1
|
Meltzer K, Yang M, Rossmann A, Kinsey EW, Cronholm PF, Morgan AU. Patient-Portal Compared with Supplemental In-Office Tablet Screening for Health-Related Social Needs in Primary Care. J Gen Intern Med 2024:10.1007/s11606-024-08929-x. [PMID: 38981941 DOI: 10.1007/s11606-024-08929-x] [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: 02/10/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Screening for health-related social needs (HRSN) has become more widespread but the best method of delivering the screening tool is not yet known. OBJECTIVE Describe HRSN screening completion rate, specifically portal-based and in-person tablet-based screening. DESIGN Cross-sectional retrospective observational study. PARTICIPANTS Adults age 18 or older who had a non-acute primary care visit at one of three internal medicine primary care clinics at a large, urban, academic medical center between July 2022 and July 2023. MAIN MEASURES We identified the proportion of individuals who were screened using the HRSN questionnaire, whether screening was completed by patient-portal or tablet, as well as the degree of burden of HRSN. Using the electronic health record, we explored associations between sociodemographic characteristics and HRSN attributes. KEY RESULTS Our study included 24,597 patients, of whom 37% completed the HRSN questionnaire. A smaller proportion of Black/African American patients and those with Medicaid insurance completed the questionnaire, yet they comprised a greater percentage of those who screened positive for unmet HRSN (p ≤ 0.001). Most patients completed the questionnaire by patient-portal (86.1%) compared with in-office tablets (14.0%). A larger proportion of those who completed screening by tablet screened positive for HRSN. Of all patients screened, 21.8% were positive for an unmet HRSN and 11.5% had more than one unmet HRSN. CONCLUSIONS A majority of patients are not being screened for HRSN and results illustrate disparities when screening patients for HRSN through portal-based compared with supplemental in-office tablet-based screening. Prevalence of unmet HRSN varied by demographics such as race and insurance status.
Collapse
Affiliation(s)
- Kerry Meltzer
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Max Yang
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Alice Rossmann
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eliza W Kinsey
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter F Cronholm
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Public Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna U Morgan
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Lemon SC, LeClair AM, Christenson E, Amburgey D, FitzGerald M, Cabral H, Lloyd-Travaglini C, Clark CR, Wang FQ, Ross J, Ohrenberger E, Haas JS, Freund KN, Battaglia TA. Implementation of social needs screening for minoritized patients newly diagnosed with breast cancer: a mixed methods evaluation in a pragmatic patient navigation trial. BMC Health Serv Res 2024; 24:783. [PMID: 38982469 PMCID: PMC11234663 DOI: 10.1186/s12913-024-11213-7] [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: 09/27/2023] [Accepted: 06/17/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Social needs inhibit receipt of timely medical care. Social needs screening is a vital part of comprehensive cancer care, and patient navigators are well-positioned to screen for and address social needs. This mixed methods project describes social needs screening implementation in a prospective pragmatic patient navigation intervention trial for minoritized women newly diagnosed with breast cancer. METHODS Translating Research Into Practice (TRIP) was conducted at five cancer care sites in Boston, MA from 2018 to 2022. The patient navigation intervention protocol included completion of a social needs screening survey covering 9 domains (e.g., food, transportation) within 90 days of intake. We estimated the proportion of patients who received a social needs screening within 90 days of navigation intake. A multivariable log binomial regression model estimated the adjusted rate ratios (aRR) and 95% confidence intervals (CI) of patient socio-demographic characteristics and screening delivery. Key informant interviews with navigators (n = 8) and patients (n = 21) assessed screening acceptability and factors that facilitate and impede implementation. Using a convergent, parallel mixed methods approach, findings from each data source were integrated to interpret study results. RESULTS Patients' (n = 588) mean age was 59 (SD = 13); 45% were non-Hispanic Black and 27% were Hispanic. Sixty-nine percent of patients in the navigators' caseloads received social needs screening. Patients of non-Hispanic Black race/ethnicity (aRR = 1.25; 95% CI = 1.06-1.48) and those with Medicare insurance (aRR = 1.13; 95% CI = 1.04-1.23) were more likely to be screened. Screening was universally acceptable to navigators and generally acceptable to patients. Systems-based supports for improving implementation were identified. CONCLUSIONS Social needs screening was acceptable, yet with modest implementation. Continued systems-based efforts to integrate social needs screening in medical care are needed.
Collapse
Affiliation(s)
- Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | | | | | | | | | - Howard Cabral
- Boston University School of Public Health, Boston, MA, USA
| | | | | | | | - Joellen Ross
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | |
Collapse
|
3
|
Rudel RK, Byhoff E, Fielman SB, Strombotne KL, Drainoni ML, Greece JA. A Qualitative Study of A Health Center-Based Mobile Produce Market. J Ambul Care Manage 2024; 47:134-142. [PMID: 38771169 DOI: 10.1097/jac.0000000000000496] [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: 05/22/2024]
Abstract
Healthcare-based food assistance programs have the potential to improve patients' food security, but are underutilized. We conducted a qualitative study of user and staff perceptions of an on-site mobile market at a federally-qualified health center (FQHC). Five themes were identified: 1) financial need drives the decision to use the market, 2) people attend specifically to receive healthy food, 3) users feel a connection to the FQHC, which increases participation, 4) social networks increase usage of the program, and 5) long lines, inclement weather, inaccessibility, and inconsistent marketing and communication are attendance barriers. Findings should inform implementation of future healthcare-based food assistance programs.
Collapse
Affiliation(s)
- Rebecca K Rudel
- Author Affiliations: Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts (Drs Rudel and Greece); Department of Medicine, Section of Infectious Diseases, Boston University Chobanian Avedisian School of Medicine/Boston Medical Center, Boston, Massachusetts (Drs Rudel and Drainoni); Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts (Dr Byhoff); Boston University School of Public Health, Department of Health, Law, Policy and Management, Boston, Massachusetts (Drs Strombotne and Drainoni); and Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian Avedisian School of Medicine, Boston, Massachusetts, (Dr Drainoni)
| | | | | | | | | | | |
Collapse
|
4
|
Egede LE, Walker RJ, Linde S, Williams JS. Identifying Individuals with Highest Social Risk in Adults with Type 2 Diabetes Using Item Response Theory. J Gen Intern Med 2024; 39:1642-1648. [PMID: 38565767 PMCID: PMC11255170 DOI: 10.1007/s11606-024-08742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of this analysis was to create a parsimonious tool to screen for high social risk using item response theory to discriminate across social risk factors in adults with type 2 diabetes. METHODS Cross-sectional data of 615 adults with diabetes recruited from two primary care clinics were used. Participants completed assessments including validated scales on economic instability (financial hardship), neighborhood and built environment (crime, violence, neighborhood rating), education (highest education, health literacy), food environment (food insecurity), social and community context (social isolation), and psychological risk factors (perceived stress, depression, serious psychological distress, diabetes distress). Item response theory (IRT) models were used to understand the association between a participant's underlying level of a particular social risk factor and the probability of that response. A two-parameter logistic IRT model was used with each of the 12 social determinant factors being added as a separate parameter in the model. Higher values in item discrimination indicate better ability of a specific social risk factor in differentiating participants from each other. RESULTS Rate of crime reported in a neighborhood (discrimination 3.13, SE 0.50; item difficulty - 0.68, SE 0.07) and neighborhood rating (discrimination 4.02, SE 0.87; item difficulty - 1.04, SE 0.08) had the highest discrimination. CONCLUSIONS Based on these findings, crime and neighborhood rating discriminate best between individuals with type 2 diabetes who have high social risk and those with low social risk. These two questions can be used as a parsimonious social risk screening tool to identify high social risk.
Collapse
Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Sebastian Linde
- Department of Health Policy & Management, Texas A&M School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77843, USA
| | - Joni S Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| |
Collapse
|
5
|
Hatef E, Chang HY, Richards TM, Kitchen C, Budaraju J, Foroughmand I, Lasser EC, Weiner JP. Development of a Social Risk Score in the Electronic Health Record to Identify Social Needs Among Underserved Populations: Retrospective Study. JMIR Form Res 2024; 8:e54732. [PMID: 38470477 DOI: 10.2196/54732] [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: 11/20/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Patients with unmet social needs and social determinants of health (SDOH) challenges continue to face a disproportionate risk of increased prevalence of disease, health care use, higher health care costs, and worse outcomes. Some existing predictive models have used the available data on social needs and SDOH challenges to predict health-related social needs or the need for various social service referrals. Despite these one-off efforts, the work to date suggests that many technical and organizational challenges must be surmounted before SDOH-integrated solutions can be implemented on an ongoing, wide-scale basis within most US-based health care organizations. OBJECTIVE We aimed to retrieve available information in the electronic health record (EHR) relevant to the identification of persons with social needs and to develop a social risk score for use within clinical practice to better identify patients at risk of having future social needs. METHODS We conducted a retrospective study using EHR data (2016-2021) and data from the US Census American Community Survey. We developed a prospective model using current year-1 risk factors to predict future year-2 outcomes within four 2-year cohorts. Predictors of interest included demographics, previous health care use, comorbidity, previously identified social needs, and neighborhood characteristics as reflected by the area deprivation index. The outcome variable was a binary indicator reflecting the likelihood of the presence of a patient with social needs. We applied a generalized estimating equation approach, adjusting for patient-level risk factors, the possible effect of geographically clustered data, and the effect of multiple visits for each patient. RESULTS The study population of 1,852,228 patients included middle-aged (mean age range 53.76-55.95 years), White (range 324,279/510,770, 63.49% to 290,688/488,666, 64.79%), and female (range 314,741/510,770, 61.62% to 278,488/448,666, 62.07%) patients from neighborhoods with high socioeconomic status (mean area deprivation index percentile range 28.76-30.31). Between 8.28% (37,137/448,666) and 11.55% (52,037/450,426) of patients across the study cohorts had at least 1 social need documented in their EHR, with safety issues and economic challenges (ie, financial resource strain, employment, and food insecurity) being the most common documented social needs (87,152/1,852,228, 4.71% and 58,242/1,852,228, 3.14% of overall patients, respectively). The model had an area under the curve of 0.702 (95% CI 0.699-0.705) in predicting prospective social needs in the overall study population. Previous social needs (odds ratio 3.285, 95% CI 3.237-3.335) and emergency department visits (odds ratio 1.659, 95% CI 1.634-1.684) were the strongest predictors of future social needs. CONCLUSIONS Our model provides an opportunity to make use of available EHR data to help identify patients with high social needs. Our proposed social risk score could help identify the subset of patients who would most benefit from further social needs screening and data collection to avoid potentially more burdensome primary data collection on all patients in a target population of interest.
Collapse
Affiliation(s)
- Elham Hatef
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Hsien-Yen Chang
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Thomas M Richards
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Christopher Kitchen
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Janya Budaraju
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Iman Foroughmand
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elyse C Lasser
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jonathan P Weiner
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
6
|
Singer AR, Coleman KF, Mahmud A, Holden E, Stefanik-Guizlo K. Assessing the Feasibility of an Empathic Inquiry Approach to Social Needs Screening in 10 Federally Qualified Health Centers. Perm J 2023; 27:136-142. [PMID: 37830869 PMCID: PMC10723089 DOI: 10.7812/tpp/22.178] [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: 10/14/2023]
Abstract
OBJECTIVES Despite an increasing emphasis from health care organizations on patients' social health, there is debate about how best to screen patients for social health needs in practice. Empathic Inquiry is a patient-centered approach to asking about patients' social needs that incorporates motivational interviewing and trauma-informed care techniques to increase patient experience of trustworthiness and safety with their care teams. The purpose of this brief report is to describe the feasibility and acceptability of implementing an Empathic Inquiry-informed approach to social needs screening in 10 federally qualified health centers. METHODS Clinical staff at community health centers implemented Empathic Inquiry as part of an 8-month learning collaborative. Patients completed surveys about their experience with Empathic Inquiry after screening conversations took place. Qualitative data on organizational implementation experience were collected monthly during 2018. FINDINGS Eight of 10 organizations completed the learning collaborative and implemented Empathic Inquiry in practice. Of 132 patient surveys received, patients agreed (64% strongly agree, 28% somewhat agree) that being screened for social needs strengthened their relationship with their care team and 83% strongly agreed the conversation was a good use of time. Most patients (54%) indicated social health screening was appropriate at every visit, and 27% answered once every 6 months. CONCLUSIONS The Empathic Inquiry approach to understanding patients' social needs was feasible for implementation in community settings. Patients said the conversations were worthwhile, built trust with their care teams, and should be conducted every 6 months or more frequently.
Collapse
Affiliation(s)
- Ariel R Singer
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Katie F Coleman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Ammarah Mahmud
- Kaiser Permanente Washington Health Research Institute; University of Washington, Seattle, WA, USA
| | - Erika Holden
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | |
Collapse
|
7
|
Doll J, Malloy J, Gonzales R. Social Determinants of Health: Opportunity for Occupational Therapy. Am J Occup Ther 2023; 77:7704090010. [PMID: 37540806 DOI: 10.5014/ajot.2023.050360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Abstract
There is a growing recognition that social determinants of health (or social drivers of health [SDOH]) affect physical well-being. In this Health Policy Perspectives column, we describe SDOH and the evolving landscape in health care. Policymakers are facilitating notable investments in social care and putting forth requirements for health care organizations to address SDOH. We share insights and perspectives on the roles occupational therapy practitioners can play in these efforts to address SDOH and the building ecosystems connecting health care and social care.
Collapse
Affiliation(s)
- Joy Doll
- Joy Doll, OTD, OTR/L, is Program Director and Associate Professor, Health Informatics, Creighton University, Omaha, NE;
| | - Julie Malloy
- Julie Malloy, OTD, MOT, OTR/L, PMP, CPHQ, FNAP, is Vice President for Practice Improvement, American Occupational Therapy Association, North Bethesda, MD
| | - Roger Gonzales
- Roger Gonzales, PhDc, MPH, is Program Coordinator for Public Health & Social Care, CyncHealth, Omaha, NE
| |
Collapse
|
8
|
Meltzer KK, Rhodes CM, Morgan AU, Lautenbach GL, Shea JA, Balasta MA. Insights Into Patients' Perceptions of Health-Related Social Needs and the Role of the Adult Primary Care Clinic. J Prim Care Community Health 2023; 14:21501319231184380. [PMID: 37381821 PMCID: PMC10333991 DOI: 10.1177/21501319231184380] [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: 05/07/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION/OBJECTIVES While it is well established that unmet healthrelated social needs (HRSN) adversely affect health outcomes, there has been limited evaluation in adult primary care of patients' perceptions of how these needs impact their health and the role of the primary care provider (PCP). The objective of this study is to identify patients' perceptions of HRSN and how PCPs could help address them. Secondary objectives include exploring the impact of goal setting and a 1-time cash transfer (CT). METHODS This qualitative study used semi-structured baseline and follow-up interviews with patients in internal medicine clinics. Adult primary care patients were included if they screened positive as having 1 of 3 HRSN: financial resource strain, transportation needs, or food insecurity. All participants completed an initial interview about their HRSN and health, and were asked to set a 6-month health goal. At enrollment, participants were randomized to receive a $500 CT or a $50 participation reward. At 6-months, patients were interviewed again to investigate progress toward meeting their health goals, [when applicable] how the CT helped, and their beliefs about the role of PCPs in addressing HRSN. RESULTS We completed 30 initial and 25 follow-up interviews. Participants identified their HRSN, however most did not readily connect identified needs to health. Although participants were receptive to HRSN screening, they did not feel it was their PCP's responsibility to address these needs. Verbal goal-setting appeared to be a useful tool, and while the CTs were appreciated, patients often found them inadequate to address HRSN. CONCLUSIONS Given the importance of identifying the social conditions that shape patients' health, providers, and health systems have an opportunity to re-evaluate their role in helping patients address these barriers. Future studies could examine the effect of more frequent disbursement of CTs over time.
Collapse
Affiliation(s)
- Kerry K. Meltzer
- National Clinician Scholars Program,
University of Pennsylvania, Philadelphia, PA, USA
- Crescenz Veterans Affairs Medical
Center, Philadelphia, PA, USA
- Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Corinne M. Rhodes
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - Anna U. Morgan
- Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - Gillian L. Lautenbach
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - Judy A. Shea
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - Marguerite A. Balasta
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| |
Collapse
|