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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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Hallgren E, Moore R, Ayers BL, Purvis RS, Bryant-Smith G, DelNero P, McElfish PA. "It was kind of a nightmare, it really was:" financial toxicity among rural women cancer survivors. J Cancer Surviv 2024; 18:1006-1015. [PMID: 36870038 DOI: 10.1007/s11764-023-01344-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/27/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE The purpose of this study was to examine how rural women cancer survivors experience and manage financial toxicity. METHODS A qualitative descriptive design was used to explore experiences of financial toxicity among rural women who received cancer treatment. We conducted qualitative interviews with 36 socioeconomically diverse rural women cancer survivors. RESULTS Participants were categorized into three groups: (1) survivors who struggled to afford basic living expenses but did not take on medical debt; (2) survivors who took on medical debt but were able to meet their basic needs; and (3) survivors who reported no financial toxicity. The groups differed by financial and job security and insurance type. We describe each group and, for the first two groups, the strategies they used to manage financial toxicity. CONCLUSIONS Financial toxicity related to cancer treatment is experienced differently by rural women cancer survivors depending on financial and job security and insurance type. Financial assistance and navigation programs should be tailored to support rural patients experiencing different forms of financial toxicity. IMPLICATIONS FOR CANCER SURVIVORS Rural cancer survivors with financial security and private insurance may benefit from policies aimed at limiting patient cost-sharing and financial navigation to help patients understand and maximize their insurance benefits. Rural cancer survivors who are financially and/or job insecure and have public insurance may benefit from financial navigation services tailored to rural patients that can assist with living expenses and social needs.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA.
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Gwendolyn Bryant-Smith
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St. - Slot 556, Little Rock, AR, 72205, USA
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
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Chuang E, Safaeinili N. Addressing Social Needs in Clinical Settings: Implementation and Impact on Health Care Utilization, Costs, and Integration of Care. Annu Rev Public Health 2024; 45:443-464. [PMID: 38134403 DOI: 10.1146/annurev-publhealth-061022-050026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
In recent years, health care policy makers have focused increasingly on addressing social drivers of health as a strategy for improving health and health equity. Impacts of social, economic, and environmental conditions on health are well established. However, less is known about the implementation and impact of approaches used by health care providers and payers to address social drivers of health in clinical settings. This article reviews current efforts by US health care organizations and public payers such as Medicaid and Medicare to address social drivers of health at the individual and community levels. We summarize the limited available evidence regarding intervention impacts on health care utilization, costs, and integration of care and identify key lessons learned from current implementation efforts.
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Affiliation(s)
- Emmeline Chuang
- School of Social Welfare, Mack Center on Public and Nonprofit Management in the Human Services, University of California, Berkeley, California, USA;
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford University, Stanford, California, USA
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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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Vu M, Boyd K, De Marchis EH, Garnache BG, Gottlieb LM, Gross CP, Lee NK, Lindau ST, Mun S, Winslow VA, Makelarski JA. Perceived Appropriateness of Assessing for Health-related Socioeconomic Risks Among Adult Patients with Cancer. CANCER RESEARCH COMMUNICATIONS 2023; 3:521-531. [PMID: 37020993 PMCID: PMC10069714 DOI: 10.1158/2767-9764.crc-22-0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/17/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
Cancer treatment can trigger or exacerbate health-related socioeconomic risks (HRSR; food/housing insecurity, transportation/utilities difficulties, and interpersonal violence). The American Cancer Society and National Cancer Institute recommend HRSR screening and referral, but little research has examined the perceptions of patients with cancer on the appropriateness of HRSR screening in healthcare settings. We examined whether HRSR status, desire for assistance with HRSRs, and sociodemographic and health care-related factors were associated with perceived appropriateness of HRSR screening in health care settings and comfort with HRSR documentation in electronic health records (EHR). A convenience sample of adult patients with cancer at two outpatient clinics completed self-administered surveys. We used χ 2 and Fisher exact tests to test for significant associations. The sample included 154 patients (72% female, 90% ages 45 years or older). Thirty-six percent reported ≥1 HRSRs and 27% desired assistance with HRSRs. Overall, 80% thought it was appropriate to assess for HRSRs in health care settings. The distributions of HRSR status and sociodemographic characteristics were similar among people who perceived screening to be appropriate and those who did not. Participants who perceived screening as appropriate were three times as likely to report prior experience with HRSR screening (31% vs. 10%, P = 0.01). Moreover, 60% felt comfortable having HRSRs documented in the EHR. Comfort with EHR documentation of HRSRs was significantly higher among patients desiring assistance with HRSRs (78%) compared with those who did not (53%, P < 0.01). While initiatives for HRSR screening are likely to be seen by patients with cancer as appropriate, concerns may remain over electronic documentation of HRSRs. Significance National organizations recommend addressing HRSRs such as food/housing insecurity, transportation/utilities difficulties, and interpersonal violence among patients with cancer. In our study, most patients with cancer perceived screening for HRSRs in clinical settings as appropriate. Meanwhile, concerns may remain over the documentation of HRSRs in EHRs.
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Affiliation(s)
- Milkie Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kelly Boyd
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Emilia H. De Marchis
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Bridgette G. Garnache
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Laura M. Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Cary P. Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, Connecticut
- National Clinician Scholars Program, Yale University, New Haven, Connecticut
| | - Nita K. Lee
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
- Department of Medicine-Geriatrics, The University of Chicago Medicine, Chicago, Illinois
- Comprehensive Cancer Center, The University of Chicago Medicine, Chicago, Illinois
| | - Sophia Mun
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, Connecticut
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Victoria A. Winslow
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Jennifer A. Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
- College of Education and Health Services, Benedictine University, Lisle, Illinois
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Grimes LM, Garg R, Weng O, Wolff JM, McQueen A, Carpenter KM, Kreuter MW. Appeal of Tobacco Quitline Services Among Low-Income Smokers. Prev Chronic Dis 2023; 20:E11. [PMID: 36862604 PMCID: PMC9983599 DOI: 10.5888/pcd20.220214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION State tobacco quitlines are delivering cessation assistance through an increasingly diverse range of channels. However, offerings vary from state to state, many smokers are unaware of what is available, and it is not yet clear how much demand exists for different types of assistance. In particular, the demand for online and digital cessation interventions among low-income smokers, who bear a disproportionate burden of tobacco-related disease, is not well understood. METHODS We examined interest in using 13 tobacco quitline services in a racially diverse sample of 1,605 low-income smokers in 9 states who had called a 2-1-1 helpline and participated in an ongoing intervention trial from June 2020 through September 2022. We classified services as standard (used by ≥90% of state quitlines [eg, calls from a quit coach, nicotine replacement therapy, printed cessation booklets]) or nonstandard (mobile app, personalized web, personalized text, online chat with quit coach). RESULTS Interest in nonstandard services was high. Half or more of the sample reported being very or somewhat interested in a mobile app (65%), a personalized web program (59%), or chatting online with quit coaches (49%) to help them quit. In multivariable regression analyses, younger smokers were more interested than older smokers in digital and online cessation services, as were women and smokers with greater nicotine dependence. CONCLUSION On average, participants were very interested in at least 3 different cessation services, suggesting that bundled or combination interventions might be designed to appeal to different groups of low-income smokers. Findings provide some initial hints about potential subgroups and the services they might use in a rapidly changing landscape of behavioral interventions for smoking cessation.
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Affiliation(s)
- Lauren M Grimes
- Health Communication Research Laboratory, Brown School at Washington University in St Louis, St Louis, Missouri
- Health Communication Research Laboratory, Washington University in St Louis, 1 Brookings Dr, St Louis, MO 63130
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School at Washington University in St Louis, St Louis, Missouri
| | - Olivia Weng
- Health Communication Research Laboratory, Brown School at Washington University in St Louis, St Louis, Missouri
| | - Jennifer M Wolff
- Health Communication Research Laboratory, Brown School at Washington University in St Louis, St Louis, Missouri
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School at Washington University in St Louis, St Louis, Missouri
- Division of General Medical Sciences, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | | | - Matthew W Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St Louis, St Louis, Missouri
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Spatial analysis of community service availability in rural Kentucky, United States. J Public Health Policy 2023; 44:6-22. [PMID: 36624271 DOI: 10.1057/s41271-022-00388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
This study examined community service provider (CSP) availability relative to neighborhood socioeconomic status and its association with health-related social needs in Eastern Kentucky, United States. We used GIS methods to generate 10-mile network service areas around addresses of 736 CSPs and 10,161 Medicaid and Medicare beneficiaries screened August 2018-April 2020 in 27-county study region. We observed wide variation in CSP availability and an inverse relationship between CSP availability and rates of unemployment, poverty, and federal Supplemental Nutrition Assistance Program. The CSPs appear to have higher availability in more affluent census block groups. We found a statistically significant negative relationship between CSP availability within 10 miles of a beneficiary's resident and the presence of food, housing, transportation needs. Our findings suggest that healthcare providers, government entities, and non-profit organizations should consider geographic accessibility to those most in need when making referral and funding decisions, particularly in rural communities.
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White KB, Resmondo ZN, Jennings JC, Creel LM, Kelly Pryor BN. A social network analysis of interorganisational collaboration: Efforts to improve social connectedness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6067-e6079. [PMID: 36181388 PMCID: PMC10092426 DOI: 10.1111/hsc.14044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
The Covid-19 pandemic has challenged public health practitioners and clinicians at multiple levels to intentionally consider the impact of social isolation on health outcomes. Many community-based programmes design interventions to address tangible challenges within the social determinants of health, such as asset insecurity or food insecurity, to address health inequities. The growing need to address social isolation within marginalised communities also requires organisations to collaborate and create community partnerships that strengthen their own social integration within the community. The present research reports on the results of a Social Network Analysis (SNA) of community programmes within three southern U.S. cities and their local collaborations to address social isolation. After interviewing representatives of 46 community organisations, it was found that social service organisations that also offer public health services play a central role in community efforts to improve social isolation. The participating organisations primarily collaborate through referrals and information sharing, and report inadequate resources. With a growing recognition that social services and supports play a considerable role in addressing health inequities, this study provides evidence of opportunities for interorganisational collaboration to promote individual and community health.
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Affiliation(s)
- Kelsey B. White
- Department of Patient Counseling, College of Health ProfessionsVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Zoë N. Resmondo
- Medical University of South Carolina HealthCharlestonSouth CarolinaUSA
| | - J’Aime C. Jennings
- Department of Health Management and System SciencesUofL Center for Health Organization TransformationLouisvilleKentuckyUSA
| | - Liza M. Creel
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Brandy N. Kelly Pryor
- Department of Health Promotion and Behavioral SciencesUniversity of LouisvilleLouisvilleKentuckyUSA
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Steeves-Reece AL, Nicolaidis C, Richardson DM, Frangie M, Gomez-Arboleda K, Barnes C, Kang M, Goldberg B, Lindner SR, Davis MM. "It Made Me Feel like Things Are Starting to Change in Society:" A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12668. [PMID: 36231967 PMCID: PMC9566653 DOI: 10.3390/ijerph191912668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Many healthcare organizations are screening patients for health-related social needs (HRSN) to improve healthcare quality and outcomes. Due to both the COVID-19 pandemic and limited time during clinical visits, much of this screening is now happening by phone. To promote healing and avoid harm, it is vital to understand patient experiences and recommendations regarding these activities. We conducted a pragmatic qualitative study with patients who had participated in a HRSN intervention. We applied maximum variation sampling, completed recruitment and interviews by phone, and carried out an inductive reflexive thematic analysis. From August to November 2021 we interviewed 34 patients, developed 6 themes, and used these themes to create a framework for generating positive patient experiences during phone-based HRSN interventions. First, we found patients were likely to have initial skepticism or reservations about the intervention. Second, we identified 4 positive intervention components regarding patient experience: transparency and respect for patient autonomy; kind demeanor; genuine intention to help; and attentiveness and responsiveness to patients' situations. Finally, we found patients could be left with feelings of appreciation or hope, regardless of whether they connected with HRSN resources. Healthcare organizations can incorporate our framework into trainings for team members carrying out phone-based HRSN interventions.
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Affiliation(s)
- Anna L. Steeves-Reece
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, OR 97201, USA
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Dawn M. Richardson
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
| | - Melissa Frangie
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Katherin Gomez-Arboleda
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Chrystal Barnes
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Minnie Kang
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Bruce Goldberg
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Stephan R. Lindner
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Melinda M. Davis
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
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Oates GR, Schechter MS. Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies. Expert Rev Respir Med 2022; 16:637-650. [PMID: 35705523 DOI: 10.1080/17476348.2022.2090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from socioeconomically disadvantaged backgrounds have worse health and die younger than those in more advantaged positions. AREAS COVERED This paper reviews the literature on the mechanisms that are responsible for generating and sustaining disparities in CF health, and the ways by which social determinants translate into health advantages or disadvantages in people with CF. The authors make recommendations for addressing social risk factors in CF clinical practice. EXPERT OPINION Socioeconomic factors are not dichotomous and their impact is felt at every step of the social ladder. CF care programs need to adopt a systematic protocol to screen for health-related social risk factors, and then connect patients to available resources to meet individual needs. Considerations such as daycare, schooling options, living and working conditions, and opportunities for physical exercise and recreation as well as promotion of self-efficacy are often overlooked. In addition, advocacy for changes in public policies on health insurance, environmental regulations, social welfare, and education would all help address the root causes of CF health inequities.
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Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, USA
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Garg R, McQueen A, Wolff JM, Skinner KE, Kegler MC, Kreuter MW. Low housing quality, unmet social needs, stress and depression among low-income smokers. Prev Med Rep 2022; 27:101767. [PMID: 35321214 PMCID: PMC8935510 DOI: 10.1016/j.pmedr.2022.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 11/25/2022] Open
Abstract
Over 60% of low-income smokers reported housing quality problems. Problems with housing quality were among the most common social needs. Housing quality problems were associated with worse measures of health. Poor housing quality may exacerbate health disparities for low-income smokers.
Smokers are at greater risk of multiple health conditions that are exacerbated by environmental hazards associated with low housing quality. However, little is known about the prevalence of low housing quality among low-income smokers. Using correlations and logistic regression, we examined associations among eight housing quality indicators – pests, water leaks, mold, lead paint, and working smoke detectors, appliances, heating, and air conditioning – and between housing quality and social needs, depressive symptoms, perceived stress, sleep problems, and self-rated health in a community-based sample of 786 low-income smokers from 6 states. Most participants were female (68%), and White (45%) or African-American (43%). One in four (27%) completed less than high school education, and 41% reported annual pre-tax household income of less than $10,000. Housing quality problems were common. Most participants (64%) reported at least one problem in their home, and 41% reported two or more problems, most commonly pest infestations (40%), water leaks (22%), lack of air conditioning (22%) and mold (18%). Lack of heat and air conditioning were correlated, as were water leaks and mold. Using logistic regression analyses controlling for participant demographic characteristics, we found that reporting more housing quality problems was associated with greater odds of worse mental and physical health outcomes. Multiple health threats, including housing quality, depressive symptoms, stress, poor sleep, and financial strain may be mutually reinforcing and compound the health consequence of smoking. Future research should seek to replicate these findings in other samples, and examine associations longitudinally to better understand causality.
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Yan AF, Chen Z, Wang Y, Campbell JA, Xue QL, Williams MY, Weinhardt LS, Egede LE. Effectiveness of Social Needs Screening and Interventions in Clinical Settings on Utilization, Cost, and Clinical Outcomes: A Systematic Review. Health Equity 2022; 6:454-475. [PMID: 35801145 PMCID: PMC9257553 DOI: 10.1089/heq.2022.0010] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: This systematic review examined and synthesized peer-reviewed research studies that reported the process of integrating social determinants of health (SDOH) or social needs screening into electronic health records (EHRs) and the intervention effects in the United States. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, a systematic search of Scopus, Web of Science Core Collection, MEDLINE, and Cochrane Central Register of Clinical Trials was performed. English language peer-reviewed studies that reported the process of integrating SDOH or social needs screening into EHRs within the U.S. health systems and published between January 2015 and December 2021 were included. The review focused on process measures, social needs changes, health outcomes, and health care cost and utilization. Results: In total, 28 studies were included, and half were randomized controlled trials. The majority of the studies targeted multiple SDOH domains. The interventions vary by the levels of intensity of their approaches and heterogeneities in outcome measures. Most studies (82%, n=23) reported the findings related to the process measures, and nearly half (43%, n=12) reported outcomes related to social needs. By contrast, only 39% (n=11) and 32% (n=9) of the studies reported health outcomes and impact on health care cost and utilization, respectively. Findings on patients' social needs change demonstrated improved access to resources. However, findings were mixed on intervention effects on health and health care cost and utilization. We also identified gaps in implementation challenges to be overcome. Conclusion: Our review supports the current policy efforts to increase U.S. health systems' investment toward directly addressing SDOH. While effective interventions can be more complex or resource intensive than an online referral, health care organizations hoping to achieve health equity and improve population health must commit the effort and investment required to achieve this goal.
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Affiliation(s)
- Alice F. Yan
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Yang Wang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jennifer A. Campbell
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine and the Center on Aging and Health, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle Y. Williams
- Division of Research, Nursing and Patient Care Services, Stanford Health Care, Palo Alto, California, USA
| | - Lance S. Weinhardt
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Leonard E. Egede
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
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Brewster AL, Wilson TL, Kunkel SR, Curry LA, Rubeo C. Factors Associated With Contracting Between Area Agencies on Aging and Health Care Entities. J Appl Gerontol 2022; 41:1878-1886. [PMID: 35505592 DOI: 10.1177/07334648221096137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Contracting with health care entities offers an avenue for Area Agencies on Aging (AAAs) to be reimbursed for providing services that improve health and avoid the need for expensive health care among older adults. However, we have little systematic evidence about the organizational characteristics and policy environments that facilitate these contractual relationships. Using survey data on AAAs from 2017-18, we found that contracting with health insurers was significantly more likely if AAAs had strong business capabilities and access to a state CBO contracting network. AAA contracting with health care delivery organizations trended with different factors, becoming more likely if states had implemented more integrated health care delivery programs, and becoming less likely if states had managed long-term services and supports. Contracting could be facilitated by supports for AAA business capabilities, as well as state policies that increase demand for their services among health insurers and health care delivery organizations.
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Affiliation(s)
- Amanda L Brewster
- Health Policy and Management, 1439University of California, Berkeley, CA, USA
| | | | | | | | - Chris Rubeo
- 1439University of California, Berkeley, CA, USA
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15
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Steeves-Reece AL, Totten AM, Broadwell KD, Richardson DM, Nicolaidis C, Davis MM. Social Needs Resource Connections: A Systematic Review of Barriers, Facilitators, and Evaluation. Am J Prev Med 2022; 62:e303-e315. [PMID: 35078672 PMCID: PMC9850790 DOI: 10.1016/j.amepre.2021.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/20/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Healthcare organizations increasingly are screening patients for social needs (e.g., food, housing) and referring them to community resources. This systematic mixed studies review assesses how studies evaluate social needs resource connections and identifies patient- and caregiver-reported factors that may inhibit or facilitate resource connections. METHODS Investigators searched PubMed and CINAHL for articles published from October 2015 to December 2020 and used dual review to determine inclusion based on a priori selection criteria. Data related to study design, setting, population of interest, intervention, and outcomes were abstracted. Articles' quality was assessed using the Mixed Methods Appraisal Tool. Data analysis was conducted in 2021. RESULTS The search identified 34 articles from 32 studies. The authors created a taxonomy of quantitative resource connection measures with 4 categories: whether participants made contact with resources, received resources, had their social needs addressed, or rated some aspect of their experience with resources. Barriers to resource connections were inadequacy, irrelevancy, or restrictiveness; inaccessibility; fears surrounding stigma or discrimination; and factors related to staff training and resource information sharing. Facilitators were referrals' relevancy, the degree of support and simplicity embedded within the interventions, and interventions being comprehensive and inclusive. DISCUSSION This synthesis of barriers and facilitators indicates areas where healthcare organizations may have agency to improve the efficacy of social needs screening and referral interventions. The authors also recommend that resource connection measures be explicitly defined and focus on whether participants received new resources and whether their social needs were addressed.
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Affiliation(s)
- Anna Louise Steeves-Reece
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Annette Marie Totten
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon; Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; Department of Medical Informatics & Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Katherine DuBose Broadwell
- Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Dawn Michele Richardson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, Oregon; Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Melinda Marie Davis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon; Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
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16
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Garg R, Croston MA, Thompson T, McQueen A, Kreuter MW. Correlates of smoking discarded cigarettes in a sample of low-income adults. Addict Behav 2022; 128:107237. [PMID: 35074637 PMCID: PMC9137428 DOI: 10.1016/j.addbeh.2022.107237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Unconventional smoking behaviors such as smoking used or discarded cigarettes may increase the risk of nicotine dependence and exposure to toxins. To better understand low-income smokers who smoke discarded cigarettes and to inform effective tobacco cessation strategies, the current study examined potential correlates not considered in prior studies. METHODS This secondary analysis examined baseline data from 1936 low-income smokers participating in a randomized cessation trial. To assess smoking discarded cigarettes, participants were asked: "In the past 30 days, have you smoked what's left of a cigarette that someone else left behind?" Unadjusted and adjusted logistic regression were used to explore associations between smoking discarded cigarettes and social needs, social environment, mental and physical health, other smoking-related behaviors, and demographic characteristics. RESULTS One in six participants reported smoking discarded cigarettes. Younger smokers, men, smokers with lower incomes and those who were not employed were more likely to smoke discarded cigarettes. Other correlates included having unmet social needs (transportation, food, housing, physical safety, and neighborhood safety), living with other smokers, worse mental health, greater perceived stress, heavier smoking, using other tobacco products, and bumming cigarettes from others. In a multivariable model, income, social environment, and other smoking behaviors emerged as significant correlates. CONCLUSIONS In addition to financial hardship, mental health, and nicotine dependence, the social needs, social environment, and other smoking behaviors of low-income smokers are important correlates of smoking discarded cigarettes. Future research to understand and address tobacco health disparities should examine these relationships longitudinally.
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17
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Liu PY, Beck AF, Lindau ST, Holguin M, Kahn RS, Fleegler E, Henize AW, Halfon N, Schickedanz A. A Framework for Cross-Sector Partnerships to Address Childhood Adversity and Improve Life Course Health. Pediatrics 2022; 149:e2021053509O. [PMID: 35503315 PMCID: PMC9549524 DOI: 10.1542/peds.2021-053509o] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Childhood adversity and its structural causes drive lifelong and intergenerational inequities in health and well-being. Health care systems increasingly understand the influence of childhood adversity on health outcomes but cannot treat these deep and complex issues alone. Cross-sector partnerships, which integrate health care, food support, legal, housing, and financial services among others, are becoming increasingly recognized as effective approaches address health inequities. What principles should guide the design of cross-sector partnerships that address childhood adversity and promote Life Course Health Development (LCHD)? The complex effects of childhood adversity on health development are explained by LCHD concepts, which serve as the foundation for a cross-sector partnership that optimizes lifelong health. We review the evolution of cross-sector partnerships in health care to inform the development of an LCHD-informed partnership framework geared to address childhood adversity and LCHD. This framework outlines guiding principles to direct partnerships toward life course-oriented action: (1) proactive, developmental, and longitudinal investment; (2) integration and codesign of care networks; (3) collective, community and systemic impact; and (4) equity in praxis and outcomes. Additionally, the framework articulates foundational structures necessary for implementation: (1) a shared cross-sector theory of change; (2) relational structures enabling shared leadership, trust, and learning; (3) linked data and communication platforms; and (4) alternative funding models for shared savings and prospective investment. The LCHD-informed cross-sector partnership framework presented here can be a guide for the design and implementation of cross-sector partnerships that effectively address childhood adversity and advance health equity through individual-, family-, community-, and system-level intervention.
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Affiliation(s)
- Patrick Y. Liu
- Center for Healthier Children, Families, and Communities
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Andrew F. Beck
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology and The University of Chicago, Chicago, Illinois
- Section of Geriatrics and Palliative Medicine, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Monique Holguin
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Robert S. Kahn
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Neal Halfon
- Center for Healthier Children, Families, and Communities
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Adam Schickedanz
- Center for Healthier Children, Families, and Communities
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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18
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Sandhu S, Alderwick H, Gottlieb LM. Financing Approaches to Social Prescribing Programs in England and the United States. Milbank Q 2022; 100:393-423. [PMID: 35348249 DOI: 10.1111/1468-0009.12562] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Policy Points The number of social prescribing practices, which aim to link patients with nonmedical services and supports to address patients' social needs, is increasing in both England and the United States. Traditional health care financing mechanisms were not designed to support social prescribing practices, and flexible payment approaches may not support their widespread adoption. Policymakers in both countries are shifting toward developing explicit financing streams for social prescribing programs. Consequently, we need an evaluation of them to assess their success in supporting both the acceptance of these programs and their impacts. Investment in community-based organizations and wider public services will likely be crucial to both the long-term effectiveness and the sustainability of social prescribing.
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Affiliation(s)
- Sahil Sandhu
- Harvard Medical School, Boston, Massachusetts.,Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne
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19
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Park Y, Quinn JW, Hurvitz PM, Hirsch JA, Goldsmith J, Neckerman KM, Lovasi GS, Rundle AG. Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study. BMC Health Serv Res 2022; 22:367. [PMID: 35305617 PMCID: PMC8934473 DOI: 10.1186/s12913-022-07749-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background To address patient’s unmet social needs and improve health outcomes, health systems have developed programs to refer patients in need to social service agencies. However, the capacity to respond to patient referrals varies tremendously across communities. This study assesses the emergence of disparities in spatial access to social services from 1990 to 2014. Methods Social service providers in the lower 48 continental U.S. states were identified annually from 1990 to 2014 from the National Establishment Times Series (NETS) database. The addresses of providers were linked in each year to 2010 US Census tract geometries. Time series analyses of annual counts of services per Km2 were conducted using Generalized Estimating Equations with tracts stratified into tertiles of 1990 population density, quartiles of 1990 poverty rate and quartiles of 1990 to 2010 change in median household income. Results Throughout the period, social service agencies/Km2 increased across tracts. For high population density tracts, in the top quartile of 1990 poverty rate, compared to tracts that experienced the steepest declines in median household income from 1990 to 2010, tracts that experienced the largest increases in income had more services (+ 1.53/Km2, 95% CI 1.23, 1.83) in 1990 and also experienced the steepest increases in services from 1990 to 2010: a 0.09 services/Km2/year greater increase (95% CI 0.07, 0.11). Similar results were observed for high poverty tracts in the middle third of population density, but not in tracts in the lowest third of population density, where there were very few providers. Conclusion From 1990 to 2014 a spatial mismatch emerged between the availability of social services and the expected need for social services as the population characteristics of neighborhoods changed. High poverty tracts that experienced further economic decline from 1990 to 2010, began the period with the lowest access to services and experienced the smallest increases in access to services. Access was highest and grew the fastest in high poverty tracts that experienced the largest increases in median household income. We theorize that agglomeration benefits and the marketization of welfare may explain the emergence of this spatial mismatch.
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20
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Zellmer L, Johnson B, Idris A, Mehus CJ, Borowsky IW. Post-Identification Approaches to Addressing Health-Related Social Needs in Primary Care: A Qualitative Study. J Gen Intern Med 2022; 37:802-808. [PMID: 34331212 PMCID: PMC8904656 DOI: 10.1007/s11606-021-07033-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Social determinants of health play a fundamental role in a patient's health status. In recent years, health systems across the nation have implemented numerous strategies aimed at identifying and addressing the health-related social needs of the patients they serve. Despite the influx of peer-reviewed research highlighting outcomes of specific health-related social needs interventions, the spectrum of practices utilized by primary care clinics has not been established. OBJECTIVE To determine the range of ways primary care clinics address health-related social needs after identification and initial contact with a frontline staff person is completed. DESIGN We conducted 12 semi-structured, in-person interviews with staff from purposively sampled clinics. If the interview included more than one staff person, all participants were interviewed together. PARTICIPANTS Twenty-one administrative staff and frontline clinic personnel with experience in 24 separate primary care clinics in the Minneapolis-St. Paul, Minnesota metropolitan area. APPROACH Interviews focused on the range of health-related social needs processes utilized by clinics, including staff titles, referral procedures, and barriers to addressing needs. Interview recordings were transcribed and coded using thematic analysis. KEY RESULTS Thematic analysis identified variation in four key areas involving how clinics address patients' health-related social needs after identification and initial contact by frontline staff: clinic personnel involved in addressing needs, clinic referral processes, "resource" and "success" definitions, and barriers to accessing community-based supports. CONCLUSIONS This study describes the large variation in primary care clinic practices to address health-related social needs after they are identified. The results suggest challenges to standardization and real-world application of previously published studies. Our findings also highlight the opportunity for improved relationships between health systems and community-based agencies.
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Affiliation(s)
- Lucas Zellmer
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA.
| | - Bryan Johnson
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Ahmed Idris
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Christopher J Mehus
- Institute for Translational Research in Children's Mental Health, University of Minnesota, Minneapolis, MN, USA
| | - Iris W Borowsky
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
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21
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Integrated Health and Social Care in the United States: A Decade of Policy Progress. Int J Integr Care 2021; 21:9. [PMID: 34785994 PMCID: PMC8570194 DOI: 10.5334/ijic.5687] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction: Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. Policy practice: This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice. Discussion and Conclusion: National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors.
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22
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Garg R, Steensma JT, Luke AA, Huang K, Golla B, Greer R, Joynt Maddox KE. Helpline Calls Associated With Preventable Emergency Department Utilization. Am J Prev Med 2021; 61:729-732. [PMID: 34210582 DOI: 10.1016/j.amepre.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Unmet social needs are linked with greater healthcare utilization, but most studies lack timely and granular data on these needs. The 2-1-1 helpline is a telephone helpline focused on social needs. The objective of the study is to determine whether the number of 2-1-1 requests per 1,000 people is associated with preventable emergency department visits and compare the strength of the association with another commonly used predictor, Area Deprivation Index. METHODS This cross-sectional study linked 2-1-1 requests to emergency department visits from uninsured and Medicaid-insured patients by ZIP code for a large urban hospital system from January 1, 2016 to August 31, 2019. Negative binomial regression analysis was used to estimate the association of 2-1-1 service requests and Area Deprivation Index with preventable emergency department visits. RESULTS A total of 233,146 preventable emergency department visits and 520,308 2-1-1 requests were analyzed. For every 1-SD increase in 2-1-1 requests per 1,000 population, preventable emergency department visits increased by a factor of 3.05, even after controlling for local area deprivation and other population characteristics (p<0.001). CONCLUSIONS Requests to 2-1-1 helplines are strongly associated with preventable emergency department visits. This information may help hospital leaders and policymakers target social needs interventions to the neighborhoods with the greatest need.
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Affiliation(s)
- Rachel Garg
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri.
| | - Joseph T Steensma
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Alina A Luke
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, School of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kristine Huang
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, School of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Balaji Golla
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Regina Greer
- United Way 2-1-1, United Way of Greater St. Louis, St. Louis, Missouri
| | - Karen E Joynt Maddox
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, School of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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23
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Verdecias N, Garg R, Steensma J, McQueen A, Greer R, Kreuter MW. Expressed and unexpressed social needs in low-income adults in the U.S. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e184-e191. [PMID: 33378603 PMCID: PMC8243392 DOI: 10.1111/hsc.13265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/09/2020] [Accepted: 12/01/2020] [Indexed: 06/01/2023]
Abstract
Many healthcare organisations are now routinely screening patients for social needs such as food and housing. It is largely unknown whether the needs they identify would have been expressed by the patient in the absence of screening. To better understand expressed and unexpressed social needs, we administered a social needs screener to 1,397 low-income adults who called a 2-1-1 helpline in Missouri seeking assistance with social needs between June 2017 and October 2019. Merging data from the screener and 2-1-1, we found that the screener identified all of the social needs expressed to 2-1-1 for about half the participants, and on average identified at least one social need not expressed to 2-1-1 (i.e., unexpressed needs). Certain social needs (utility payment assistance, housing) were much more likely to be expressed than unexpressed, while others (childcare, employment, personal safety) were almost universally unexpressed. In regression analyses, having certain expressed needs significantly increased the odds of having certain unexpressed needs. For example, those seeking transportation assistance from 2-1-1 had greater odds of unexpressed needs for food (OR = 3.19; 95% CI = 1.45-7.02) and healthcare (OR = 2.18; 95% CI = 1.06-4.48) than those not expressing transportation needs. Those seeking employment assistance from 2-1-1 had greater odds of unexpressed needs for personal safety (OR = 3.04; 95% CI = 1.20-7.68) and healthcare (OR = 2.58; 95% CI = 1.15-5.77) than those not expressing employment needs. Implications for healthcare (screening detects expressed and unexpressed needs) and social service organisations (certain requests may be markers for other needs) are discussed.
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Affiliation(s)
- Niko Verdecias
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
| | - Rachel Garg
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
| | - Joe Steensma
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
| | - Amy McQueen
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
- Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Regina Greer
- United Way of Greater St. Louis 2-1-1, St. Louis, MO
| | - Matthew W. Kreuter
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
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Dauner KN, Loomer L. A qualitative assessment of barriers and facilitators associated with addressing social determinants of health among members of a health collaborative in the rural Midwest. BMC Health Serv Res 2021; 21:867. [PMID: 34429097 PMCID: PMC8384464 DOI: 10.1186/s12913-021-06859-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose Rural communities have unique economic and social structures, different disease burdens, and a more patchworked healthcare delivery system compared to urban counterparts. Yet research into addressing social determinants of health has focused on larger, urban, integrated health systems. Our study sought to understand capacities, facilitators, and barriers related to addressing social health needs across a collaborative of independent provider organizations in rural Northeastern Minnesota and Northwestern Wisconsin. Methods We conducted qualitative, semi-structured interviews with a purposive sample of 37 key informants from collaborative members including 4 stand-alone critical access hospitals, 3 critical access hospitals affiliated with primary care, 1 multi-clinic system, and 1 integrated regional health system. Findings Barriers were abundant and occurred at the organizational, community and policy levels. Rural providers described a lack of financial, labor, Internet, and community-based social services resources, a limited capacity to partner with other organizations, and workflows that were less than optimal for addressing SDOH. State Medicaid and other payer policies posed challenges that made it more difficult to use available resources, as did misaligned incentives between partners. While specific payer programs and organizational innovations helped facilitate their work, nothing was systemic. Relationships within the collaborative that allowed sharing of innovations and information were helpful, as was the role leadership played in promoting value-based care. Conclusions Policy change is needed to support rural providers in this work. Collaboration among rural health systems should be fostered to develop common protocols, promote value-based care, and offer economies of scale to leverage value-based payment. States can help align incentives and performance metrics across rural health care entities, engage payers in promoting value-based care, and bolster social service capacity.
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Affiliation(s)
- Kim Nichols Dauner
- Department of Economics and Health Care Management, Labovitz School of Business & Economics, University of Minnesota Duluth, 1318 Kirby Drive, Duluth, MN, 55812, USA.
| | - Lacey Loomer
- Department of Economics and Health Care Management, Labovitz School of Business & Economics, University of Minnesota Duluth, 1318 Kirby Drive, Duluth, MN, 55812, USA
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The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations. J Am Board Fam Med 2021; 34:698-708. [PMID: 34312263 PMCID: PMC9875859 DOI: 10.3122/jabfm.2021.04.200591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Social determinants of health (SDoH) influence health outcomes and contribute to disparities in chronic disease in vulnerable populations. To inform health system strategies to address SDoH, we conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for those living in socio-economically deprived contexts. METHODS Varied qualitative inquiry methods - in-depth interviews, participant-led neighborhood tours, and clinic visit observations - involving a total of 23 participants (10 patients with chronic illnesses in San Francisco neighborhoods with high chronic disease rates, 10 community leaders serving the same neighborhoods, and 3 providers from San Francisco's public health care delivery system). Qualitative analyses were guided by the Chronic Care Model (CCM). RESULTS Several key themes emerged from this study. First, we enumerated a large array, neighborhood resources such as food pantries, parks/green spaces, and financial assistance services that interact with patients' self-management. Health service providers leveraged these resources to address patients' social needs but suggested a clear need for expanding this work. Second, analyses uncovered multiple essential mechanisms by which community-based organizations (CBOs) provided and navigated among many neighborhood health resources, including social support and culturally aligned knowledge. Finally, many examples of how structural issues such as institutional racism, transportation, and housing inequities are intertwined with health and social service delivery were elucidated. CONCLUSION The results contribute new evidence toward the community domain of the CCM. Health care systems must intentionally partner with CBOs to address SDoH and improve community resources for chronic care management, and directly address structural issues to make progress.
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O'Hara NN, Kringos DS, Slobogean GP, Degani Y, Klazinga NS. Patients Place More of an Emphasis on Physical Recovery Than Return to Work or Financial Recovery. Clin Orthop Relat Res 2021; 479:1333-1343. [PMID: 33239518 PMCID: PMC8133069 DOI: 10.1097/corr.0000000000001583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/02/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Value-based healthcare models aim to incentivize healthcare providers to offer interventions that address determinants of health. Understanding patient priorities for physical and socioeconomic recovery after injury can help determine which services and resources are most useful to patients. QUESTIONS/PURPOSES (1) Do trauma patients consistently identify a specific aspect/domain of recovery as being most important at 6 weeks, 6 months, and 12 months after an injury? (2) Does the relative importance of those domains change within the first year after injury? (3) Are differences in priorities greater between patients than for a given patient over time? (4) Are different recovery priorities associated with identifiable biopsychosocial factors? METHODS Between June 2018 and December 2018, 504 adult patients with fractures of the extremities or pelvis were surgically treated at the study site. For this prospective longitudinal study, we purposefully sampled patients from 6 of the 12 orthopaedic attendings' postoperative clinics. The participating surgeons surgically treated 243 adult patients with fractures of the extremities or pelvis. Five percent (11 of 243) of patients met inclusion criteria but missed their appointments during the 6-week recruitment window and could not be consented. We excluded 4% (9 of 243) of patients with a traumatic brain injury, 1% (2) of patients with a spinal cord injury, and 5% (12) of non-English-speaking patients (4% Spanish speaking [10]; 1% other languages [2]). Eighty-six percent of eligible patients (209 of 243) were approached for consent, and 5% (11 of 209) of those patients refused to participate. All remaining 198 patients consented and completed the baseline survey; 83% (164 of 198 patients) completed at least 6 months of follow-up, and 68% (134 of 198 patients) completed the 12-month assessment. The study participants' mean age was 44 ± 17 years, and 63% (125 of 198) were men. The primary outcome was the patient's recovery priorities, assessed at 6 weeks, 6 months, and 12 months after fracture using a discrete choice experiment. Discrete choice experiments are a well-established method for eliciting decisional preferences. In this technique, respondents are presented with a series of hypothetical scenarios, described by a set of plausible attributes or outcomes, and asked to select their preferred scenario. We used hierarchical Bayesian modeling to calculate individual-level estimates of the relative importance of physical recovery, work-related recovery, and disability benefits, based on the discrete choice experiment responses. The hierarchical Bayesian model improves upon more commonly used regression techniques by accounting for the observed response patterns of individual patients and the sequence of scenarios presented in the discrete choice experiment when calculating the model estimates. We computed the coefficient of variation for the three recovery domains and compared the between-patient versus within-patient differences using asymptotic tests. Separate prognostic models were fit for each of the study's three recovery domains to assess marginal changes in the importance of the recovery domain based on patient characteristics and factors that remained constant over the study (such as sex or preinjury work status) and patient characteristics and factors that varied over the study (including current work status or patient-reported health status). We previously published the 6-week results. This paper expands upon the prior publication to evaluate longitudinal changes in patient recovery priorities. RESULTS Physical recovery was the respondents' main priority at all three timepoints, representing 60% ± 9% of their overall concern. Work-related recovery and access to disability benefits were of secondary importance and were associated with 27% ± 6% and 13% ± 7% of the patients' concern, respectively. The patients' concern for physical recovery was 6% (95% CrI 4% to 7%) higher at 12 months after fracture that at 6 weeks postfracture. The mean concern for work-related recovery increased by 7% (95% CrI 6% to 8%) from 6 weeks to 6 months after injury. The mean importance of disability benefits increased by 2% (95% CrI 1% to 4%) from 6 weeks to 6 months and remained 2% higher (95% CrI 0% to 3%) at 12 months after the injury. Differences in priorities were greater within a given patient over time than between patients as measured using the coefficient of variation (physical recovery [245% versus 7%; p < 0.001], work-related recovery [678% versus 12%; p < 0.001], and disability benefits [620% versus 33%; p < 0.001]. There was limited evidence that biopsychosocial factors were associated with variation in recovery priorities. Patients' concern for physical recovery was 2% higher for every 10-point increase in their Patient-reported Outcome Measure Information System (PROMIS) physical health status score (95% CrI 1% to 3%). A 10-point increase in the patient's PROMIS mental health status score was associated with a 1% increase in concern for work-related recovery (95% CrI 0% to 2%). CONCLUSION Work-related recovery and accessing disability benefits were a secondary concern compared with physical recovery in the 12 months after injury for patients with fractures. However, the importance of work-related recovery was elevated after the subacute phase. Priorities were highly variable within a given patient in the year after injury compared with between-patient differences. Given this variation, orthopaedic surgeons should consider assessing and reassessing the socioeconomic well-being of their patients throughout their continuum of care. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Nathan N O'Hara
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Dionne S Kringos
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Gerard P Slobogean
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Yasmin Degani
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Niek S Klazinga
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Chen M, Tan X, Padman R. Social determinants of health in electronic health records and their impact on analysis and risk prediction: A systematic review. J Am Med Inform Assoc 2021; 27:1764-1773. [PMID: 33202021 DOI: 10.1093/jamia/ocaa143] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This integrative review identifies and analyzes the extant literature to examine the integration of social determinants of health (SDoH) domains into electronic health records (EHRs), their impact on risk prediction, and the specific outcomes and SDoH domains that have been tracked. MATERIALS AND METHODS In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a literature search in the PubMed, CINAHL, Cochrane, EMBASE, and PsycINFO databases for English language studies published until March 2020 that examined SDoH domains in the context of EHRs. RESULTS Our search strategy identified 71 unique studies that are directly related to the research questions. 75% of the included studies were published since 2017, and 68% were U.S.-based. 79% of the reviewed articles integrated SDoH information from external data sources into EHRs, and the rest of them extracted SDoH information from unstructured clinical notes in the EHRs. We found that all but 1 study using external area-level SDoH data reported minimum contribution to performance improvement in the predictive models. In contrast, studies that incorporated individual-level SDoH data reported improved predictive performance of various outcomes such as service referrals, medication adherence, and risk of 30-day readmission. We also found little consensus on the SDoH measures used in the literature and current screening tools. CONCLUSIONS The literature provides early and rapidly growing evidence that integrating individual-level SDoH into EHRs can assist in risk assessment and predicting healthcare utilization and health outcomes, which further motivates efforts to collect and standardize patient-level SDoH information.
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Affiliation(s)
- Min Chen
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, USA
| | - Xuan Tan
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, USA
| | - Rema Padman
- The H. John Heinz III College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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Sandhu S, Lemmon ME, Eisenson H, Crowder C, Bettger JP. Addressing the Social Determinants of Health During the COVID-19 Pandemic: Ensuring Equity, Quality, and Sustainability. FAMILY & COMMUNITY HEALTH 2021; 44:78-80. [PMID: 33351516 DOI: 10.1097/fch.0000000000000290] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has highlighted the importance of social determinants of health in affecting health outcomes. Populations with high social risk are disproportionately impacted by the virus and its economic consequences. Primary care practices have a unique opportunity to implement interventions to mitigate their patients' unmet social needs, such as food and income insecurity. In this commentary, we outline key considerations for clinics implementing programs that identify and address patients' social needs in a way that promotes equity, quality, and sustainability. We provide examples from our own experience at a federally qualified health center.
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Affiliation(s)
- Sahil Sandhu
- Trinity College of Arts & Sciences (Mr Sandhu), Department of Pediatrics, School of Medicine (Dr Lemmon), and Department of Orthopaedic Surgery, School of Medicine (Dr Bettger), Duke University, Durham, North Carolina; Duke-Margolis Center for Health Policy, Durham, North Carolina (Mr Sandhu and Drs Lemmon and Bettger); and Lincoln Community Health Center, Durham, North Carolina (Dr Eisenson and Ms Crowder)
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Kreuter MW, Thompson T, McQueen A, Garg R. Addressing Social Needs in Health Care Settings: Evidence, Challenges, and Opportunities for Public Health. Annu Rev Public Health 2021; 42:329-344. [PMID: 33326298 PMCID: PMC8240195 DOI: 10.1146/annurev-publhealth-090419-102204] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There has been an explosion of interest in addressing social needs in health care settings. Some efforts, such as screening patients for social needs and connecting them to needed social services, are already in widespread practice. These and other major investments from the health care sector hint at the potential for new multisector collaborations to address social determinants of health and individual social needs. This article discusses the rapidly growing body of research describing the links between social needs and health and the impact of social needs interventions on health improvement, utilization, and costs. We also identify gaps in the knowledge base and implementation challenges to be overcome. We conclude that complementary partnerships among the health care, public health, and social services sectors can build on current momentum to strengthen social safety net policies, modernize social services, and reshape resource allocation to address social determinants of health.
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Affiliation(s)
- Matthew W Kreuter
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Tess Thompson
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Amy McQueen
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63110, USA
| | - Rachel Garg
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
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Kuroki L, Massad LS, Martin A, Liu J, Brown D, Leon A, Groesch K, Wilson T, Zeino Y, Diaz-Sylvester P, Delfino K, Hyon K, Kreuter M. Addressing Unmet Basic Needs to Improve Colposcopy Adherence Among Women With Abnormal Cervical Cancer Screening. J Low Genit Tract Dis 2021; 25:106-112. [PMID: 33631781 PMCID: PMC7987876 DOI: 10.1097/lgt.0000000000000593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to identify unmet basic needs (BNs) among women referred to colposcopy, to assess patient acceptability/satisfaction with assistance from a navigator to address unmet BNs, and to estimate adherence to colposcopy. METHODS Women were recruited between September 2017 and January 2019 from 2 academic colposcopy centers, one serving a rural and one an urban area. Basic needs were assessed by phone before colposcopy appointments and considered unmet if unlikely to resolve in 1 month. Colposcopy adherence prestudy and poststudy implementation was abstracted over 4-6 months from administrative records. After a lead-in phase of 25 patients at each site, a BN navigator was offered to new participants with 1 or more unmet BNs. Primary outcome was adherence to initial appointment. RESULTS Among 100 women, 59% had 1 or more unmet BNs, with similar prevalence between urban and rural sites. Adherence to initial colposcopy was 83% overall, 72% at the rural clinic, and 94% at the urban clinic (p = .006). These adherence rates were improved from 4 months before study launch (30/59 [51%] rural clinic and 68/137 [50%] urban clinic). Although acceptability of BN navigation was greater than 96% and women felt that it helped them get to their colposcopy visit, having a navigator was not associated with adherence. Women reporting no unmet BNs had the lowest adherence compared with women with 1 or more unmet BNs, regardless of navigator assistance (p = .03). CONCLUSIONS Disadvantaged women who need colposcopy have unmet BNs and value navigator assistance for initial appointments. However, when appointment scheduling includes telephone reminders and inquiring about BNs, a navigator may not add value.
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Affiliation(s)
- Lindsay Kuroki
- Division of Gynecologic Oncology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO
| | - L Stewart Massad
- Division of Gynecologic Oncology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO
| | - Anne Martin
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine (SIUM), Springfield, IL
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Dominique Brown
- Health Communication Research Laboratory, The Brown School, Washington University in St Louis, St Louis, MO
| | - Andrea Leon
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | | | | | - Yahia Zeino
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine (SIUM), Springfield, IL
| | | | | | - Katherine Hyon
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine (SIUM), Springfield, IL
| | - Matthew Kreuter
- Health Communication Research Laboratory, The Brown School, Washington University in St Louis, St Louis, MO
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Nehme E, Castedo de Martell S, Matthews H, Lakey D. Experiences and Perspectives on Adopting New Practices for Social Needs-targeted Care in Safety-net Settings: A Qualitative Case Series Study. J Prim Care Community Health 2021; 12:21501327211017784. [PMID: 34053346 PMCID: PMC8165864 DOI: 10.1177/21501327211017784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Clinical settings are being encouraged to identify and address patients' social needs within the clinic or through partner organizations. The purpose of this qualitative study was to describe the current practice of social needs-targeted care in 3 Texas safety net clinics, and facilitators and barriers to adopting new social needs-targeted care tools and practices. METHODS Interviews were conducted with staff at 3 safety net clinics serving small and mid-sized communities. Analysis focused on perspectives and decisions around adopting new tools or practices related to social needs-targeted care, including standardized screening tools and community resource referral platforms. RESULTS Nine staff across 3 organizations were interviewed. Two organizations were currently using a standard social needs screening tool in their routine practice, and a third was considering doing so. One organization had adopted a community resource referral platform in partnership with a large community collaboration. Three case studies illustrate a range of facilitators, barriers, perceived benefits, and drawbacks influencing social needs-targeted practices. Benefits of systematic data collection on social needs included the generation of data for community action. Drawbacks include concerns about data privacy. Community resource referral platforms were seen as valuable for creating accountability, but required an influential community partner and adequate community resources. Concerns about disempowering clients and blurring roles were voiced, and potential to increase provider job satisfaction was identified. CONCLUSIONS Benefits and drawbacks of adopting new tools and practices related to social needs-targeted care are strongly influenced by the community context. For the adoption of community resource referral platforms, the outer setting is particularly relevant; adoption readiness is best assessed at the community or regional level rather than the clinic system level. While screening tools are much easier than referral platforms for clinics to adopt, the ability to address identified needs remains heavily based on the outer setting.
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Affiliation(s)
- Eileen Nehme
- The University of Texas Health Science Center at Tyler, Tyler, TX, USA
- The University of Texas System, Austin, TX, USA
| | | | - Hannah Matthews
- UT Health School of Public Health, Austin Regional Campus, Austin, TX, USA
| | - David Lakey
- The University of Texas System, Austin, TX, USA
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Kreuter MW, Garg R, Li L, McNulty L, Thompson T, McQueen A, Luke AA. How Do Social Needs Cluster Among Low-Income Individuals? Popul Health Manag 2020; 24:322-332. [PMID: 32877298 DOI: 10.1089/pop.2020.0107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Social needs screening in health care settings reveals that many low-income individuals have multiple unmet social needs at the same time. Having multiple simultaneous social needs greatly increases the odds of experiencing adverse health outcomes. To better understand how and which social needs cluster in these cases, the authors examined data from 14,749 low-income adults who completed a social needs assessment in one of 4 separate studies conducted between 2008 and 2019 in the United States. Participants were Medicaid beneficiaries, helpline callers, and daily smokers. Findings were strikingly consistent across the 4 studies. Participants with ≥2 social needs (n = 5621; 38% of total) experienced more stress, depressive symptoms, sleep problems, and chronic diseases and were more likely to rate their health as fair or poor. Social needs reflecting financial strain were highly correlated, such as needing help paying utility bills and needing money for necessities such as food, shelter, and clothing (r = .49 to .71 across studies). Participants experienced 351 distinct combinations of ≥2 social needs. The 10 most common combinations accounted for more than half of all participants with ≥2 needs. Clusters of social needs varied by subgroups. Women with children were more likely than others to need more space in their home and help paying utility bills; low-income men were more likely to be physically threatened and need a place to stay; older, sicker adults were more likely to need money for necessities and unexpected expenses, as well as transportation. Findings are discussed in the context of creating smarter, more efficient social needs interventions.
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Affiliation(s)
- Matthew W Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Linda Li
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Laura McNulty
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.,Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alina A Luke
- Cardiovascular Division, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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