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Broaddus-Shea ET, Jimenez-Zambrano A, Holliman BD, Connelly L, Huebschmann AG, Nederveld A. Unpacking patient perspectives on social needs screening: A mixed methods study in western Colorado primary care practices. PATIENT EDUCATION AND COUNSELING 2024; 125:108298. [PMID: 38735120 DOI: 10.1016/j.pec.2024.108298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Explore factors influencing patient comfort with and perceived helpfulness of screening for health-related social needs. METHODS In a parallel secondary mixed-methods analysis of data from three primary care clinics, we used logistic regression to examine effects of practice- and patient-level factors on comfort with and perceived helpfulness of social needs screening. We applied narrative analysis to 20 patient interviews to further understand how patients' lived experiences influenced their perceptions of screening. RESULTS Among 511 patients, receiving an explanation about screening was associated with increased odds of comfort (OR 2.1, 95% CI [1.1-4.30]) and perceived helpfulness (OR 4.7 [2.8-7.8]). Those experiencing more needs were less likely to report comfort (3 + needs vs. 0: OR 0.2 [0.1-0.5]). Narratives elucidated how a history of stigmatizing experiences increased discomfort disclosing needs and captured how relationship quality with healthcare teams influenced perceptions of screening for patients with extensive needs. CONCLUSION Practice-level (screening explanation and therapeutic rapport) and patient-level factors (history and extent of needs) are key influences on comfort with and perceived helpfulness of screening. PRACTICE IMPLICATIONS Good communication about screening benefits all patients. Patients with extensive social needs may require additional sensitivity to their past experiences.
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Affiliation(s)
- Elena T Broaddus-Shea
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Andrea Jimenez-Zambrano
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauri Connelly
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amy G Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Khullar D, Schpero WL, Casalino LP, Pierre R, Carter S, Civelek Y, Zhang M, Bond AM. Meeting The Needs Of Socially Vulnerable Patients: Views Of ACO Leaders On Moving From Intent To Action. Health Aff (Millwood) 2024; 43:1100-1108. [PMID: 39102602 DOI: 10.1377/hlthaff.2023.00673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
The Centers for Medicare and Medicaid Services has placed growing emphasis on social drivers of health, but little is known about how accountable care organizations (ACOs) aim to meet the needs of vulnerable patients. During September-December 2022, we interviewed leaders of forty-nine ACOs participating in the Medicare Shared Savings Program (MSSP). Participants were asked about strategies to identify socially vulnerable patients, programs that addressed their needs, and Medicare reforms that could support their efforts. Seven themes emerged: ACOs were in the early stages of collecting social needs data; leaders were frustrated by an incomplete ability to act on such data; ACOs tended to stratify patients by medical, rather than social, risk; some ACOs have introduced pilot programs to address challenges, including social isolation and drug costs; programs were often payer agnostic; rural ACOs faced unique challenges; and Medicare reforms related to reimbursement, logistical support, quality metrics, and patient benefits could support ACO efforts. These findings suggest that the MSSP alone has not been sufficient to promote consistent investment in social needs provision at most ACOs. Policy makers may want to consider more direct support and incentives for health care organizations, or greater investment in non-health care sectors, to help socially vulnerable patients.
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Affiliation(s)
- Dhruv Khullar
- Dhruv Khullar , Cornell University, New York, New York
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Hatef E, Richards T, Topel K, Hail S, Kitchen C, Shaw K, Zhang T, Lasser EC, Weiner JP. Piloting a Clinical Decision Support Tool to Identify Patients With Social Needs and Provide Navigation Services and Referral to Community-Based Organizations: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e57316. [PMID: 39042426 PMCID: PMC11303893 DOI: 10.2196/57316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Social needs and social determinants of health (SDOH) significantly outrank medical care when considering the impact on a person's length and quality of life, resulting in poor health outcomes and worsening life expectancy. Integrating social needs and SDOH data along with clinical risk information within operational clinical decision support (CDS) systems built into electronic health records (EHRs) is an effective approach to addressing health-related social needs. To achieve this goal, applied research is needed to develop EHR-integrated CDS tools and closed-loop referral systems and implement and test them in the digital and clinical workflows at health care systems and collaborating community-based organizations (CBOs). OBJECTIVE This study aims to describe the protocol for a mixed methods study including a randomized controlled trial and a qualitative phase assessing the feasibility, acceptability, and effectiveness of an EHR-integrated digital platform to identify patients with social needs and provide navigation services and closed-loop referrals to CBOs to address their social needs. METHODS The randomized controlled trial will enroll and randomize adult patients living in socioeconomically challenged neighborhoods in Baltimore City receiving care at a single academic health care institution in the 3-month intervention (using the digital platform) or the 3-month control (standard-of-care assessment and addressing of social needs) arms (n=295 per arm). To evaluate the feasibility and acceptability of the digital platform and its impact on the clinical and digital workflow and patient care, we will conduct focus groups with the care teams in the health care system (eg, clinical providers, social workers, and care managers) and collaborating CBOs. The outcomes will be the acceptability, feasibility, and effectiveness of the CDS tool and closed-loop referral system. RESULTS This clinical trial opened to enrollment in June 2023 and will be completed in March 2025. Initial results are expected to be published in spring 2025. We will report feasibility outcome measures as weekly use rates of the digital platform. The acceptability outcome measure will be the provider's and patient's responses to the truthfulness of a statement indicating a willingness to use the platform in the future. Effectiveness will be measured by tracking a 3-month change in identified social needs and provided navigation services as well as clinical outcomes such as hospitalization and emergency department visits. CONCLUSIONS The results of this investigation are expected to contribute to our understanding of the use of digital interventions and the implementation of such interventions in digital and clinical workflows to enhance the health care system and CBO ability related to social needs assessment and intervention. These results may inform the construction of a future multi-institutional trial designed to test the effectiveness of this intervention across different health care systems and care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05574699; https://clinicaltrials.gov/study/NCT05574699. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57316.
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Affiliation(s)
- Elham Hatef
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Thomas Richards
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kristin Topel
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sofia Hail
- Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD, United States
| | - Christopher Kitchen
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Shaw
- Johns Hopkins Community Physicians East Baltimore Medical Center, Baltimore, MD, United States
| | - Talan Zhang
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elyse C Lasser
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jonathan P Weiner
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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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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LaPoint M, Vu MB, Ricks K, Flower KB, Domino ME, Dave G, Berkowitz SA. Benefits, Challenges, and Opportunities in Addressing Medicaid Beneficiaries' Non-Medical Risks to Health: A Qualitative Analysis. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:597-604. [PMID: 38330375 DOI: 10.1097/phh.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
CONTEXT North Carolina's Healthy Opportunities Pilots (HOP) is a Medicaid 1115 Waiver program that seeks to address nonmedical risks to health for Medicaid beneficiaries through multisector collaboration. Among other stakeholders, HOP involves collaboration between human services organizations that deliver interventions, network leads, which establish and oversee the human services organizations within a region of the state. OBJECTIVE To understand how employees at human services organizations and network leads prepared to deliver HOP services. DESIGN Qualitative analysis of semistructured interviews. Interviews were conducted between April and June 2022. Interviews were recorded, transcribed verbatim, coded thematically, and analyzed using a conceptual model derived from the consolidated framework for implementation research. SETTING Organizations within North Carolina counties participating in HOP. PARTICIPANTS Employees of human services and network lead organizations across all 3 HOP regions of North Carolina. RESULTS The researchers interviewed 37 participants. Overall, organizations experienced benefits from HOP participation, including capacity-building resources, flexibility in allocating resources, and creating community-wide enthusiasm for addressing nonmedical risks to health. There were also key challenges. These included the time needed to build capacity, adjustments to the work processes and regulations inherent to multisector collaboration, geographic variation in availability of services to offer, and the difficulty of addressing different needs. Finally, participants recognized substantial opportunities that HOP presented, including membership in a more extensive network, exposure to a learning community, and a more sustainable funding source. CONCLUSIONS The perspectives of individuals preparing to deliver HOP services offer important lessons for those developing and implementing large-scale programs that can address nonmedical threats to health.
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Affiliation(s)
- Myklynn LaPoint
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Maihan B Vu
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Katharine Ricks
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Kori B Flower
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Marisa Elena Domino
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Gaurav Dave
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Seth A Berkowitz
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
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Callahan CM, Carter A, Carty HS, Clark DO, Grain T, Grant SL, McElroy-Jones K, Reinoso D, Harris LE. Building the Infrastructure to Integrate Social Care in a Safety Net Health System. Am J Public Health 2024; 114:619-625. [PMID: 38574317 PMCID: PMC11079822 DOI: 10.2105/ajph.2024.307602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
A recent National Academies report recommended that health systems invest in new infrastructure to integrate social and medical care. Although many health systems routinely screen patients for social concerns, few health systems achieve the recommended model of integration. In this critical case study in an urban safety net health system, we describe the human capital, operational redesign, and financial investment needed to implement the National Academy recommendations. Using data from this case study, we estimate that other health systems seeking to build and maintain this infrastructure would need to invest $1 million to $3 million per year. While health systems with robust existing resources may be able to bootstrap short-term funding to initiate this work, we conclude that long-term investments by insurers and other payers will be necessary for most health systems to achieve the recommended integration of medical and social care. Researchers seeking to test whether integrating social and medical care leads to better patient and population outcomes require access to health systems and communities who have already invested in this model infrastructure. (Am J Public Health. 2024;114(6):619-625. https://doi.org/10.2105/AJPH.2024.307602).
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Affiliation(s)
- Christopher M Callahan
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Amy Carter
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Hannah S Carty
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Daniel O Clark
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Tedd Grain
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Seth L Grant
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Kimberly McElroy-Jones
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Deanna Reinoso
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Lisa E Harris
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
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BERKOWITZ SETHA. Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health. Milbank Q 2024; 102:280-301. [PMID: 38156764 PMCID: PMC11176409 DOI: 10.1111/1468-0009.12685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/13/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
Policy Points Multisector collaboration, the dominant approach for responding to health harms created by adverse social conditions, involves collaboration among health care insurers, health care systems, and social services organizations. Social democracy, an underused alternative, seeks to use government policy to shape the civil (e.g., civil rights), political (e.g., voting rights), and economic (e.g., labor market institutions, property rights, and the tax-and-transfer system) institutions that produce health. Multisector collaboration may not achieve its goals, both because the collaborations are difficult to accomplish and because it does not seek to transform social conditions, only to mitigate their harms. Social democracy requires political contestation but has greater potential to improve population health and health equity.
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Seiber EE, Garrity K, Moon KJ, Jankowski E, Nawaz S, Garner JA, Headings A, Jonas DE, Clark A, Bose-Brill S, Shrodes JC, Hoseus J, Baker C, McAlearney AS, Hefner JL, Joseph JJ, Vallangeon D, Walker DM. Sustainability of Social Needs Resolution Interventions: A Call to Consider Cost. Am J Prev Med 2024; 66:1100-1104. [PMID: 38272244 PMCID: PMC11102842 DOI: 10.1016/j.amepre.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
| | - Katharine Garrity
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH, USA
| | - Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Emma Jankowski
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Jennifer A Garner
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH, USA; John Glenn College of Public Affairs, Ohio State University, Columbus, OH, USA
| | - Amy Headings
- The Mid-Ohio Food Collective, Columbus, Ohio, USA
| | - Daniel E Jonas
- Division of General Internal Medicine, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Aaron Clark
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer C Shrodes
- Division of General Internal Medicine, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Jenelle Hoseus
- Health Impact Ohio, Columbus, Ohio, United States of America
| | - Carrie Baker
- Health Impact Ohio, Columbus, Ohio, United States of America
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer L Hefner
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dana Vallangeon
- Ohio Association of Community Health Centers, Columbus, OH, USA
| | - Daniel M Walker
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University College of Medicine, Columbus, OH, USA
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9
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Fiori KP, Levano S, Haughton J, Whiskey-LaLanne R, Telzak A, Muleta H, Vani K, Chambers EC, Racine A. Advancing social care integration in health systems with community health workers: an implementation evaluation based in Bronx, New York. BMC PRIMARY CARE 2024; 25:140. [PMID: 38678171 PMCID: PMC11055265 DOI: 10.1186/s12875-024-02376-7] [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: 02/09/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND In recent years, health systems have expanded the focus on health equity to include health-related social needs (HRSNs) screening. Community health workers (CHWs) are positioned to address HRSNs by serving as linkages between health systems, social services, and the community. This study describes a health system's 12-month experience integrating CHWs to navigate HRSNs among primary care patients in Bronx County, NY. METHODS We organized process and outcome measures using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation framework domains to evaluate a CHW intervention of the Community Health Worker Institute (CHWI). We used descriptive and inferential statistics to assess RE-AIM outcomes and socio-demographic characteristics of patients who self-reported at least 1 HRSN and were referred to and contacted by CHWs between October 2022 and September 2023. RESULTS There were 4,420 patients who self-reported HRSNs in the standardized screening tool between October 2022 and September 2023. Of these patients, 1,245 were referred to a CHW who completed the first outreach attempt during the study period. An additional 1,559 patients self-reported HRSNs directly to a clinician or CHW without being screened and were referred to and contacted by a CHW. Of the 2,804 total patients referred, 1,939 (69.2%) were successfully contacted and consented to work with a CHW for HRSN navigation. Overall, 78.1% (n = 1,515) of patients reported receiving social services. Adoption of the CHW clinician champion varied by clinical team (median 22.2%; IQR 13.3-39.0%); however, there was no difference in referral rates between those with and without a clinician champion (p = 0.50). Implementation of CHW referrals via an electronic referral order appeared successful (73.2%) and timely (median 11 days; IQR 2-26 days) compared to standard CHWI practices. Median annual cost per household per CHW for the intervention was determined to be $184.02 (IQR $134.72 - $202.12). CONCLUSIONS We observed a significant proportion of patients reporting successful receipt of social services following engagement with an integrated CHW model. There are additional implementation factors that require further inquiry and research to understand barriers and enabling factors to integrate CHWs within clinical teams.
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Affiliation(s)
- Kevin P Fiori
- Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Samantha Levano
- Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Jessica Haughton
- Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Renee Whiskey-LaLanne
- Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Andrew Telzak
- Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Hemen Muleta
- Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kavita Vani
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Andrew Racine
- Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
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10
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Patnaik A, Mateen H, Buck DS. A Call for an American Social Care System: Social Services Reimbursement to Address Fragmented Care. Popul Health Manag 2024; 27:146-149. [PMID: 38236712 DOI: 10.1089/pop.2023.0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Anish Patnaik
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Haaris Mateen
- C.T. Bauer College of Business, University of Houston, Houston, Texas, USA
| | - David S Buck
- Department of Health Systems & Population Health, Fertitta Family College of Medicine, University of Houston, Houston, Texas, USA
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11
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Ramesh T, Kadakia K, Moura L. Transforming Value-Based Dementia Care-Implications for the GUIDE Model. JAMA Intern Med 2024; 184:237-239. [PMID: 38315458 DOI: 10.1001/jamainternmed.2023.7669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
This Viewpoint reviews the Guiding an Improved Dementia Experience (GUIDE) Model to assess its suitability in providing equitable and cost-effective dementia care and to compare it with previously introduced specialty care payment models to identify opportunities for refining payment innovation in dementia care.
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Affiliation(s)
| | | | - Lidia Moura
- Harvard Medical School, Boston, Massachusetts
- Center for Value-Based Health Care and Sciences, Massachusetts General Hospital, Boston
- Department of Neurology, Massachusetts General Hospital, Boston
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12
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Kormanis A, Quinones S, Obermiller C, Denizard-Thompson N, Palakshappa D. Feasibility of Using Text Messaging to Identify and Assist Patients With Hypertension With Health-Related Social Needs: Cross-Sectional Study. JMIR Cardio 2024; 8:e54530. [PMID: 38349714 PMCID: PMC10900090 DOI: 10.2196/54530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Health-related social needs are associated with poor health outcomes, increased acute health care use, and impaired chronic disease management. Given these negative outcomes, an increasing number of national health care organizations have recommended that the health system screen and address unmet health-related social needs as a routine part of clinical care, but there are limited data on how to implement social needs screening in clinical settings to improve the management of chronic diseases such as hypertension. SMS text messaging could be an effective and efficient approach to screen patients; however, there are limited data on the feasibility of using it. OBJECTIVE We conducted a cross-sectional study of patients with hypertension to determine the feasibility of using SMS text messaging to screen patients for unmet health-related social needs. METHODS We randomly selected 200 patients (≥18 years) from 1 academic health system. Patients were included if they were seen at one of 17 primary care clinics that were part of the academic health system and located in Forsyth County, North Carolina. We limited the sample to patients seen in one of these clinics to provide tailored information about local community-based resources. To ensure that the participants were still patients within the clinic, we only included those who had a visit in the previous 3 months. The SMS text message included a link to 6 questions regarding food, housing, and transportation. Patients who screened positive and were interested received a subsequent message with information about local resources. We assessed the proportion of patients who completed the questions. We also evaluated for the differences in the demographics between patients who completed the questions and those who did not using bivariate analyses. RESULTS Of the 200 patients, the majority were female (n=109, 54.5%), non-Hispanic White (n=114, 57.0%), and received commercial insurance (n=105, 52.5%). There were no significant differences in demographics between the 4446 patients who were eligible and the 200 randomly selected patients. Of the 200 patients included, the SMS text message was unable to be delivered to 9 (4.5%) patients and 17 (8.5%) completed the social needs questionnaire. We did not observe a significant difference in the demographic characteristics of patients who did versus did not complete the questionnaire. Of the 17, a total of 5 (29.4%) reported at least 1 unmet need, but only 2 chose to receive resource information. CONCLUSIONS We found that only 8.5% (n=17) of patients completed a SMS text message-based health-related social needs questionnaire. SMS text messaging may not be feasible as a single modality to screen patients in this population. Future research should evaluate if SMS text message-based social needs screening is feasible in other populations or effective when paired with other screening modalities.
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Affiliation(s)
- Aryn Kormanis
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Selina Quinones
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Corey Obermiller
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Nancy Denizard-Thompson
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, United States
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC, United States
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, United States
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13
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Bultema S, Piper K, Salas E, Forberg P, Grinnell S. Exploring how health equity is addressed in accountable communities of/for health (ACHs). Health Serv Res 2024; 59 Suppl 1:e14258. [PMID: 37963440 PMCID: PMC10796284 DOI: 10.1111/1475-6773.14258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To explore how Accountable Communities of/for Health (ACHs), a type of health-focused multisector collaborative, are developing strategies to address health equity with diverse partners. DATA SOURCES AND STUDY SETTING Interview and focus group participants were recruited from a purposive sample of 22 ACH participant organizations in Washington (n = 9 ACHs) and California (n = 13 ACH). STUDY DESIGN Interview and focus group data were thematized using constant comparison analysis. DATA COLLECTION Interviews were conducted to learn how each ACH's system context, collaboration processes, and goals influence its progress toward health equity. Focus groups were conducted to gain a deeper understanding of how local context and power dynamics influence an ACH's ability to make progress toward health equity. There were 22 focus group participants and 65 interview participants. PRINCIPAL FINDINGS Results indicate that ACHs advance health equity across the social-ecological spectrum of health with approaches targeting the individual, community, and societal levels. Specific approaches used by ACHs to collaboratively address health equity include providing equity education to participating organizations and community groups; including diverse community voices in collaborative decision-making; changing practices in their participant's daily operations; improving existing services and developing new services; and actively promoting a culture of keeping equity at the center of ACH efforts. CONCLUSIONS This study identifies strategies for advancing health equity in multisector collaboratives. ACHs in Washington and California are devoting resources to ensure health equity is central to their work. The numerous approaches ACHs use to advance health equity are important to ensure everyone can reach their full health potential. While current literature argues that multisector health initiatives are integral for advancing health equity, there is a lack of research on how these initiatives advance equity in practice. Thus, this paper provides generalizable strategies that can be further investigated to optimize progress toward health equity.
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Affiliation(s)
- Stephanie Bultema
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Kendra Piper
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Esmeralda Salas
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Peter Forberg
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Sue Grinnell
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
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14
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Nava M, English AS, Fulmer L, Sanchez K. An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments. Front Public Health 2023; 11:1244143. [PMID: 37900035 PMCID: PMC10613110 DOI: 10.3389/fpubh.2023.1244143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background The Affordable Care Act mandated triennial community health needs assessments (CHNAs) for greater nonprofit hospital accountability in responding to community health needs. Over 10 years later, hospital spending on community benefits remains largely unchanged. While greater collaboration in CHNA implementation can increase hospital investment in community-based initiatives, nonprofit hospitals in conservative states are subject to policy, political, and economic factors that inhibit public health partnerships and magnify existing disparities in health care access. This participatory action research study explores the decision-making environment of collaborative CHNA implementation within a group of nonprofit hospitals in a north Texas urban county. Methods In 2017 faculty from an urban anchor institution initiated an academic-community partnership with a coalition of nonprofit hospitals, public health departments, and academic institutions. An interdisciplinary research team engaged in multi-method document review and qualitative data collection to describe historical barriers for local CHNA processes and develop practical strategies for joint CHNA initiatives. Local CHNA documents were first reviewed through team-based content analysis and results applied to develop a qualitative study protocol. Key informants were recruited from county-based nonprofit hospitals, community-based nonprofit organizations, and public health systems. Seventeen senior- and mid-level professionals participated in semi-structured research interviews to describe their perspectives relating to CHNA-related planning and implementation decisions. Through iterative data collection and analysis, the research team explored CHNA-related knowledge, experiences, and processes. A constructivist lens was subsequently applied to examine historical barriers and future opportunities for local collaboration. Results Findings reveal CHNA implementation is a multi-stage cyclical process in organizational environments with accountability to a wide range of public and private stakeholders. This promotes varied levels of inclusivity and conservatism in data collection and community benefit implementation. Decisions to collaborate are hindered by competing priorities, including compliance with existing guidelines, administrative simplicity, alignment with health care service delivery, and efficient resource use. Efforts to promote greater CHNA collaboration may be facilitated through intentional alignment with organizational priorities and clearly communicated benefits of participation for leaders in both public and private nonprofit health systems. Discussion We consider implications for policymakers and health systems in restrictive political environments and advance a conceptual framework for greater CHNA collaboration.
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Affiliation(s)
- Marcela Nava
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Amanda S. English
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Linda Fulmer
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Katherine Sanchez
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
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15
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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: 1] [Impact Index Per Article: 1.0] [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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