the reasons for these differences. METHODS Repeated cross-sectional analysis of hospitalization records was conducted for Veterans discharged in VA and non-VA hospitals from January 1, 2013 to December 31, 2017 in 11 states. Hospital outcomes included 30-day mortality, 30-day readmissions, inpatient costs, and length of stay. Hospitalizations were for acute myocardial infarction, coronary artery bypass graft surgery, gastrointestinal bleeding, heart failure, pneumonia, and stroke. Differences in outcomes were estimated between Black and White patients for VA and non-VA hospitals and age groups younger than 65 years or 65 years and older in regression models adjusting for patient and hospital factors. RESULTS There were a total of 459,574 study patients. Older Black patients had lower adjusted mortality for acute myocardial infarction, gastrointestinal bleeding, heart failure, and pneumonia. Adjusted probability of readmission was higher and adjusted mean length of stay and costs were greater for older Black patients relative to White patients in non-VA hospitals for several conditions. Fewer differences were observed in younger patients and in VA hospitals. CONCLUSION While older Black patients had lower mortality, other outcomes compared poorly with White patients. Differences were not fully explained by observable patient and hospital factors although social determinants may contribute to these differences.
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Affiliation(s)
- Jean Yoon
- VA Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
- Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA
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Sage WM, Warren KD. Swimming Together Upstream: How to Align MLP Services with U.S. Healthcare Delivery. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2024; 51:786-797. [PMID: 38477273 PMCID: PMC10937178 DOI: 10.1017/jme.2023.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Medical-legal partnership (MLP) embeds attorneys and paralegals into care delivery to help clinicians address root causes of health inequities. Notwithstanding decades of favorable outcomes, MLP is not as well-known as might be expected. In this essay, the authors explore ways in which strategic alignment of legal services with healthcare services in terms of professionalism, information collection and sharing, and financing might help the MLP movement become a more widespread, sustainable model for holistic care delivery.
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Affiliation(s)
- William M Sage
- TEXAS A&M UNIVERSITY SCHOOL OF LAW, FORT WORTH, TX, USA
- TEXAS A&M UNIVERSITY SCHOOL OF MEDICINE, FORT WORTH, TX, USA
| | - Keegan D Warren
- TEXAS A&M UNIVERSITY HEALTH SCIENCE CENTER, FORT WORTH, TX, USA
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Patel MR, Zhang G, Heisler M, Piette JD, Resnicow K, Choe HM, Shi X, Song P. A Randomized Controlled Trial to Improve Unmet Social Needs and Clinical Outcomes Among Adults with Diabetes. J Gen Intern Med 2024:10.1007/s11606-024-08708-8. [PMID: 38467918 DOI: 10.1007/s11606-024-08708-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Adults with type 1 or type 2 diabetes often face financial challenges and other unmet social needs to effective diabetes self-management. OBJECTIVE Whether a digital intervention focused on addressing socioeconomic determinants of health improves diabetes clinical outcomes more than usual care. DESIGN Randomized trial from 2019 to 2023. PARTICIPANTS A total of 600 adults with diabetes, HbA1c ≥ 7.5%, and self-reported unmet social needs or financial burden from a health system and randomized to the intervention or standard care. INTERVENTION CareAvenue is an automated, e-health intervention with eight videos that address unmet social needs contributing to poor outcomes. MEASURES Primary outcome was HbA1c, measured at baseline, and 6 and 12 months after randomization. Secondary outcomes included systolic blood pressure and reported met social needs, cost-related non-adherence (CRN), and financial burden. We examined main effects and variation in effects across predefined subgroups. RESULTS Seventy-eight percent of CareAvenue participants completed one or more modules of the website. At 12-month follow-up, there were no significant differences in HbA1c changes between CareAvenue and control group (p = 0.24). There were also no significant between-group differences in systolic blood pressure (p = 0.29), met social needs (p = 0.25), CRN (p = 0.18), and perceived financial burden (p = 0.31). In subgroup analyses, participants with household incomes 100-400% FPL (1.93 (SE = 0.76), p < 0.01), 201-400% FPL (1.30 (SE = 0.62), p < 0.04), and > 400% FPL (1.27 (SE = 0.64), p < 0.05) had significantly less A1c decreases compared to the control group. CONCLUSIONS On average, CareAvenue participants did not achieve better A1c lowering, met needs, CRN, or perceived financial burden compared to control participants. CareAvenue participants with higher incomes achieved significantly less A1c reductions than control. Further research is needed on social needs interventions that consider tailored approaches to population subgroups. CLINICAL TRIALS REGISTRY ClinicalTrials.gov ID NCT03950973, May 2019.
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Affiliation(s)
- Minal R Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Guanghao Zhang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Michele Heisler
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
- U.S. Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - John D Piette
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- U.S. Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Kenneth Resnicow
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Hae-Mi Choe
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Medical Group, Ann Arbor, MI, USA
| | - Xu Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Peter Song
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
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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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Williams S, Hill K, Mathew MS, Messiah SE. Disparities in Patient Family Social Determinants of Health in a Large Urban Pediatric Health System. J Pediatr Health Care 2024; 38:172-183. [PMID: 38429029 DOI: 10.1016/j.pedhc.2023.11.005] [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: 09/01/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This analysis sought to identify disparities in social determinants of health (SDOH) outcomes at a Texas pediatric hospital. METHODS This retrospective study used electronic health records of pediatric patients families surveyed August -December 2022. Outcomes for health literacy, social support, food, transportation, energy, digital, and housing insecurity, and tobacco exposure were analyzed across demographic categories. RESULTS Among 15,294 respondents to the survey (mean child age, 8.73 years; 43.68% Hispanic, 29.73% non-Hispanic White, 18.27% non-Hispanic Black, 6.79% other race/ethnicity; 53.95% male), 50.25% of respondents reported at least one SDOH, whereas 23.39% reported two or more SDOH. The most prevalent SDOH was lack of social support (3,456, 23.91%). Hispanic, non-Hispanic Black, and other race/ethnicity respondents, non-English speakers, and public insurance users had higher odds of reporting almost all SDOH in logistic regression models adjusted for age, race/ethnicity, language, gender, and insurance type. DISCUSSION Race/ethnicity, language, and insurance type disparities were identified for all SDOH.
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Garcia C, Doran K, Kushel M. Homelessness And Health: Factors, Evidence, Innovations That Work, And Policy Recommendations. Health Aff (Millwood) 2024; 43:164-171. [PMID: 38315930 DOI: 10.1377/hlthaff.2023.01049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, we highlight structural and individual risk factors that can lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations. Health system efforts to address homelessness and improve the health of homeless populations have included interventions such as screening for social needs and medical respite programs. Initiatives using the Housing First approach to permanent supportive housing have a strong track record of success. Health care financing innovations using Medicaid Section 1115 waivers offer promising new approaches to improving health and housing for people experiencing homelessness. To substantially reduce homelessness and its many adverse health impacts, changes are needed to increase the supply of affordable housing for households with very low incomes. Health care providers and systems should leverage their political power to advocate for policies that scale durable, evidence-based solutions to reduce homelessness, including increased funding to expand housing choice vouchers and greater investment in the creation and preservation of affordable housing.
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Affiliation(s)
- Cheyenne Garcia
- Cheyenne Garcia, University of California San Francisco, San Francisco, California
| | - Kelly Doran
- Kelly Doran, New York University, New York, New York
| | - Margot Kushel
- Margot Kushel , University of California San Francisco
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24
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Arias F, Dufour AB, Jones RN, Alegria M, Fong TG, Inouye SK. Social determinants of health and incident postoperative delirium: Exploring key relationships in the SAGES study. J Am Geriatr Soc 2024; 72:369-381. [PMID: 37933703 PMCID: PMC10922227 DOI: 10.1111/jgs.18662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Examining the associations of social determinants of health (SDOH) with postoperative delirium in older adults will broaden our understanding of this potentially devastating condition. We explored the association between SDOH factors and incident postoperative delirium. METHODS A retrospective study of a prospective cohort of patients enrolled from June 18, 2010, to August 8, 2013, across two academic medical centers in Boston, Massachusetts. Overall, 560 older adults age ≥70 years undergoing major elective non-cardiac surgery were included in this analysis. Exposure variables included income, lack of private insurance, and neighborhood disadvantage. Our main outcome was incident postoperative delirium, measured using the Confusion Assessment Method long form. RESULTS Older age (odds ratio, OR: 1.01, 95% confidence interval, CI: 1.00, 1.02), income <20,000 a year (OR: 1.12, 95% CI: 1.00, 1.26), lack of private insurance (OR: 1.19, 95% CI: 1.04, 1.38), higher depressive symptomatology (OR: 1.02, 95% CI: 1.01, 1.04), and the Area Deprivation Index (OR: 1.02, 95% CI: 1.01, 1.04) were significantly associated with increased risk of postoperative delirium in bivariable analyses. In a multivariable model, explaining 27% of the variance in postoperative delirium, significant independent variables were older age (OR 1.01, 95% CI 1.00, 1.02), lack of private insurance (OR 1.18, 95% CI 1.02, 1.36), and depressive symptoms (OR 1.02, 95% CI 1.00, 1.03). Household income was no longer a significant independent predictor of delirium in the multivariable model (OR:1.02, 95% CI: 0.90, 1.15). The type of medical insurance significantly mediated the association between household income and incident delirium. CONCLUSIONS Lack of private insurance, a social determinant of health reflecting socioeconomic status, emerged as a novel and important independent risk factor for delirium. Future efforts should consider targeting SDOH factors to prevent postoperative delirium in older adults.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32608, USA
| | - Alyssa B. Dufour
- Harvard Medical School, Boston, MA 02131, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, RI 02912, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA 02131, USA
- Department of Medicine and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02131, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
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Kroese L, Lobo K, Meyer M, Tate J, Mays M, Adye R, Qureshi H, Al-Shammaa B, Brito A, Seo-Mayer P, Moyer K, Port C. Improving food insecurity screening across a health system throughout the COVID-19 pandemic. BMJ Open Qual 2024; 13:e002462. [PMID: 38296603 PMCID: PMC10831437 DOI: 10.1136/bmjoq-2023-002462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Food insecurity has direct and indirect negative outcomes on the physical and mental health of children, with impacts throughout adult life. Rates of food insecurity have increased dramatically since the start of the COVID-19 pandemic. The American Academy of Pediatrics recommends paediatricians screen and intervene to address food insecurity. We aimed to increase the percentage of patient encounters with food insecurity screening completion at the paediatric medical home from 0% to 85% by July 2020 with extension to the paediatric emergency department (ED) and paediatric specialty clinic in the following year. METHODS This multicentre project occurred in three sites within our health system: a teaching safety-net, paediatric medical home; a paediatric ED; and five divisions within paediatric specialty medical clinics. A screening tool was created using the validated Hunger Vital Sign Questionnaire. A standard screening, documentation and referral process was developed. The Model for Improvement was used testing changes via Plan-Do-Study-Act cycles. RESULTS The percentage of households screened for food insecurity increased from a median of 0% to 30% for all sites combined. There was significant variability in screening with the ED screening a median of 24% and the medical home screening 80% by the end of the study period. A total of 9842 households (20.9%) screened were food insecure. During the study period, 895 families with 3925 household members received 69 791 pounds of food from our primary community resource using our clinic's food prescription. Of these families, 44% (398) also qualified for the US Department of Agriculture programme ensuring ongoing food distribution up to twice a month. DISCUSSION Using quality improvement methodology to address a critical community need, we implemented food insecurity screening across a hospital system including multiple sites and specialties and provided critical resources to households in need.
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Affiliation(s)
- Lani Kroese
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Kenia Lobo
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Mary Meyer
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Jordan Tate
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Mitra Mays
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Rebecca Adye
- Inova Children's Multispecialty Center, Inova Health System, Fairfax, Virginia, USA
| | - Henna Qureshi
- Inova Cares Clinic for Children, Inova Health System, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Bann Al-Shammaa
- Inova Cares Clinic for Children, Inova Health System, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Albert Brito
- Inova Cares Clinic for Children, Inova Health System, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Patty Seo-Mayer
- Inova Children's Multispecialty Center, Inova Health System, Fairfax, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Katherine Moyer
- Inova Children's Multispecialty Center, Inova Health System, Fairfax, Virginia, USA
| | - Courtney Port
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
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Nurse KM, Parkin PC, Keown-Stoneman CDG, Bayoumi I, Birken CS, Maguire JL, Macarthur C, Borkhoff CM. Association Between Family Income and Positive Developmental Screening Using the Infant Toddler Checklist at the 18-Month Health Supervision Visit. J Pediatr 2024; 264:113769. [PMID: 37821023 DOI: 10.1016/j.jpeds.2023.113769] [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: 05/25/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To examine the associations between several potential predictors (child biologic, social, and family factors) and a positive screen for developmental delay using the Infant Toddler Checklist (ITC) at the 18-month health supervision visit in primary care. METHODS This was a cross-sectional study of healthy children attending an 18-month health supervision visit in primary care. Parents completed a standardized questionnaire, addressing child, social, and family characteristics, and the ITC. Logistic regression analyses were used to assess the associations between predictors and a positive ITC. RESULTS Among 2188 participants (45.5% female; mean age, 18.2 months), 285 (13%) had a positive ITC and 1903 (87%) had a negative ITC. The aOR for a positive ITC for male compared with female sex was 2.15 (95% CI, 1.63-2.83; P < .001). The aOR for birthweight was 0.65 per 1 kg increase (95% CI, 0.53-0.80; P < .001). The aOR for a family income of <$40,000 compared with ≥$150,000 was 3.50 (95% CI, 2.22-5.53; P < .001), and the aOR for family income between $40,000-$79,999 compared with ≥$150,000 was 1.88 (95% CI, 1.26-2.80; P = .002). CONCLUSIONS Screening positive on the ITC may identify children at risk for the double jeopardy of developmental delay and social disadvantage and allow clinicians to intervene through monitoring, referral, and resource navigation for both child development and social needs. TRIAL REGISTRATION Clinicaltrials.gov (NCT01869530).
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Affiliation(s)
- Kimberly M Nurse
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Imaan Bayoumi
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Department of Pediatrics, Unity Health Toronto, Toronto, Ontario, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin Macarthur
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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DeCamp LR, Yousuf S, Peters C, Cruze E, Kutchman E. Assessing Strengths, Challenges, and Equity Via Pragmatic Evaluation of a Social Care Program. Acad Pediatr 2024; 24:23-32. [PMID: 37024078 DOI: 10.1016/j.acap.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Models of pragmatic social care program evaluations are needed as many are clinical services programs and are not focused on research, limiting the ability to address key evidence gaps. We describe the use of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to conduct a pragmatic evaluation of a pediatric ambulatory social care program. METHODS Our evaluation was based on automated electronic health record data on clinics, community partners, social care program processes, and social needs screen data linked to patient sociodemographic characteristics from February 2020 to September 2021. Two Reach outcomes were assessed: 1) the proportion of eligible patients that completed social needs screening and 2) the proportion of positive screens that receive social care program follow-up. The Effectiveness outcome was meeting families' resource need(s). RESULTS Reach among eligible patients who completed screening was 79.2%. Reach for positive screens receiving social care program referrals demonstrated a higher proportion of referrals among patients with a preferred healthcare language (PHL) of Spanish (45.1%) compared to English (31.2%, P < .001). Effectiveness analyses demonstrated that overall, 75.1% of social care program referrals had all social resource needs met, 17.5% had some needs met, and 7.4% had no needs met. The percent of patients with all resource needs met was higher for patients with PHL of Spanish or Non-English, Non-Spanish (79% for each respectively) compared to English (73%, P = .023). CONCLUSIONS Maximizing automated data collection is likely the most feasible way for social care programs to complete evaluation activities outside of the research context.
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Affiliation(s)
- Lisa Ross DeCamp
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora; Department of Pediatrics (LR DeCamp), University of Colorado School of Medicine, Aurora; Adult and Child Center for Outcomes Research and Delivery Science (LR DeCamp), Aurora, Colo.
| | - Sana Yousuf
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
| | - Claire Peters
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
| | - Ellen Cruze
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
| | - Eve Kutchman
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
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Assaf RR, Dolce M, Garg A. Sustainably Implementing Social Determinants of Health Interventions in the Pediatric Emergency Department. JAMA Pediatr 2024; 178:9-10. [PMID: 37983050 DOI: 10.1001/jamapediatrics.2023.4949] [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: 11/21/2023]
Abstract
This Viewpoint discusses 5 principal challenges and opportunities for the sustainable implementation of social determinants of health interventions in emergency department settings.
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Affiliation(s)
- Raymen Rammy Assaf
- Emergency Medicine Specialists of Orange County, Children's Hospital of Orange County, Orange, California
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California
| | | | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children's Medical Center, Worcester, Massachusetts
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Kitzman H, Dodgen L, Vargas C, Khan M, Montgomery A, Patel M, Ajoku B, Allison P, Strauss AM, Bowen M. Community health worker navigation to improve allostatic load: The Integrated Population Health (IPOP) study. Contemp Clin Trials Commun 2023; 36:101235. [PMID: 38156244 PMCID: PMC10753173 DOI: 10.1016/j.conctc.2023.101235] [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: 08/14/2023] [Revised: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023] Open
Abstract
Background Social determinants of health (SDOH) and cumulative stress contribute to chronic disease development. The physiological response to repeated stressors typical of lower-income environments can be measured through allostatic load - a composite measure of cardiovascular, metabolic, and immune variables. Healthcare systems have employed patient navigation for social and medical needs to improve SDOH that has demonstrated limited impact on chronic disease outcomes. This study evaluates a novel community health worker navigation intervention developed using behavioral theories to improve access to social and medical services and provide social support for poverty stressed adults. Methods The Integrated Population Health Study (IPOP) study is a randomized, parallel two arm study evaluating community health worker navigation in addition to an existing integrated population health program (IPOP CHW) as compared to Usual Care (population health program only, IPOP) on allostatic load and chronic disease risk factors. IPOP CHW participants receive a 10-month navigation intervention. Results From 381 screened individuals, a total of 202 participants (age 58.15 ± 12.03 years, 74.75 % female, 79.21 % Black/African American, 17.33 % Hispanic) were enrolled and randomized to IPOP CHW (n = 100) or IPOP Only (n = 102). Conclusion This study will evaluate whether CHW navigation, using a structured intervention based on health behavior theories, can effectively guide poverty stressed individuals to address social and medical needs to improve allostatic load-a composite of cumulative stress and physiological responses. Healthcare systems, nonprofit organizations, and governmental entities are interested in addressing SDOH to improve health, thus developing evidence-based interventions could have broad clinical and policy implications.
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Affiliation(s)
- Heather Kitzman
- Peter J. O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Leilani Dodgen
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Cristian Vargas
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Mahbuba Khan
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Aisha Montgomery
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Meera Patel
- Peter J. O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Brittany Ajoku
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Patricia Allison
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | | | - Michael Bowen
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Ndumele CE, Neeland IJ, Tuttle KR, Chow SL, Mathew RO, Khan SS, Coresh J, Baker-Smith CM, Carnethon MR, Després JP, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV, Rangaswami J. A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1636-1664. [PMID: 37807920 DOI: 10.1161/cir.0000000000001186] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
A growing appreciation of the pathophysiological interrelatedness of metabolic risk factors such as obesity and diabetes, chronic kidney disease, and cardiovascular disease has led to the conceptualization of cardiovascular-kidney-metabolic syndrome. The confluence of metabolic risk factors and chronic kidney disease within cardiovascular-kidney-metabolic syndrome is strongly linked to risk for adverse cardiovascular and kidney outcomes. In addition, there are unique management considerations for individuals with established cardiovascular disease and coexisting metabolic risk factors, chronic kidney disease, or both. An extensive body of literature supports our scientific understanding of, and approach to, prevention and management for individuals with cardiovascular-kidney-metabolic syndrome. However, there are critical gaps in knowledge related to cardiovascular-kidney-metabolic syndrome in terms of mechanisms of disease development, heterogeneity within clinical phenotypes, interplay between social determinants of health and biological risk factors, and accurate assessments of disease incidence in the context of competing risks. There are also key limitations in the data supporting the clinical care for cardiovascular-kidney-metabolic syndrome, particularly in terms of early-life prevention, screening for risk factors, interdisciplinary care models, optimal strategies for supporting lifestyle modification and weight loss, targeting of emerging cardioprotective and kidney-protective therapies, management of patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically assessing and addressing social determinants of health. This scientific statement uses a crosswalk of major guidelines, in addition to a review of the scientific literature, to summarize the evidence and fundamental gaps related to the science, screening, prevention, and management of cardiovascular-kidney-metabolic syndrome.
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Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS, Coresh J, Mathew RO, Baker-Smith CM, Carnethon MR, Despres JP, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation 2023; 148:1606-1635. [PMID: 37807924 DOI: 10.1161/cir.0000000000001184] [Citation(s) in RCA: 87] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Cardiovascular-kidney-metabolic health reflects the interplay among metabolic risk factors, chronic kidney disease, and the cardiovascular system and has profound impacts on morbidity and mortality. There are multisystem consequences of poor cardiovascular-kidney-metabolic health, with the most significant clinical impact being the high associated incidence of cardiovascular disease events and cardiovascular mortality. There is a high prevalence of poor cardiovascular-kidney-metabolic health in the population, with a disproportionate burden seen among those with adverse social determinants of health. However, there is also a growing number of therapeutic options that favorably affect metabolic risk factors, kidney function, or both that also have cardioprotective effects. To improve cardiovascular-kidney-metabolic health and related outcomes in the population, there is a critical need for (1) more clarity on the definition of cardiovascular-kidney-metabolic syndrome; (2) an approach to cardiovascular-kidney-metabolic staging that promotes prevention across the life course; (3) prediction algorithms that include the exposures and outcomes most relevant to cardiovascular-kidney-metabolic health; and (4) strategies for the prevention and management of cardiovascular disease in relation to cardiovascular-kidney-metabolic health that reflect harmonization across major subspecialty guidelines and emerging scientific evidence. It is also critical to incorporate considerations of social determinants of health into care models for cardiovascular-kidney-metabolic syndrome and to reduce care fragmentation by facilitating approaches for patient-centered interdisciplinary care. This presidential advisory provides guidance on the definition, staging, prediction paradigms, and holistic approaches to care for patients with cardiovascular-kidney-metabolic syndrome and details a multicomponent vision for effectively and equitably enhancing cardiovascular-kidney-metabolic health in the population.
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Rudisill AC, Eicken MG, Gupta D, Macauda M, Self S, Kennedy AB, Thomas D, Kao E, Jeanty M, Hartley J. Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study. JAMA Netw Open 2023; 6:e2345444. [PMID: 38015502 PMCID: PMC10685887 DOI: 10.1001/jamanetworkopen.2023.45444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/19/2023] [Indexed: 11/29/2023] Open
Abstract
Importance Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited. Objective To examine patient and care team experiences in early implementation of SDOH screening in primary care. Design, Setting, and Participants This qualitative study included cross-sectional analysis of SDOH screenings during primary care visits from February 22 to May 10, 2022, primary care team member interviews from July 6, 2022, to March 8, 2023, and patient stakeholder engagement on June 30, 2022. The setting was a large southeastern US health care system. Eligible patients were aged 18 years or older with completed visits in primary care. Exposure Screening for SDOH in primary care. Main outcomes and Measures Multivariable logistic regression evaluated patient (eg, age, race and ethnicity) and care team characteristics (eg, practice type), and screening completeness. Interviews contextualized the quantitative analysis. Results There were 78 928 visits in practices conducting any SDOH screening. The population with visits had a mean (SD) age of 57.6 (18.1) years; 48 086 (60.9%) were female, 12 569 (15.9%) Black, 60 578 (76.8%) White, and 3088 (3.9%) Hispanic. A total of 54 611 visits (69.2%) were with a doctor of medicine and 13 035 (16.5%) with a nurse practitioner. Most had no SDOH questions answered (75 298 [95.4%]) followed by all questions (2976 [3.77%]). Logistic regression analysis found that clinician type, patient race, and primary payer were associated with screening likelihood: for clinician type, nurse practitioner (odds ratio [OR], 0.13; 95% CI, 0.03-0.62; P = .01) and physician assistant (OR, 3.11; 95% CI, 1.19-8.10; P = .02); for patient race, Asian (OR, 1.69; 95% CI, 1.25-2.28; P = .001); Black (OR, 1.49; 95% CI, 1.10-2.01; P = .009); or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P = .006); and for primary payer, Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P < .001); managed care (OR, 1.17; 95% CI, 1.07-1.29; P = .001); uninsured or with Access Health (OR, 0.26; 95% CI, 0.10-0.67; P = .005), and Tricare (OR, 0.71; 95% CI, 0.55-0.92; P = .01). Interview themes included barriers (patient hesitancy, time and resources for screening and referrals, and number of questions/content overlap) and facilitators (communication, practice champions, and support for patient needs). Conclusions and Relevance This qualitative study presents potential guidance regarding factors that could improve SDOH screening within busy clinical workflows.
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Affiliation(s)
- A. Caroline Rudisill
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Greenville
| | - Meredith G.A. Eicken
- Department of Medicine, Prisma Health, Upstate, University of South Carolina School of Medicine Greenville, Greenville
| | - Deeksha Gupta
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Greenville
| | - Mark Macauda
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Greenville
| | - Stella Self
- Department of Epidemiology/Biostatistics, Arnold School of Public Health, University of South Carolina, Greenville
| | - Ann Blair Kennedy
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville
| | - Darin Thomas
- Addiction Medicine Center, Prisma Health, Greenville, South Carolina
| | - Elise Kao
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville
| | - Mia Jeanty
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville
| | - Jackson Hartley
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville
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Fiori K, Levano S, Haughton J, Whiskey-LaLanne R, Telzak A, Hodgson S, Spurrell-Huss E, Stark A. Learning in real world practice: Identifying implementation strategies to integrate health-related social needs screening within a large health system. J Clin Transl Sci 2023; 7:e229. [PMID: 38028350 PMCID: PMC10643918 DOI: 10.1017/cts.2023.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/14/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Health systems have many incentives to screen patients for health-related social needs (HRSNs) due to growing evidence that social determinants of health impact outcomes and a new regulatory context that requires health equity measures. This study describes the experience of one large urban health system in scaling HRSN screening by implementing improvement strategies over five years, from 2018 to 2023. Methods In 2018, the health system adapted a 10-item HRSN screening tool from a widely used, validated instrument. Implementation strategies aimed to foster screening were retrospectively reviewed and categorized according to the Expert Recommendations for Implementing Change (ERIC) study. Statistical process control methods were utilized to determine whether implementation strategies contributed to improvements in HRSN screening activities. Results There were 280,757 HRSN screens administered across 311 clinical teams in the health system between April 2018 and March 2023. Implementation strategies linked to increased screening included integrating screening within an online patient portal (ERIC strategy: involve patients/consumers and family members), expansion to discrete clinical teams (ERIC strategy: change service sites), providing data feedback loops (ERIC strategy: facilitate relay of clinical data to providers), and deploying Community Health Workers to address HRSNs (ERIC strategy: create new clinical teams). Conclusion Implementation strategies designed to promote efficiency, foster universal screening, link patients to resources, and provide clinical teams with an easy-to-integrate tool appear to have the greatest impact on HRSN screening uptake. Sustained increases in screening demonstrate the cumulative effects of implementation strategies and the health system's commitment toward universal screening.
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Affiliation(s)
- Kevin Fiori
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Office of Community & Population Health, Montefiore Health System, Bronx, NY, USA
| | - Samantha Levano
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica Haughton
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Renee Whiskey-LaLanne
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew Telzak
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sybil Hodgson
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Group, Bronx, NY, USA
| | | | - Allison Stark
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Redman BK. Rebalancing commercial and public interests in prioritizing biomedical, social and environmental aspects of health through defining and managing conflicts of interest. Front Med (Lausanne) 2023; 10:1247258. [PMID: 37809337 PMCID: PMC10556523 DOI: 10.3389/fmed.2023.1247258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Biomedical research is intended to benefit human beings and their health. Toward that end, scientific norms involve examining and criticizing the work of others and prioritizing questions that should be studied. Yet, in areas of health research where industry is active, it has often utilized well-honed strategies aimed at evading scientific standards and at dominating the research agenda, largely through its financial support and lack of transparency of its research practices. These tactics have now been documented to uniformly support industry products. Commercial entities are aided in this pursuit by public policy that has significantly embedded commercial interests and agendas into federal research funding and infrastructure. Therefore, to understand the resulting landscape and its effect on priority in health research agendas, traditional definitions of individual conflicts of interest (COI) and the less well developed institutional COI must be supplemented by a new construct of structural COI, largely operating as intellectual monopolies, in support of industry. These arrangements often result in financial and reputational resources that assure dominance of commercial priorities in research agendas, crowding out any other interests and ignoring justified returns to the public from investment of its tax dollars. There is no sustained attention to mechanisms by which public interests can be heard, normative issues raised, and then balanced with commercial interests which are transparently reported. Focus on research supporting approval of commercial products ignores social and environmental determinants of health. Commercial bias can invalidate regulatory research protections through obscuring valid risk-benefit ratios considered by IRBs.
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Affiliation(s)
- Barbara K. Redman
- Division of Medical Ethics, Grossman School of Medicine, New York University, New York, NY, United States
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Gusoff GM, Zuckerman D, Pham BH, Ryan GW. Moving upstream: healthcare partnerships addressing social determinants of health through community wealth building. BMC Public Health 2023; 23:1824. [PMID: 37726750 PMCID: PMC10510172 DOI: 10.1186/s12889-023-16761-x] [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: 01/04/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Healthcare-based interventions addressing social needs such as food and housing generally fail to impact the upstream wealth and power inequities underlying those needs. However, a small number of US healthcare organizations have begun addressing these upstream inequities by partnering with community wealth building initiatives. These initiatives include community land trusts, resident-owned communities, and worker cooperatives, which provide local residents ownership and control over their housing and workplaces. While these partnerships represent a novel, upstream approach to the social determinants of health, no research has yet evaluated them. METHODS To assess the current state and key aspects of healthcare-community wealth building partnerships, we conducted a multiple case study analysis using semi-structured interviews with thirty-eight key informants across ten partnerships identified through the Healthcare Anchor Network. To analyze the interviews, we used a two-stage coding process. First, we coded responses based on the phase of the intervention to which they corresponded: motivation, initiation, implementation, or evaluation. Then we assessed responses within each aspect for common themes and variation on salient topics. RESULTS Partnerships were generally motivated by a combination of community needs, such as affordable housing and living wage jobs, and health system interests, such as workforce housing and supply chain resilience. Initiating projects required identifying external partners, educating leadership, and utilizing risk mitigation strategies to obtain health system buy-in. Implementation took various forms, with healthcare organizations providing financial capital in the form of grants and loans, social capital in the form of convening funders and other stakeholders, and/or capacity building support in the form of strategic planning or technical assistance resources. To evaluate projects, healthcare organizations used more process and community-level metrics rather than metrics based on individual health outcomes or returns on investment. Based on best practices from each partnership phase, we provide a roadmap for healthcare organizations to develop effective community wealth building partnerships. CONCLUSIONS Assessing healthcare partnerships with community wealth building organizations yields key strategies healthcare organizations can use to develop more effective partnerships to address the upstream causes of poor health.
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Affiliation(s)
- Geoffrey M Gusoff
- National Clinician Scholars Program & Department of Family Medicine, University of California, Los Angeles, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, USA.
| | - David Zuckerman
- Healthcare Anchor Network, 2202 18th St. NW, Suite 317, Washington, DC, 20009, USA
| | - Bich Ha Pham
- Healthcare Anchor Network, 2202 18th St. NW, Suite 317, Washington, DC, 20009, USA
| | - Gery W Ryan
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 100 South Los Robles Avenue, Pasadena, CA, 91101, USA
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Brown MC, Paolino AR, Dorsey CN, Kelly C, Lewis CC. Kaiser Permanente's Social Needs Network for Evaluation and Translation Empirical Research Agenda. AJPM FOCUS 2023; 2:100101. [PMID: 37790674 PMCID: PMC10546547 DOI: 10.1016/j.focus.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Healthcare systems such as Kaiser Permanente are increasingly focusing on patients' social health. However, there is limited evidence to guide social health integration strategy. The purpose of this study was to identify social health research opportunities using a stakeholder-driven process. Methods A modified Concept Mapping approach was implemented from June 2021 to February 2022. Stakeholders (n=746) received the prompt, "One thing I wish we knew more about to advance my work addressing social health..." An inductive content analysis approach was used to assign topics and synthesize and refine research-focused statements into research questions. Questions were then rated on impact and priority by researcher stakeholders (n=16). Mean impact and priority scores and an overall combined score were calculated. Question rankings were generated using the combined score. Results Brainstorming produced 148 research-focused statements. A final list of 59 research questions was generated for rating. Question topics were (1) Data, Measures, and Metrics; (2) Intervention Approach and Impact; (3) Technology; (4) Role of Healthcare Systems; (5) Community-Based Organizations; (6) Equity; (7) Funding; and (8) Social Health Integration. On a scale from 1 (low) to 10 (high), the mean impact score was 6.12 (range=4.14-7.79), and the mean priority score was 5.61 (range=3.07-8.64). Twenty-four statements were rated as both high impact (>6.12) and high priority (>5.61). Conclusions The broad range of topics with high impact and priority scores reveals how nascent the evidence base is, with fundamental research on the nature of social risk and health system involvement still needed.
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Affiliation(s)
- Meagan C. Brown
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Andrea R. Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Caitlin N. Dorsey
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Cheryl Kelly
- Kaiser Permanente National Office of Community Health, Denver, Colorado
| | - Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Palinkas LA, Belanger R, Newton S, Saldana L, Landsverk J, Dubowitz H. Assessment of Adoption and Early Implementation Barriers and Facilitators of the Safe Environment for Every Kid (SEEK) Model. Acad Pediatr 2023; 23:1434-1445. [PMID: 37354951 PMCID: PMC10592284 DOI: 10.1016/j.acap.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Although the use of interventions for screening for social determinants of health of families in pediatric primary care clinics has increased in the past decade, research on the barriers and facilitators of implementing such interventions has been limited. We explored barriers, facilitators, and the mechanisms clarifying their roles in the adoption and implementation of the Safe Environment for Every Kid (SEEK) model, an approach for strengthening families, promoting children's health and development, and preventing child maltreatment. METHODS A total of 28 semistructured interviews were completed with 9 practice champions, 11 primary care professionals, 5 behavioral health professionals, and 3 nursing/administrative staff representing 12 pediatric primary care practices participating in a larger randomized control trial of implementing SEEK. RESULTS We identified several barriers and facilitators in the stages of SEEK's adoption and early implementation. Barriers associated with outer and inner setting determinants and poor innovation-organization fit declined in importance over time, while facilitators associated with SEEK characteristics increased in importance based on participants' responses. Barriers and facilitators were linked by mechanisms of comparison and contrast of burdens and benefits, and problem-solving to address limited capacity with available resources. CONCLUSIONS Any screening for and addressing social determinants of health demands greater attention to adoption and implementation mechanisms and the processes by which primary care professionals assess and utilize facilitators to address barriers. This occurs in a context defined by perceived burdens and benefits of innovation adoption and implementation, the capacity of the practice, and changes in perception with experiencing the innovation.
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Affiliation(s)
- Lawrence A Palinkas
- Suzanne Dworak-Peck School of Social Work (LA Palinkas), University of Southern California, Los Angeles, Calif.
| | - Rosemarie Belanger
- Department of Pediatrics (R Belanger, S Newton, and H Dubowitz), University of Maryland School of Medicine, Baltimore, MD
| | - Stacey Newton
- Department of Pediatrics (R Belanger, S Newton, and H Dubowitz), University of Maryland School of Medicine, Baltimore, MD
| | - Lisa Saldana
- Oregon Social Learning Center (L Saldana and J Landsverk), Eugene, Ore
| | - John Landsverk
- Oregon Social Learning Center (L Saldana and J Landsverk), Eugene, Ore
| | - Howard Dubowitz
- Department of Pediatrics (R Belanger, S Newton, and H Dubowitz), University of Maryland School of Medicine, Baltimore, MD
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Allen S, Onsando WM, Patel I, Canavan C, Goodman D, Dev A. Food Insecurity and Food Access Among Women in Northern New England During the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2023; 52:374-383. [PMID: 37524310 DOI: 10.1016/j.jogn.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To describe the experience of food insecurity and food access among women in northern New England during the perinatal period. DESIGN Qualitative descriptive. SETTING Hospital system in northern New England. PARTICIPANTS Twelve pregnant women and two women who gave birth. METHODS We interviewed participants during pregnancy and the postpartum period about their experiences of food insecurity, including screening, their willingness and ability to access food programs, and the extent to which their food needs were met through referrals. We analyzed interview transcripts to identify themes related to participants' experiences of food insecurity; food support, including screening and referral; and opportunities for improvement in current food support interventions. RESULTS Most participants accepted being screened for food insecurity and were satisfied with the food distributed in their perinatal care settings. Food insecurity consistently occurred alongside general financial strain, housing insecurity, and transportation needs, which affirmed the interconnectedness of social determinants of health. Other co-occurring risks included intimate partner violence, substance use, and mental health challenges. Food receipt was facilitated by care team members who were knowledgeable about food distribution programs. Barriers to food receipt included challenges with enrolling in public assistance programs, poor awareness among participants of available resources, the persistence and unpredictability of food insecurity, and stigma. We identified three distinct themes that described participants' experiences with food insecurity during pregnancy and the postpartum period: Experience of Being Screened for Food Insecurity, Intersecting Social Needs, and Experience of Accessing Resources. CONCLUSION These findings can be used to inform comprehensive food support programs that reflect the needs and values of women during the perinatal period. Interventions to screen and intervene for food insecurity during and after pregnancy align with the quality standards of The Joint Commission and should be integrated into nursing practice.
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Ashe JJ, Baker MC, Alvarado CS, Alberti PM. Screening for Health-Related Social Needs and Collaboration With External Partners Among US Hospitals. JAMA Netw Open 2023; 6:e2330228. [PMID: 37610754 PMCID: PMC10448297 DOI: 10.1001/jamanetworkopen.2023.30228] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
Importance In recent years, hospitals and health systems have reported increasing rates of screening for patients' individual and community social needs, but few studies have explored the national landscape of screening and interventions directed at addressing health-related social needs (HRSNs) and social determinants of health (SDOH). Objective To evaluate the associations of hospital characteristics and area-level socioeconomic indicators to quantify the presence and intensity of hospitals' screening practices, interventions, and collaborative external partnerships that seek to measure and ameliorate patients' HRSNs and SDOH. Design, Setting, and Participants This cross-sectional study used national data from the American Hospital Association Annual Survey Database for fiscal year 2020. General-service, acute-care, nonfederal hospitals were included in the study's final sample, representing nationally diverse hospital settings. Data were analyzed from July 2022 to February 2023. Exposures Organizational characteristics and area-level socioeconomic indicators. Main Outcomes and Measures The outcomes of interest were hospital-reported patient screening of and strategies to address 8 HRSNs and 14 external partnership types to address SDOH. Composite scores for screening practices and external partnership types were calculated, and ordinary least-square regression analyses tested associations of organizational characteristics with outcome measures. Results Of 2858 US hospital respondents (response rate, 67.0%), most hospitals (79.2%; 95% CI, 77.7%-80.7%) reported screening patients for at least 1 HRSN, with food insecurity or hunger needs (66.1%; 95% CI, 64.3%-67.8%) and interpersonal violence (66.4%; 95% CI, 64.7%-68.1%) being the most commonly screened social needs. Most hospitals (79.4%; 95% CI, 66.3%-69.7%) reported having strategies and programs to address patients' HRSNs; notably, most hospitals (52.8%; 95% CI, 51.0%-54.5%) had interventions for transportation barriers. Hospitals reported a mean of 4.03 (95% CI, 3.85-4.20) external partnership types to address SDOH and 5.69 (5.50-5.88) partnership types to address HRSNs, with local or state public health departments and health care practitioners outside of the health system being the most common. Hospitals with accountable care contracts (ACCs) and bundled payment programs (BPPs) reported higher screening practices (ACC: β = 1.03; SE = 0.13; BPP: β = 0.72; SE = 0.14), interventions (ACC: β = 1.45; SE = 0.12; BPP: β = 0.61; SE = 0.13), and external partnership types to address HRSNs (ACC: β = 2.07; SE = 0.23; BPP: β = 1.47; SE = 0.24) and SDOH (ACC: β = 2.64; SE = 0.20; BPP: β = 1.57; SE = 0.21). Compared with nonteaching, government-owned, and for-profit hospitals, teaching and nonprofit hospitals were also more likely to report more HRSN-directed activities. Patterns based on geographic and area-level socioeconomic indicators did not emerge. Conclusions and Relevance This cross-sectional study found that most US hospitals were screening patients for multiple HRSNs. Active participation in value-based care, teaching hospital status, and nonprofit status were the characteristics most consistently associated with greater overall screening activities and number of related partnership types. These results support previously posited associations about which types of hospitals were leading screening uptake and reinforce understanding of the role of hospital incentives in supporting health equity efforts.
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Affiliation(s)
- Jason J. Ashe
- Association of American Medical Colleges, Washington, District of Columbia
| | - Matthew C. Baker
- Association of American Medical Colleges, Washington, District of Columbia
| | - Carla S. Alvarado
- Association of American Medical Colleges, Washington, District of Columbia
| | - Philip M. Alberti
- Association of American Medical Colleges, Washington, District of Columbia
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He Z, Pfaff E, Guo SJ, Guo Y, Wu Y, Tao C, Stiglic G, Bian J. Enriching Real-world Data with Social Determinants of Health for Health Outcomes and Health Equity: Successes, Challenges, and Opportunities. Yearb Med Inform 2023; 32:253-263. [PMID: 38147867 PMCID: PMC10751148 DOI: 10.1055/s-0043-1768732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE To summarize the recent methods and applications that leverage real-world data such as electronic health records (EHRs) with social determinants of health (SDoH) for public and population health and health equity and identify successes, challenges, and possible solutions. METHODS In this opinion review, grounded on a social-ecological-model-based conceptual framework, we surveyed data sources and recent informatics approaches that enable leveraging SDoH along with real-world data to support public health and clinical health applications including helping design public health intervention, enhancing risk stratification, and enabling the prediction of unmet social needs. RESULTS Besides summarizing data sources, we identified gaps in capturing SDoH data in existing EHR systems and opportunities to leverage informatics approaches to collect SDoH information either from structured and unstructured EHR data or through linking with public surveys and environmental data. We also surveyed recently developed ontologies for standardizing SDoH information and approaches that incorporate SDoH for disease risk stratification, public health crisis prediction, and development of tailored interventions. CONCLUSIONS To enable effective public health and clinical applications using real-world data with SDoH, it is necessary to develop both non-technical solutions involving incentives, policies, and training as well as technical solutions such as novel social risk management tools that are integrated into clinical workflow. Ultimately, SDoH-powered social risk management, disease risk prediction, and development of SDoH tailored interventions for disease prevention and management have the potential to improve population health, reduce disparities, and improve health equity.
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Affiliation(s)
- Zhe He
- School of Information, Florida State University, United States
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, United States
| | - Emily Pfaff
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, United States
| | - Serena Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, United States
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States
| | - Cui Tao
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, United States
| | - Gregor Stiglic
- Faculty of Health Science, University of Maribor, Slovenia
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Slovenia
- Usher Institute, University of Edinburgh, UK
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States
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McCurley JL, Fung V, Levy DE, McGovern S, Vogeli C, Clark CR, Bartels S, Thorndike AN. Assessment of the Massachusetts Flexible Services Program to Address Food and Housing Insecurity in a Medicaid Accountable Care Organization. JAMA HEALTH FORUM 2023; 4:e231191. [PMID: 37266960 PMCID: PMC10238945 DOI: 10.1001/jamahealthforum.2023.1191] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/03/2023] [Indexed: 06/03/2023] Open
Abstract
Importance Health systems are increasingly addressing health-related social needs. The Massachusetts Flexible Services program (Flex) is a 3-year pilot program to address food insecurity and housing insecurity by connecting Medicaid accountable care organization (ACO) enrollees to community resources. Objective To understand barriers and facilitators of Flex implementation in 1 Medicaid ACO during the first 17 months of the program. Design, Setting, and Participants This mixed-methods qualitative evaluation study from March 2020 to July 2021 used the Reach, Efficacy, Adoption, Implementation, Maintenance/Practical, Robust Implementation, and Sustainability Model (RE-AIM/PRISM) framework. Two Mass General Brigham (MGB) hospitals and affiliated community health centers were included in the analysis. Quantitative data included all MGB Medicaid ACO enrollees. Qualitative interviews were conducted with 15 members of ACO staff and 17 Flex enrollees. Main Outcomes and Measures Reach was assessed by the proportion of ACO enrollees who completed annual social needs screening (eg, food insecurity and housing insecurity) and the proportion and demographics of Flex enrollees. Qualitative interviews examined other RE-AIM/PRISM constructs (eg, implementation challenges, facilitators, and perceived effectiveness). Results Of 67 098 Medicaid ACO enrollees from March 2020 to July 2021 (mean [SD] age, 28.8 [18.7] years), 38 442 (57.3%) completed at least 1 social needs screening; 10 730 (16.0%) screened positive for food insecurity, and 7401 (11.0%) screened positive for housing insecurity. There were 658 (1.6%) adults (mean [SD] age, 46.6 [11.8] years) and 173 (0.7%) children (<21 years; mean [SD] age, 10.1 [5.5]) enrolled in Flex; of these 831 people, 613 (73.8%) were female, 444 (53.4%) were Hispanic/Latinx, and 172 (20.7%) were Black. Most Flex enrollees (584 [88.8%] adults; 143 [82.7%] children) received the intended nutrition or housing services. Implementation challenges identified by staff interviewed included administrative burden, coordination with community organizations, data-sharing and information-sharing, and COVID-19 factors (eg, reduced clinical visits). Implementation facilitators included administrative funding for enrollment staff, bidirectional communication with community partners, adaptive strategies to identify eligible patients, and raising clinician awareness of Flex. In Flex enrollee interviews, those receiving nutrition services reported increased healthy eating and food security; they also reported higher program satisfaction than Flex enrollees receiving housing services. Enrollees who received nutrition services that allowed for selecting food based on preferences reported higher satisfaction than those not able to select food. Conclusions and Relevance This mixed-methods qualitative evaluation study found that to improve implementation, Medicaid and health system programs that address social needs may benefit from providing funding for administrative costs, developing bidirectional data-sharing platforms, and tailoring support to patient preferences.
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Affiliation(s)
- Jessica L. McCurley
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Department of Psychology, San Diego State University, San Diego, California
| | - Vicki Fung
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Douglas E. Levy
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Sydney McGovern
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Christine Vogeli
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Cheryl R. Clark
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine & Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stephen Bartels
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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Liu PY, Spiker S, Holguin M, Schickedanz A. Innovations in social health delivery to advance equitable pediatric and adolescent life course health development: A review and roadmap forward. Curr Probl Pediatr Adolesc Health Care 2023; 53:101451. [PMID: 37957084 PMCID: PMC10802152 DOI: 10.1016/j.cppeds.2023.101451] [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] [Indexed: 11/15/2023]
Abstract
Recognizing the influence of social determinants on health and development, health care has increasingly advocated for interventions that target upstream factors as part of routine pediatric care delivery. In response, clinic-based social risk screening and referral programs have proliferated wherein patients are screened for health-related social needs (HRSNs, such as food and housing insecurity) and referred to community-based organizations (CBOs) and social service providers to address those needs. In recent years, an array of digital platforms, known as Social Health Access and Referral Platforms (SHARPs), have emerged to facilitate the scale and implementation of these models amidst growing system demand. Recent evidence on the effectiveness of social risk screen and refer models and SHARPs has been mixed, giving researchers pause and calling for more nuanced understanding of the limitations of such models, especially for promoting child and family health. Design thinking informed by the Life-Course Health Development (LCHD) framework provides a particularly useful lens for synthesizing emerging limitations of such models in the pediatric context, given the dynamic and developmentally-driven circumstances that shape family health and well-being in the early life course. By (1) focusing on addressing deficits-based social risks, (2) scoping to act upon narrow, downstream needs, (3) timing to react to social needs that have already caused harm rather than preventing them, and (4) limiting scale to individual-by-individual responses rather than structural and population-wide interventions, the current design of prevailing social risk screen and refer programs fundamentally limits their potential impact and misses opportunities to improve health equity over the life course. How can health care, social care, and technology partners move forward in collaboration with families and communities to better support equitable lifelong health and social development? In this narrative review, we will summarize the current design, implementation, and limitations of the predominant social risk screen and refer approach in the context of early childhood and adolescent care delivery. We then will apply LCHD principles to advance and improve on this approach from a reactionary focus towards a Family Journey Model that better supports life course health development.
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Affiliation(s)
- Patrick Y Liu
- Medical and Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, California, United States.
| | - Steve Spiker
- One Degree, Inc., 360 Grand Ave, Unit 190, Oakland, California, United States
| | - Monique Holguin
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, United States
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Renaud J, McClellan SR, DePriest K, Witgert K, O'Connor S, Abowd Johnson K, Barolin N, Gottlieb LM, De Marchis EH, Rojas-Smith L, Haber SG. Addressing Health-Related Social Needs Via Community Resources: Lessons From Accountable Health Communities. Health Aff (Millwood) 2023:101377hlthaff202201507. [PMID: 37196207 DOI: 10.1377/hlthaff.2022.01507] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The Center for Medicare and Medicaid Innovation launched the Accountable Health Communities (AHC) Model in 2017 to assess whether identifying and addressing Medicare and Medicaid beneficiaries' health-related social needs reduced health care use and spending. We surveyed a subset of AHC Model beneficiaries with one or more health-related social needs and two or more emergency department visits in the prior twelve months to assess their use of community services and whether their needs were resolved. Survey findings indicated that navigation-connecting eligible patients with community services-did not significantly increase the rate of community service provider connections or the rate of needs resolution, relative to a randomized control group. Findings from interviews with AHC Model staff, community service providers, and beneficiaries identified challenges connecting beneficiaries to community services. When connections were made, resources often were insufficient to resolve beneficiaries' needs. For navigation to be successful, investments in additional resources to assist beneficiaries in their communities may be required.
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Affiliation(s)
| | | | | | | | - Shannon O'Connor
- Shannon O'Connor, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | | | | | - Laura M Gottlieb
- Laura M. Gottlieb, University of California San Francisco, San Francisco, California
| | | | | | - Susan G Haber
- Susan G. Haber, RTI International, Waltham, Massachusetts
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Brewer L, Jones C, Slusser J, Pasha M, Lalika M, Chacon M, Takawira P, Shanedling S, Erickson P, Woods C, Krogman A, Ferdinand D, Underwood P, Cooper L, Patten C, Hayes S. Mobile Health Intervention to Promote Hypertension Self-Management among African Americans Receiving Care at a Community Health Center: Formative Evaluation of the FAITH! Hypertension App. JMIR Form Res 2023. [PMID: 37115658 DOI: 10.2196/45061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND African Americans (AAs) are at a higher risk of premature death from cardiovascular diseases compared to White Americans, with disproportionate attributable risk from uncontrolled hypertension. These health disparities are rooted in structural racism with resultant adverse social determinants of health (SDOH) including limited access to quality healthcare. Given their high usage among AAs, mobile technologies, including smartphones, show promise in increasing access to reliable health information. Thus, culturally tailored mobile health (mHealth) interventions may promote hypertension self-management among this population. OBJECTIVE This formative study assessed the feasibility of integrating an innovative mHealth intervention into clinical and community settings to improve blood pressure (BP) control among AAs. METHODS A mixed methods study of AA patients with uncontrolled hypertension was implemented over two consecutive phases. In Phase 1, patients and clinicians from two federally qualified health centers (FQHCs) in the Minneapolis-St. Paul, Minnesota metropolitan area provided input through a focus group series to refine an existing culturally tailored mHealth app (FAITH! [Fostering African-American Improvement in Total Health!] App) to promote hypertension self-management among AA patients with uncontrolled hypertension. Phase 2 was a single-arm pre-post intervention pilot study to assess feasibility and patient satisfaction. Patients receiving care at an FQHC participated in a 10-week intervention utilizing the refined FAITH! Hypertension App synchronized with a wireless BP monitor and support from a community health worker (CHW) to address SDOH-related social needs. The multimedia app consisted of a 10-module educational series focused on hypertension and cardiovascular risk factors with interactive self-assessments, medication/BP self-monitoring and social networking. Primary outcomes were feasibility (app engagement/satisfaction) and preliminary efficacy (change in BP) at immediate post-intervention. RESULTS In Phase 1, 13 AA patients (69% age ≥50, 77% female) and 16 clinicians (69% age ≥50, 88% female, 63% AA) participated in focus groups. Based on their feedback, app modifications included addition of: BP/medications-tracking, BP self-care task reminders, and culturally sensitive contexts. In Phase 2, 16 AA patients were enrolled (mean age 52.6 years [SD 12.3], 75% female). Of the 16, 38% completed at least half of 10 education modules. Seven of the 16 completed the post-intervention assessment. These patients rated the intervention a 9 (out of 10) as helpful in hypertension self-management. Qualitative data revealed that these patients viewed the app as user-friendly, engaging, and informative, and CHWs were perceived as providing accountability and support. Of the 7 patients, mean systolic and diastolic BPs decreased by 6.4 mmHg (p=.15) and 2.8 mmHg (p=.78) at immediate post-intervention, respectively. CONCLUSIONS A culturally tailored mHealth app, with reinforcement by CHW support, may improve hypertension self-management among under-resourced AAs receiving care at FQHCs. A future randomized efficacy trial of the intervention is warranted. CLINICALTRIAL Registration: ClinicalTrials.gov Identifier: NCT03777709.
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Affiliation(s)
- LaPrincess Brewer
- Mayo Clinic College of Medicine, Department of Cardiovascular Medicine, 200 1st St S.W., Rochester, US
| | | | - Joshua Slusser
- Mayo Clinic, Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Rochester, US
| | | | - Mathias Lalika
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, US
| | - Megan Chacon
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, St. Paul, US
| | - Patricia Takawira
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, St. Paul, US
| | - Stanton Shanedling
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, St. Paul, US
| | - Paul Erickson
- NorthPoint Health and Wellness Center, Minneapolis, US
| | | | - Ashton Krogman
- Mayo Clinic College of Medicine, Department of Cardiovascular Medicine, Rochester, US
| | - Daphne Ferdinand
- Healthy Heart Community Prevention Project, Inc., New Orleans, US
| | | | - Lisa Cooper
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, US
| | - Christi Patten
- Mayo Clinic College of Medicine, Department of Psychiatry and Psychology, Rochester, US
| | - Sharonne Hayes
- Mayo Clinic College of Medicine, Department of Cardiovascular Medicine, Rochester, US
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Steinman LE, Gasca A, Hoeft TJ, Raue PJ, Henderson S, Perez R, Huerta A, Fajardo A, Vredevoogd MA, James K, Hinton L, Rath L, Unutzer J. "We are the sun for our community:" Partnering with community health workers/promotores to adapt, deliver and evaluate a home-based collaborative care model to improve equity in access to quality depression care for older U.S. Latino adults who are underserved. Front Public Health 2023; 11:1079319. [PMID: 36817932 PMCID: PMC9932325 DOI: 10.3389/fpubh.2023.1079319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Background While depression is a leading cause of poor health, less than half of older adults receive adequate care. Inequities in both access and outcomes are even more pronounced for socially disadvantaged older adults. The collaborative care model (CCM) has potential to reduce this burden through community-based organizations (CBOs) who serve these populations. However, CCM has been understudied in diverse cultural and resource-constrained contexts. We evaluated the implementation and effectiveness of PEARLS, a home-based CCM adapted with and for community health workers/promotores (CHWs/Ps). Methods We used an instrumental case study design. Our case definition is a community-academic partnership to build CHW/P capacity for evidence-based depression care for older U.S. Latino adults in the Inland Empire region of California (2017-2020). We aimed to understand adaptations to fit local context; acceptability, feasibility, and fidelity; clinical effectiveness; and contextual determinants of implementation success or failure. Data sources included quantitative and qualitative administrative and evaluation data from participants and providers. We used descriptive statistics and paired t-tests to characterize care delivery and evaluate effectiveness post-intervention, and deductive thematic analysis to answer other aims. Findings This case study included 152 PEARLS participants and nine data sources (N = 67 documents). The CBO including their CHWs/Ps partnered with the external implementation team made adaptations to PEARLS content, context, and implementation strategies to support CHWs/Ps and older adults. PEARLS was acceptable, feasible and delivered with fidelity. Participants showed significant reductions in depression severity at 5 months (98% clinical response rate [mean (SD), 13.7 (3.9) drop in pre/post PHQ-9; p < 0.001] and received support for 2.6 social needs on average. PEARLS delivery was facilitated by its relative advantage, adaptability, and trialability; the team's collective efficacy, buy-in, alignment with organization mission, and ongoing reflection and evaluation during implementation. Delivery was challenged by weak partnerships with clinics for participant referral, engagement, reimbursement, and sustainability post-grant funding. Discussion This case study used existing data to learn how home-based CCM was adapted by and for CHWs/Ps to reduce health inequities in late-life depression and depression care among older Latino immigrants. The CBOs and CHWs/Ps strong trust and rapport, addressing social and health needs alongside depression care, and regular internal and external coaching and consultation, appeared to drive successful implementation and effectiveness.
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Affiliation(s)
- Lesley E. Steinman
- Department of Health Systems and Population Health, Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, United States
| | - Amelia Gasca
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Theresa J. Hoeft
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Patrick J. Raue
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Stuart Henderson
- School of Medicine Office of Research, University of California Davis, Sacramento, Sacramento, CA, United States
| | - Rosa Perez
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Alfredo Huerta
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Alex Fajardo
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Melinda A. Vredevoogd
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Katherine James
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, Sacramento, CA, United States
| | - Laura Rath
- Archstone Foundation, Long Beach, CA, United States
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
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Thornton RL, Yang TJ. Addressing population health inequities: investing in the social determinants of health for children and families to advance child health equity. Curr Opin Pediatr 2023; 35:8-13. [PMID: 36301135 PMCID: PMC9803382 DOI: 10.1097/mop.0000000000001189] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW This review provides a critical assessment of recent pediatric population health research with a specific focus on child health equity. The review addresses: the role of the healthcare sector in addressing fundamental social drivers of health, challenges within healthcare organizations in addressing health-related social needs and the social determinants of health, and the rationale for incorporating race and racism in pediatric population health research and practice. RECENT FINDINGS The coronavirus disease 2019 pandemic brought greater attention to the disparities and inequities in American health and healthcare. In response to these stark inequities, many health systems are adopting efforts and initiatives to address social needs, social determinants of health, racism, and health equity. However, empirical evaluation detailing the effectiveness of these interventions and initiatives is limited. SUMMARY While attention to identifying social needs among pediatric populations is increasing, there is limited evidence regarding the effectiveness of these interventions in producing sustained reductions in health disparities. To advance child health equity, researchers should move beyond individual behavior modification and directly examine fundamental drivers of health inequities. These drivers include government and health policies as well as societal forces such as systemic racism.
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Affiliation(s)
| | - Tracy J. Yang
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Brown J, Ahmed N, Biel M, Patchen L, Rethy J, Thomas A, Arem H. Considerations in implementation of social risk factor screening and referral in maternal and infant care in Washington, DC: A qualitative study. PLoS One 2023; 18:e0283815. [PMID: 37053233 PMCID: PMC10101493 DOI: 10.1371/journal.pone.0283815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The District of Columbia (DC) has striking disparities in maternal and infant outcomes comparing Black to White women and babies. Social determinants of health (SDoH) are widely recognized as a significant contributor to these disparities in health outcomes. Screening for social risk factors and referral for appropriate services is a critical step in addressing social needs and reducing outcome disparities. METHODS We conducted interviews among employees (n = 18) and patients (n = 9) across three diverse, urban clinics within a healthcare system and one community-based organization involved in a five-year initiative to reduce maternal and infant disparities in DC. Interviews were guided by the Consolidated Framework for Implementation Research to understand current processes and organizational factors that contributed to or impeded delivery of social risk factor screening and referral for indicated needs. RESULTS We found that current processes for social risk factor screening and referral differed between and within clinics depending on the patient population. Key facilitators of successful screening included a supportive organizational culture and adaptability of more patient-centered screening processes. Key barriers to delivery included high patient volume and limited electronic health record capabilities to record results and track the status of internal and community referrals. Areas identified for improvement included additional social risk factor assessment training for new providers, patient-centered approaches to screening, improved tracking processes, and facilitation of connections to social services within clinical settings. CONCLUSION Despite proliferation of social risk factor screeners and recognition of their importance within health care settings, few studies detail implementation processes for social risk factor screening and referrals. Future studies should test implementation strategies for screening and referral services to address identified barriers to implementation.
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Affiliation(s)
- Jason Brown
- Medstar Health Research Institute, Healthcare Delivery Research, Washington, DC, United States of America
| | - Naheed Ahmed
- Medstar Health Research Institute, Healthcare Delivery Research, Washington, DC, United States of America
| | - Matthew Biel
- Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, United States of America
- Department of Psychiatry, MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Loral Patchen
- MedStar Washington Hospital Center, Women and Infant Services, Washington, DC, United States of America
- MedStar Washington Hospital Center, Obstetrics/Gynecology, Washington, DC, United States of America
| | - Janine Rethy
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Angela Thomas
- Medstar Health Research Institute, Healthcare Delivery Research, Washington, DC, United States of America
| | - Hannah Arem
- Medstar Health Research Institute, Healthcare Delivery Research, Washington, DC, United States of America
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, United States of America
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Karran EL, G. Cashin A, Barker T, A. Boyd M, Chiarotto A, Dewidar O, Petkovic J, Sharma S, Tugwell P, Moseley GL. The ' what' and ' how' of screening for social needs in healthcare settings: a scoping review. PeerJ 2023; 11:e15263. [PMID: 37101795 PMCID: PMC10124546 DOI: 10.7717/peerj.15263] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
Background Adverse social determinants of health give rise to individual-level social needs that have the potential to negatively impact health. Screening patients to identify unmet social needs is becoming more widespread. A review of the content of currently available screening tools is warranted. The aim of this scoping review was to determine what social needs categories are included in published Social Needs Screening Tools that have been developed for use in primary care settings, and how these social needs are screened. Methods We pre-registered the study on the Open Science Framework (https://osf.io/dqan2/). We searched MEDLINE and Embase from 01/01/2010 to 3/05/2022 to identify eligible studies reporting tools designed for use in primary healthcare settings. Two reviewers independently screened studies, a single reviewer extracted data. We summarised the characteristics of included studies descriptively and calculated the number of studies that collected data relevant to specific social needs categories. We identified sub-categories to classify the types of questions relevant to each of the main categories. Results We identified 420 unique citations, and 27 were included. Nine additional studies were retrieved by searching for tools that were used or referred to in excluded studies. Questions relating to food insecurity and the physical environment in which a person lives were the most frequently included items (92-94% of tools), followed by questions relating to economic stability and aspects of social and community context (81%). Seventy-five percent of the screening tools included items that evaluated five or more social needs categories (mean 6.5; standard deviation 1.75). One study reported that the tool had been 'validated'; 16 reported 'partial' validation; 12 reported that the tool was 'not validated' and seven studies did not report validation processes or outcomes.
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Affiliation(s)
- Emma L. Karran
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Aidan G. Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health and Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Trevor Barker
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Mark A. Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University/Rotterdam, Rotterdam, Netherlands
| | - Omar Dewidar
- Bruyere Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Saurab Sharma
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health and Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Tugwell
- Department of Medicine and School of Epidemiology, University of Ottawa, Ottawa, Canada
| | - G. Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
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Joseph JJ, Gray DM, Williams A, Zhao S, McKoy A, Odei JB, Brock G, Lavender D, Walker DM, Nawaz S, Baker C, Hoseus J, Price T, Gregory J, Nolan TS. Addressing non-medical health-related social needs through a community-based lifestyle intervention during the COVID-19 pandemic: The Black Impact program. PLoS One 2023; 18:e0282103. [PMID: 36893165 PMCID: PMC9997965 DOI: 10.1371/journal.pone.0282103] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Non-medical health-related social needs (social needs) are major contributors to worse health outcomes and may have an adverse impact on cardiovascular risk factors and cardiovascular disease. The present study evaluated the effect of a closed-loop community-based pathway in reducing social needs among Black men in a lifestyle change program. METHODS Black men (n = 70) from a large Midwestern city participated in Black Impact, a 24-week community-based team lifestyle change single-arm pilot trial adapted from the Diabetes Prevention Program and American Heart Association's (AHA) Check, Change, Control Blood Pressure Self-Management Program, which incorporates AHA's Life's Simple 7 (LS7) framework. Participants were screened using the Centers for Medicare and Medicaid Services (CMS) Accountable Health Communities Health-Related Social Needs Screening Tool. Participants with affirmative responses were referred to a community hub pathway to address social needs. The primary outcome for this analysis is change in social needs based on the CMS social needs survey at 12 and 24 weeks using mixed effect logistic regressions with random intercepts for each participant. Change in a LS7 score (range 0-14) from baseline to 12 and 24 weeks was evaluated using a linear mixed-effects model stratified by baseline social needs. RESULTS Among 70 participants, the mean age of participants was 52 ±10.5 years. The men were sociodemographically diverse, with annual income ranging from <$20,000 (6%) to ≥$75,000 (23%). Forty-three percent had a college degree or higher level of education, 73% had private insurance, and 84% were employed. At baseline 57% of participants had at least one social need. Over 12 and 24 weeks, this was reduced to 37% (OR 0.33, 95%CI: 0.13, 0.85) and 44% (OR 0.50, 95%CI: 0.21, 1.16), respectively. There was no association of baseline social needs status with baseline LS7 score, and LS7 score improved over 12 and 24 weeks among men with and without social needs, with no evidence of a differential effect. CONCLUSIONS The Black Impact lifestyle change single-arm pilot program showed that a referral to a closed-loop community-based hub reduced social needs in Black men. We found no association of social needs with baseline or change in LS7 scores. Further evaluation of community-based strategies to advance the attainment of LS7 and address social needs among Black men in larger trials is warranted.
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Affiliation(s)
- Joshua J. Joseph
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
- * E-mail:
| | - Darrell M. Gray
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
- The Ohio State University James Center for Cancer Health Equity, Columbus, Ohio, United States of America
| | - Amaris Williams
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Songzhu Zhao
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Alicia McKoy
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
- The Ohio State University James Center for Cancer Health Equity, Columbus, Ohio, United States of America
| | - James B. Odei
- The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Guy Brock
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Dana Lavender
- The African American Male Wellness Agency, National Center for Urban Solutions, Columbus, Ohio, United States of America
| | - Daniel M. Walker
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Saira Nawaz
- The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Carrie Baker
- Healthcare Collaborative of Greater Columbus, Columbus, Ohio, United States of America
| | - Jenelle Hoseus
- Healthcare Collaborative of Greater Columbus, Columbus, Ohio, United States of America
| | - Tanikka Price
- Healthcare Collaborative of Greater Columbus, Columbus, Ohio, United States of America
| | - John Gregory
- The African American Male Wellness Agency, National Center for Urban Solutions, Columbus, Ohio, United States of America
| | - Timiya S. Nolan
- The Ohio State University James Center for Cancer Health Equity, Columbus, Ohio, United States of America
- The Ohio State University College of Nursing, Columbus, Ohio, United States of America
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