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Hatef E, Kitchen C, Pandya C, Kharrazi H. Assessing Patient and Community-Level Social Factors; The Synergistic Effect of Social Needs and Social Determinants of Health on Healthcare Utilization at a Multilevel Academic Healthcare System. J Med Syst 2023; 47:95. [PMID: 37656284 DOI: 10.1007/s10916-023-01990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
We investigated the role of both individual-level social needs and community-level social determinants of health (SDOH) in explaining emergency department (ED) utilization rates. We also assessed the potential synergies between the two levels of analysis and their combined effect on patterns of ED visits. We extracted electronic health record (EHR) data between July 2016 and June 2020 for 1,308,598 unique Maryland residents who received care at Johns Hopkins Health System, of which 28,937 (2.2%) patients had at least one documented social need. There was a negative correlation between median household income in a neighborhood with having a social need such as financial resource strain, food insecurity, and residential instability (correlation coefficient: -0.05, -0.01, and - 0.06, p = 0, respectively). In a multilevel model with random effects after adjusting for other factors, living in a more disadvantaged neighborhood was found to be significantly associated with ED utilization statewide and within Baltimore City (OR: 1.005, 95% CI: 1.003-1.007 and 1.020, 95% CI: 1.017-1.022, respectively). However, individual-level social needs appeared to enhance the statewide effect of living in a more disadvantaged neighborhood with the OR for the interaction term between social needs and SDOH being larger, and more positive, than SDOH alone (OR: 1.012, 95% CI: 1.011-1.014). No such moderation was found in Baltimore City. To our knowledge, this study is one of the first attempts by a major academic healthcare system to assess the combined impact of patient-level social needs in association with community-level SDOH on healthcare utilization and can serve as a baseline for future studies using EHR data linked to population-level data to assess such synergistic association.
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Affiliation(s)
- Elham Hatef
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA.
| | - Christopher Kitchen
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA
| | - Chintan Pandya
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA
| | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA
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Lake KJ, Boyd MA, Smithers L, Howard NJ, Dawson AP. Exploring the readiness of senior doctors and nurses to assess and address patients' social needs in the hospital setting. BMC Health Serv Res 2022; 22:246. [PMID: 35197049 PMCID: PMC8867718 DOI: 10.1186/s12913-022-07642-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse social circumstances are a key factor in health outcomes. Hospitals are an opportune setting for assessing and addressing the unmet social needs of patients, however, the readiness of healthcare workers in hospitals to undertake such tasks requires further exploration in the Australian context. This study aimed to generate a theory of doctors' and nurses' readiness to assess and address patients' social needs in a hospital setting. METHODS A constructivist grounded theory methodology was applied, with purposive and theoretical sampling used to gather diverse perspectives of readiness during semi-structured interviews with twenty senior doctors and nurses from a variety of clinical specialties working in hospitals serving communities experiencing inequitable social and health outcomes. Line-by-line coding, memo writing, and diagramming were used in analysis to construct an interpretive theory of readiness. Application of constant comparison analytic processes were used to test the robustness of the theory. RESULTS The readiness of doctors and nurses varies across individuals and departments, and is founded upon a state of being comfortable and confident to assess social need as determined by a range of personal attributes (e.g. knowledge of social need; skills to assess social need); a state of being willing and prepared to assess and address social need facilitated by supportive environments (e.g. departmental culture); and enabling characteristics of the clinical encounter (e.g. time, rapport). CONCLUSIONS We found that the readiness of doctors and nurses is dynamic and impacted by a complex interplay of personal attributes along with contextual and situational factors. These findings indicate that any efforts to strengthen the readiness of doctors and nurses to assess and address social needs must target personal capabilities in addition to characteristics of the working environment.
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Affiliation(s)
- Katherine J Lake
- School of Public Health, The University of Adelaide, Adelaide, South, 5005, Australia
| | - Mark A Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, Chair of Medicine, The University of Adelaide, Level 2, Women's Health Building, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Adelaide, South Australia, 5005, Australia. .,Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South, 5000, Australia.
| | - Lisa Smithers
- School of Public Health, The University of Adelaide, Adelaide, South, 5005, Australia.,School of Health and Society, The University of Wollongong, Wollongong, New South Wales, 2522, Australia
| | - Natasha J Howard
- Adelaide Medical School, Faculty of Health and Medical Sciences, Chair of Medicine, The University of Adelaide, Level 2, Women's Health Building, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Adelaide, South Australia, 5005, Australia.,Northern Adelaide Local Health Network, Adelaide, South Australia, 5000, Australia
| | - Anna P Dawson
- Adelaide Medical School, Faculty of Health and Medical Sciences, Chair of Medicine, The University of Adelaide, Level 2, Women's Health Building, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Adelaide, South Australia, 5005, Australia.,Northern Adelaide Local Health Network, Adelaide, South Australia, 5000, Australia
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Poleshuck E, Possemato K, Johnson EM, Cohen AJ, Fogarty CT, Funderburk JS. Leveraging Integrated Primary Care to Address Patients' and Families' Unmet Social Needs: Aligning Practice with National Academy of Sciences, Engineering and Medicine Recommendations. J Am Board Fam Med 2022; 35:185-189. [PMID: 35039426 DOI: 10.3122/jabfm.2022.01.210287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/08/2022] Open
Abstract
Primary care is well-poised to address unmet social needs that affect health. Integrated primary care is increasingly common and can be leveraged to facilitate identification of practice and clinician-level modifiable characteristics and assist practices to address unmet social needs for patients and families. A recent National Academies of Sciences, Engineering, and Medicine (NASEM)'s consensus report identified 5 critical system-level activities to facilitate the integration of addressing social needs into health care: awareness (ask patients), adjustment (flexible intervention delivery), assistance (intervention to address the social need), alignment (link with community resources), and advocacy (policy change). This article outlines how integrated primary care characteristics, such as routine screening, functional workflows, interprofessional team communication, and patient-centered practices, exemplify the NASEM report's activities and offer robust biopsychosocial tools for addressing social needs. We provide a case to illustrate how these strategies might be used in practice.
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Affiliation(s)
- Ellen Poleshuck
- From the Department of Veterans Affairs, VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY (EP, KP, EMJ, JSF); Departments of Psychiatry and Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY (EP); Department of Psychology, Syracuse University, Syracuse NY (KP); Veterans Affairs Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI (AJC); Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI (AJC); Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI (AJC); Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (CTF, JSF); Department of Psychiatry, University of Rochester Medical Center, Rochester, NY (JSF).
| | - Kyle Possemato
- From the Department of Veterans Affairs, VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY (EP, KP, EMJ, JSF); Departments of Psychiatry and Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY (EP); Department of Psychology, Syracuse University, Syracuse NY (KP); Veterans Affairs Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI (AJC); Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI (AJC); Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI (AJC); Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (CTF, JSF); Department of Psychiatry, University of Rochester Medical Center, Rochester, NY (JSF)
| | - Emily M Johnson
- From the Department of Veterans Affairs, VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY (EP, KP, EMJ, JSF); Departments of Psychiatry and Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY (EP); Department of Psychology, Syracuse University, Syracuse NY (KP); Veterans Affairs Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI (AJC); Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI (AJC); Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI (AJC); Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (CTF, JSF); Department of Psychiatry, University of Rochester Medical Center, Rochester, NY (JSF)
| | - Alicia J Cohen
- From the Department of Veterans Affairs, VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY (EP, KP, EMJ, JSF); Departments of Psychiatry and Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY (EP); Department of Psychology, Syracuse University, Syracuse NY (KP); Veterans Affairs Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI (AJC); Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI (AJC); Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI (AJC); Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (CTF, JSF); Department of Psychiatry, University of Rochester Medical Center, Rochester, NY (JSF)
| | - Colleen T Fogarty
- From the Department of Veterans Affairs, VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY (EP, KP, EMJ, JSF); Departments of Psychiatry and Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY (EP); Department of Psychology, Syracuse University, Syracuse NY (KP); Veterans Affairs Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI (AJC); Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI (AJC); Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI (AJC); Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (CTF, JSF); Department of Psychiatry, University of Rochester Medical Center, Rochester, NY (JSF)
| | - Jennifer S Funderburk
- From the Department of Veterans Affairs, VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY (EP, KP, EMJ, JSF); Departments of Psychiatry and Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY (EP); Department of Psychology, Syracuse University, Syracuse NY (KP); Veterans Affairs Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI (AJC); Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI (AJC); Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI (AJC); Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (CTF, JSF); Department of Psychiatry, University of Rochester Medical Center, Rochester, NY (JSF)
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Khodyakov D, Sharif MZ, Jones F, Heller SM, Pulido E, Wells KB, Bromley E. Whole Person Care in Under-resourced Communities: Stakeholder Priorities at Long-Term Follow-Up in Community Partners in Care. Ethn Dis 2018; 28:371-380. [PMID: 30202190 DOI: 10.18865/ed.28.s2.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Depressed individuals may require help from different agencies to address health and social needs, but how such coordination occurs in under-resourced communities is poorly understood. This study sought to identify priorities of Latino and African American depressed clients, explore whether service providers understand client priorities, and describe how providers address them. Methods Between October 2014 and February 2015, we interviewed 104 clients stratified by depression history and 50 representatives of different programs in health and social community agencies who participated in Community Partners in Care, a cluster-randomized trial of coalition-building approaches to delivering depression quality improvement programs. Clients were queried about their most pressing needs; program representatives identified their clients' needs and explained how they addressed them. Results Physical and mental health were clients' top priorities, followed by housing, caring for and building relationships with others, and employment. While persistently depressed clients prioritized mental health, those with improved depression prioritized relationships with others. Program representatives identified housing, employment, mental health, and improving relationships with others as clients' top priorities. Needs assessment, client-centered services, and linkages to other agencies were main strategies used to address client needs. Conclusion Depressed clients have multiple health and social needs, and program representatives in under-resourced communities understand the complexity of clients' needs. Agencies rely on needs assessment and referrals to meet their clients' needs, which enhances the importance of agency partnership in "whole person" initiatives. Our results illustrate agency capacity to adopt integrated care models that will address clients' multiple needs through multi-sector collaboration and describe potential strategies to help reach the goal of whole person care.
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Affiliation(s)
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - S Megan Heller
- Center for Health Services and Society, University of California, Los Angeles, CA
| | | | - Kenneth B Wells
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health
| | - Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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