Moving the Field Forward: A Decade of Progress Implementing Health in All Policies in the United States

Ware, Alix; Kerner, Bridget

doi:10.1097/phh.0000000000001280

Cited by 4 publications

(4 citation statements)

References 1 publication

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“…For example, the administrative burden of applications to social service and entitlement programs can be reduced, harmonized, or streamlined to promote uptake. This type of systems-approach is consistent with Health In All Policies, an overarching public health framework which posits that health promotion considerations should inform all policy decisions that influence social, political, and ecological health determinants [60].…”

Section: Discussionmentioning

confidence: 75%

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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Section: Discussionmentioning

confidence: 75%

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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“…29 In sum, the growing research field of intersectoral collaboration for health in general and of HiAP in particular have resulted in several efforts to review and synthesise the burgeoning literature, with a view to identifying the lessons for policy. [30][31][32] One of the most recent reviews reports that the available literature often finds a disappointing gap between HiAP expectations and outcomes, noting that much of this literature constitutes 'policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policy-making dynamics). ' 30 Our scoping research reached a similar conclusion and informed a decision to drop one of our original questions exploring what the existing literature suggests about the consequences of intersectoral collaboration for outcomes in policy, practice and health (in sum, the existing literature says very little about this important question).…”

Section: Introductionmentioning

confidence: 99%

Governance of Intersectoral Collaborations for Population Health and to Reduce Health Inequalities in High-Income Countries: A Complexity-Informed Systematic Review

Such

Smith

Woods

et al. 2022

Int J Health Policy Manag

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Background: A ‘Health in All Policies’ (HiAP) approach has been widely advocated as a way to involve multiple government sectors in addressing health inequalities, but implementation attempts have not always produced the expected results. Explaining how HiAP-style collaborations have been governed may offer insights into how to improve population health and reduce health inequalities. Methods: Theoretically focused systematic review. Synthesis of evidence from evaluative studies into a causal logic model. Results: Thirty-one publications based on 40 case studies from nine high-income countries were included. Intersectoral collaborations for population health and equity were multi-component and multi-dimensional with collaborative activity spanning policy, strategy, service design and service delivery. Governance of intersectoral collaboration included structural and relational components. Both internal and external legitimacy and credibility delivered collaborative power, which in turn enabled intersectoral collaboration. Internal legitimacy was driven by multiple structural elements and processes. Many of these were instrumental in developing (often-fragile) relational trust. Internal credibility was supported by multi-level collaborations that were adequately resourced and shared power. External legitimacy and credibility was created through meaningful community engagement, leadership that championed collaborations and the identification of ‘win-win’ strategies. External factors such as economic shocks and short political cycles reduced collaborative power. Conclusion: This novel review, using systems thinking and causal loop representations, offers insights into how collaborations can generate internal and external legitimacy and credibility. This offers promise for future collaborative activity for population health and equity; it presents a clearer picture of what structural and relational components and dynamics collaborative partners can focus on when planning and implementing HiAP initiatives. The limits of the literature base, however, does not make it possible to identify if or how this might deliver improved population health or health equity.

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“…Organizations including health care systems, quasi-governmental organizations, and nonprofits also contribute to the platform's success. This includes a broader organizational commitment to embracing community collaboration and advocacy for policies that advance a culture of health [42]. Additionally, NCCARE360 is optimized with dedicated resources and personnel who use the technology routinely.…”

Section: Organization-level Considerationsmentioning

confidence: 99%

“…The availability of and process for accessing resources on NCCARE360 is directly influenced by system-and policy-level determinants. Efforts to improve social and health care coordination must be complemented by policies that improve population health [42]. This extends to policies that influence the extent to which CBOs and social assistance programs (e.g., SNAP) using NCCARE360 are accessible and adequately funded.…”

Section: System-and Policy-level Considerationsmentioning

confidence: 99%

Implementation of NCCARE360, a Digital Statewide Closed-Loop Referral Platform to Improve Health and Social Care Coordination: Evidence from the North Carolina COVID-19 Support Services Program

Drake,

McPeek Hinz,

Granger

et al. 2024

North Carolina Medical Journal

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Introduction Efforts to improve population health by being responsive to patients’ social and economic conditions will benefit from care models and technologies that assess and address unmet social needs. In 2019, NCCARE360 launched in North Carolina as the first statewide digital care coordination network to “close the loop” on referrals between community-based organizations (CBOs), health service providers, and social service agencies. The platform creates a shared network for sending and receiving electronic referrals and track client outcomes. Methods As a case study, we compare NCCARE360 resolution rates for community resource referrals originating from a large integrated health system primarily in Durham County from September 1, 2020, through February 28, 2021. In the first year, COVID-19 Support Services Program (COVID-SSP) funding was available to reimburse associated CBOs for providing food assistance and case management services. We compared this with the same period the following year after funds had been exhausted. We present frontline implementation experiences and highlight opportunities, challenges, and recommendations for NCCARE360 implementation. Results Multi-level considerations for individual end users, organizations adopting the platform, and policymakers are presented. Additionally, we find that when COVID-SSP funding was available, more referrals were placed (3,220 cases) and referrals were more likely to be resolved (88% resolution rate) when compared to the same time frame when funds were no longer available (860 cases; 30% resolution rate). These results underscore the importance of reimbursement mechanisms and funding. Limitations The examination of referral rates is observational and may not generalize to other contexts. Conclusion The shift to value-based care is an opportunity to embrace structural solutions to health and social care fragmentation. There is also an opportunity to realize the potential of NCCARE360 and efforts like it to contain costs and improve health outcomes and equity.

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Moving the Field Forward: A Decade of Progress Implementing Health in All Policies in the United States

Cited by 4 publications

References 1 publication

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

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

Governance of Intersectoral Collaborations for Population Health and to Reduce Health Inequalities in High-Income Countries: A Complexity-Informed Systematic Review

Implementation of NCCARE360, a Digital Statewide Closed-Loop Referral Platform to Improve Health and Social Care Coordination: Evidence from the North Carolina COVID-19 Support Services Program

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