Factors Associated with Patients’ Connection to Referred Social Needs Resources at a Federally Qualified Health Center

Abstract

Introduction: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study aimed to identify factors associated with the successful connection (ie, services started) to social needs resources, as well as factors associated with an attempt to connect as a secondary, intermediate outcome. Methods: This retrospective cohort study included patients who had been screened, referred, and subsequently reached for follow-up navigation from March 2019 to December 2020, as part of a social needs intervention at a federally qualified health center (FQHC). Measures included demographic and social needs covariates collected during screening, as well as resource-related covariates that characterized the referred resources, including service domain (area of need addressed), service site (integration relative to the FQHC), and access modality (means of accessing services). Results: Of the 501 patients in the analytic sample, 32.7% had started services with 1 or more of their referred resources within 4 weeks of the initial referral, and 63.3% had at least attempted to contact 1 referred resource, whether or not they were able to start services. Receiving a referral to resources that patients could access via phone call or drop-in visit, as opposed to resources that required additional appointments or applications prior to accessing services, was associated with increased odds (aOR 1.95, 95% CI 1.05, 3.61) of connection success, after adjusting for age, sex, race, ethnicity, education, number of social needs, and resource-related characteristics. This study did not find statistically significant associations between connection attempt and any variable included in adjusted analyses. Conclusion: These findings suggest that referral pathways may influence the success of patients’ connection to social needs resources, highlighting opportunities for more accessible solutions to addressing patients’ unmet social needs.

Training student volunteers as community resource navigators to address patients' social needs: A curriculum toolkit

“…Our work has resulted in four student-led, peer-reviewed publications and eight presentations at state, national, international conferences focused on the development and implementation of the Help Desk model, adaptations of the program during the pandemic, evaluating factors associated with a successful patient referral, and patient-reported barriers to accessing referred resources ( 15 – 17 , 29 ).…”

“…Between March 2019 and December 2020, student volunteers called 791 patients and successfully reached 501 (78%) of patients referred to follow-up by their case manager ( 17 ). Within 4 weeks of the initial referral, 63.3% of patients had at attempted to contact at least referred resource and 32.7% had started services with 1 or more of their referred resources ( 17 ).…”

“…Between spring 2018 to present (fall 2021), key phases of the partnership included (i) a 3-month engagement period among partners to discuss the target patient population and opportunities for students to complement existing social care efforts, (ii) a six-month planning period to develop navigator workflows, trainings, resource directory, and data infrastructure, (iii) a two-month pilot, and (iv) over 2 years of program implementation, maintenance, and scale-up as part of routine clinical care. Full program details are described elsewhere ( 14 – 17 ). The program continues with annual appointments of new student leadership who recruit, train, and manage a cohort of peers who volunteer as navigators for healthcare partners as part of a university student organization.…”

Patient Barriers to Accessing Referred Resources for Unmet Social Needs

“…29,30 This is consistent with the implications found in a recent retrospective cohort study conducted at the same FQHC that found that a simplified, 'direct-access', and less complicated process for applying and receiving services was associated with a statistically significant increase in the odds of successfully connecting with a referred resource. 22 Additional qualitative research conducted with patients participating in the same social needs intervention at our FQHC also revealed that policy and societal level determinants related to resource availability and application processes were major barriers to referral success. 29 This study has several limitations.…”

“…18 Program details, including the screening instrument, workflows, and navigator training, are described in detail elsewhere. [19][20][21][22] On March 10, 2020, North Carolina declared a state of emergency for the COVID-19 pandemic. Due to pandemic safety precautions, between March 2020 and December 2020, case managers shifted from screening patients for social needs inperson to conducting proactive telephonic screening for the lowest income patients, identified through reports from the clinic's finance department.…”