Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study

Browne, Julia; McCurley, Jessica L.; Fung, Vicki; Levy, Douglas E.; Clark, Cheryl R.; Thorndike, Anne N.

doi:10.1177/2150132721993651

Cited by 23 publications

(35 citation statements)

References 33 publications

(41 reference statements)

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“…The remainder reported using observational study designs (eg, pre-post studies, feasibility studies, pilot studies). Fifty-eight studies were conducted with primary care patients, [29][30][31][72][73][74]76,[78][79][80][81][82][83][84][85][86][87][88][89] 4 took place in a specialty clinics, 32,71,75,77 1 took place in urgent care, 27 and 3 took place across multiple settings (eg, primary, specialty, and urgent care). 26,28,90 Majority of studies reported including academic sites (n = 40), 29,[34][35][36][37][38][39][41][42][43][44][47][48][49][50][51][52][53][54][55][56]…”

Section: Characteristics Of Sources Of Evidencementioning

confidence: 99%

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Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

Sandhu

Eisenson

et al. 2021

J Prim Care Community Health

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Objectives While healthcare organizations increasingly aim to address the social determinants of health (SDOH) in the clinic setting, there is little guidance on which staff are best equipped to assume this role. The present study is a scoping review of the peer-reviewed literature to characterize workforce models used to screen for and respond to patients’ unmet social needs in ambulatory settings. Methods Four online databases were used to identify papers published until February 2021. Eligible articles were original research studies or systematic reviews that described the implementation of a standardized assessment for multiple SDOH domains and resulting activities to respond to individual patient needs (eg, referral to community resources) in ambulatory care settings. Results Of the 1569 articles identified, 65 met study eligibility criteria. Majority of studies had observational study designs (11% were randomized control trials). For screening-related activities, more articles reported using traditional healthcare staff (51%), such as medical providers, medical assistants, and front-desk staff, than social care staff (32%), such as social workers and student volunteers. In contrast, for response-related activities, more articles reported using social care staff (88%) than traditional healthcare staff (60%). While we found wide variations in specific team configurations and training for the roles, social care staff generally provided more intensive forms of assistance than traditional healthcare staff. Conclusion While this review demonstrates the breadth of models for building or deploying a workforce to integrate health and social care, it also identifies the need for rigorous research on workforce development, implementation, and effectiveness.

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Section: Characteristics Of Sources Of Evidencementioning

confidence: 99%

“…28,[35][36][37][38]42,47,49,50,61,70,74,86,[88][89][90] Of note, 37 studies did not explicitly report how staff were trained to implement the program. 27,[32][33][34]40,41,43,45,[51][52][53][54][55][56]58,59,[62][63][64][65][66][67][68][69]71,73,[76][77][78][79][80][81][82][83][84][85]87…”

Section: Response Activitiesmentioning

confidence: 99%

Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

Sandhu

Eisenson

et al. 2021

J Prim Care Community Health

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“…Current literature describing efforts to screen and respond to social needs has focused on electronic health record (EHR) integration [27][28][29], provider perspectives [30][31][32][33], and patient acceptability, and has sometimes used implementation case studies [34][35][36]. This existing literature suggests that patients consider social needs S/ R an acceptable and important element of patientcentered care, but they recognize the limits of the health care sector's capacity to resolve unmet social needs.…”

Section: Introductionmentioning

confidence: 99%

Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework

Drake

Batchelder

Lian

et al. 2021

BMC Health Serv Res

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Background Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients’ health outcomes. To our knowledge, this is the first study to apply an implementation science framework to identify implementation factors and best practices for social needs screening and response. Methods Guided by the Health Equity Implementation Framework (HEIF), we collected qualitative data from clinicians and patients to evaluate barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE), a standardized social needs screening and response protocol, in a federally qualified health center. Eligible patients who received the PRAPARE as a standard of care were invited to participate in semi-structured interviews. We also obtained front-line clinician perspectives in a semi-structured focus group. HEIF domains informed a directed content analysis. Results Patients and clinicians (i.e., case managers) reported implementation barriers and facilitators across multiple domains (e.g., clinical encounters, patient and provider factors, inner context, outer context, and societal influence). Implementation barriers included structural and policy level determinants related to resource availability, discrimination, and administrative burden. Facilitators included evidence-based clinical techniques for shared decision making (e.g., motivational interviewing), team-based staffing models, and beliefs related to alignment of the PRAPARE with patient-centered care. We found high levels of patient acceptability and opportunities for adaptation to increase equitable adoption and reach. Conclusion Our results provide practical insight into the implementation of the PRAPARE or similar social needs screening and response protocols in primary care at the individual encounter, organizational, community, and societal levels. Future research should focus on developing discrete implementation strategies to promote social needs screening and response, and associated multisector care coordination to improve health outcomes and equity for vulnerable and marginalized patient populations.

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“…Nearly all prior studies have described implementation in clinics that engaged in a funded, researcher-driven implementation study 14 - 17 or were part of a larger healthcare system initiative. 18 Our study offers a window into the unfacilitated diffusion—or lack thereof—of new social-needs targeted tools and practices into small and mid-sized safety-net clinics, and contributes to the understanding of the adoption of referral platforms, which in comparison to social needs screening has received less attention.…”

Section: Discussionmentioning

confidence: 97%

Experiences and Perspectives on Adopting New Practices for Social Needs-targeted Care in Safety-net Settings: A Qualitative Case Series Study

Nehme

Martell

Matthews

et al. 2021

J Prim Care Community Health

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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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Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study

Cited by 23 publications

References 33 publications

Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework

Experiences and Perspectives on Adopting New Practices for Social Needs-targeted Care in Safety-net Settings: A Qualitative Case Series Study

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