March 2018 Research Round-Up

Below we highlight recent literature on screening for and/or addressing social needs in clinical settings. To receive the Research Round-Up in your email, sign up for our monthly newsletter.

Find these articles and many more in our searchable Evidence Library.

Enabling Sustainable Investment in Social Interventions: A Review of Medicaid Managed Care Rate-Setting Tools
D. Bachrach, J. Guyer, S. Meier, J. Meerschaert, & S. Brandel
The Commonwealth Fund
The authors of this report identify several options available to states to modify their approach to Medicaid managed care rate-setting to support Medicaid managed care plans and their network providers in addressing patients’ unmet social needs.

Prevalence of Housing Problems Among Community Health Center Patients
T.P. Baggett, S.A. Berkowitz, V. Fung, & J.M. Gaeta
JAMA
In this research letter, the authors use data from the 2014 Health Resources and Services Administration Health Center Patient Survey to assess the prevalence and health-related correlates of housing problems among CHC patients. They found that 43.6% of adult CHC patients reported housing problems, including 1.2% who reported current homelessness.

Effect of Evidence-Based Supported Employment vs Transitional Work on Achieving Steady Work Among Veterans with Posttraumatic Stress Disorder: A Randomized Clinical Trial
L.L. Davis, T.C. Kyriakides, A.M. Suris, et al.
JAMA Psychiatry
This multisite trial of employment strategies among veterans with PTSD demonstrated significantly greater effectiveness of supported employment compared to transitional work in helping veterans with chronic post-traumatic stress disorder attain steady, competitive employment.

Homelessness and Emergency Medicine: Where Do We Go from Here?
K.M. Doran & M.C. Raven
Academic Emergency Medicine
The authors of this commentary expand upon recommendations for research, education, and practice made by Salhi et al. on how to best serve emergency department patients experiencing homelessness.

From Cultural to Structural Competency-Training Psychiatry Residents to Act on Social Determinants of Health and Institutional Racism
H. Hansen, J. Braslow, & R.M. Rohrbaugh
JAMA Psychiatry
The authors of this commentary advocate for a structural competency approach in psychiatry training and education in order to train residents to understand and work at systems levels to eliminate the structural causes of illness.

Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources
A.W. Henize, A.F. Beck, M.D. Klein, J. Morehous, & R.S. Kahn
Maternal and Child Health Journal
This study reports on the impacts of a pediatric waiting room redesign focused on improving linkages to community organizations, creating a welcoming environment, and providing positive distractions for children. Caregivers surveyed in the pre-post study were more likely to perceive that the redesigned waiting room was a place to connect to community resources and was welcoming and relaxing.

Chronic Disease Burden Predicts Food Insecurity Among Older Adults
J. Jih, I. Stijacic-Cenzer, H.K. Seligman, W.J. Boscardin, T.T. Nguyen, & C.S. Ritchie
Public Health Nutrition
In this analysis of the 2013 Health and Retirement Survey, the authors found that respondents with multiple chronic conditions were significantly more likely to report food insecurity. They suggest that screening older adults with multiple chronic conditions for food insecurity in the clinical setting may be warranted in order to refer to community food resources.

Measuring the Effect of Social Determinants on Patient Outcomes: A Systematic Literature Review
A.J. Knighton, B. Stephenson, & L.A. Savitz
Journal of Health Care for the Poor and Underserved
This systematic review of research on the effects that patient material and social deprivation have on health care delivery outcomes identified a need for common measurement standards, more robust identification of deprivation-sensitive diseases or conditions, and highlighted the need for additional research to evaluate the benefits of clinical interventions designed to help address patients’ material and social needs.

Successes, Challenges, and Considerations for Integrating Referral into Food Insecurity Screening in Pediatric Settings
M. Knowles, S. Khan, D. Palakshappa, et al.
Journal of Health Care for the Poor and Underserved
The authors of this qualitative study evaluated facilitators and barriers for screening and referral for food insecurity in three pediatric clinics. Key facilitators included trust between caregivers and staff, choice of screening methods, and assistance in navigating benefits application. Barriers included complex administration of referral, privacy and stigma concerns, and caregivers' current benefit enrollment or ineligibility.

Impact of a New York City Supportive Housing Program on Housing Stability and Preventable Health Care Among Homeless Families
S. Lim, T.P. Singh, G. Hall, S. Walters, & L.H. Gould
Health Services Research Journal
This study compared participants in a supportive housing program to eligible applicants not placed in the program, and found that at two years post-baseline supportive housing tenants were less likely to make preventable ED visits.

Higher Perceived Clinic Capacity to Address Patients' Social Needs Associated with Lower Burnout in Primary Care Providers
J.N. Olayiwola, R. Willard-Grace, K. Dube, et al.
Journal of Health Care for the Poor and Underserved
The authors of this cross-sectional study in three delivery systems in San Francisco found that provider perceptions of greater clinic capacity to address social needs are significantly associated with lower burnout.

Physicians’ Broader Vision For The Center For Medicare and Medicaid Innovation's Future: Look Upstream
W. Ray & T. Norbeck
Health Affairs Blog
The authors of this blog argue for the inclusion of health-related social needs as a guiding design principle for all future CMMI Innovation Center payment and care delivery models.

Addressing Social Determinants of Health through Medical-Legal Partnerships
M. Regenstein, J. Trott, A. Williamson, & J. Theiss
Health Affairs
This article draws upon national survey data and field research to identify three models of medical-legal partnerships (MLPs) that health care organizations have adopted and the core elements of infrastructure that they share. The authors find that more than three hundred health care organizations are home to MLPs and that financing and commitment from health care organizations are key for sustaining and scaling up the MLP as a health equity intervention.

The Value of Community Health Workers in Diabetes Management in Low-Income Populations: A Qualitative Study
J. Silverman, J. Krieger, G. Sayre, & K. Nelson
Journal of Community Health
This study used encounter forms completed by community health workers (CHWs) working with low income individuals with poorly controlled diabetes self-management to identify barriers to disease control and how CHWs helped address those barriers. The authors found that, among other activities, CHWs helped participants overcome obstacles to disease control by connecting them to community resources.

Unmet Legal and Social Advocacy Needs of Children with Sickle Cell Disease: Implications for Health Care Payer Costs
R.A. Sonik, S. Teasdale, S.L. Parish, M. Champigny, & P.G. Sprinz
Children and Youth Services Review
This study reports on a novel process to distinguish between legal advocacy needs and social advocacy needs. The authors found that health costs for 52 children with sickle cell disease were $12,040 higher for families with at least one legal need, compared to children in families with no legal advocacy needs.

Food Insecurity in Older Adults in an Integrated Health Care System
J.F. Steiner, S.H. Stenmark, A.T. Sterrett, et al.
Journal of the American Geriatrics Society
This retrospective cohort study of older adults found that food insecurity was prevalent in older adults with private-sector health care coverage, and identified a number of demographic and health-related factors that could be used to identify older adults at higher risk of food insecurity.

Community Navigators Reduce Hospital Utilization in Super-Utilizers
M.P. Thompson, P.S.B. Podila, C. Clay, et al.
American Journal of Managed Care
The authors of this study found that community navigators that blended the role of patient navigators and community health workers significantly reduced hospital utilization and increased days between hospital encounters for super-utilizers working with the navigator relative to a control group of similar super utilizers.

A Key Challenge for Medicare’s Annual Wellness Visits: Spreading the Benefits to Underserved Seniors
R. Tipirneni & K.M. Langa
Health Affairs Blog
This blog post explores potential solutions to growing health inequities among seniors in the US, including a new model for annual wellness visits that incorporates screening for the social determinants of health.

Simple Screening Tools to Identify Limited Health Literacy in a Low-Income Patient Population
K.R. Ylitalo, M.R.U. Meyer, B.A. Lanning, C. During, R. Laschober, & J.O. Griggs
Medicine
This study compared a 6-item health literacy questionnaire (the Newest Vital Sign) and a single-item screening question about perceived difficulty completing medical forms. The single-item question had low sensitivity but high specificity compared to the 6-item screener.