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May 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.

 

Screening for Poverty and Poverty-Related Social Determinants of Health
R.S. Berman, M.R. Patel, P.F. Belamarich, & R.S. Gross
Pediatrics in Review
This article reviews screening tools for poverty and poverty-related social determinants of health that pediatricians may use in practice; describes interventions that support patients who screen positive; and outlines government policies and programs for families living in poverty for which pediatricians may advocate. The authors pair each area with an illustrative example from their practice.
 

Ensuring Access to Quality Health Care in Vulnerable Communities
J. Bhatt & P. Bathija
Academic Medicine
This commentary outlines characteristics and parameters of vulnerable communities as well as the essential health care services that hospitals should strive to maintain locally. It highlights addressing the social determinants of health as the first of four strategies needed to reform health care delivery.
 

Screening for Social Determinants of Health: Children's Hospitals Respond
Children’s Hospital Association
This report outlines how children's hospitals are implementing social determinants screening. Delivered in three parts and with many examples from peers, the report highlights the need for community resource connections, provides examples of screening tools being utilized, and offers questions to consider when implementing a new strategy to screen.

Health Care Utilization and Expenditures of Homeless Family Members Before and After Emergency Housing
R.E. Clark, L. Weinreb, J.M. Flahive, & R.W. Seifert
American Journal of Public Health
This study of homeless children and adult Medicaid beneficiaries in Massachusetts who had experienced 1 or more homeless episodes during a 7-year period found that ED visits, hospital admissions, and expenditures rose for months before shelter entry and declined afterward, indicating potential for early housing intervention to yield cost savings and improve health.

Addressing Social Determinants of Health through Medicaid Accountable Care Organizations
D. Crumley & M. Pierre-Wright
Center for Health Care Strategies, Inc.
This commentary summarizes four ways that states are addressing social determinants of health through Medicaid ACOs: (1) encouraging or requiring SDOH interventions; (2) developing risk adjustment strategies; (3) recruiting SDOH-savvy ACOs; and (4) encouraging or requiring community partnerships.

Prescribing Food as a Specialty Drug
A. Feinberg, A. Hess, M. Passaretti, S. Coolbaugh, & T.H. Lee
New England Journal of Medicine Catalyst
This commentary describes Geisinger Health’s Fresh Food Farmacy pilot program, which provides healthy food, health education, and case management to food insecure patients with poorly controlled type 2 diabetes. Compared to baseline, the authors found an average 2.1 percentage point drop in HbA1c levels and an 80% reduction in health care costs over 18 months.

Providing Home- and Community-Based Nutrition Services to Low-Income Older Adults: Promising Health Plan Practices
S. Gibbs & A. Herr
Center for Health Care Strategies, Inc.
This brief highlights promising community-based nutrition practices used by Medicaid health plans to address the needs of low-income older adults, including leveraging community-based resources to increase access to nutritious food.

Advancing Social Prescribing with Implementation Science
L. Gottlieb, E.K. Cottrell, B. Park, K.D. Clark, R. Gold R, & C. Fichtenberg
The Journal of the American Board of Family Medicine
This commentary highlights three areas where implementation research can advance the practice of social prescribing: social screening research; workforce research; and research on payment models.

Proactive Strategies to Address Health Equity and Disparities: Recommendations from a Bi-National Symposium
J. Haggerty, M.H. Chin, A. Katz, et al.
The Journal of the American Board of Family Medicine
This commentary summarizes recommendations from a 2017 Canada-US symposium on health equity and disparities. Insights include systematically identifying social determinants of health in patient care so that they can become visible and inform care delivery and incentivizing the reduction of disparities.

Collection of Social Determinants of Health in the Community Clinic Setting: A Cross-Sectional Study
S.V. Kusnoor, T.Y. Koonce, S.T. Hurley, et al.
BMC Public Health
This cross-sectional study found that administering a hybrid social and behavioral needs questionnaire in a community clinic waiting room was feasible and that the response rate was high for all questions aside from annual household income.

Original Texas Public Health Case Study: Utilizing Students to Move Upstream with Social Determinants of Health Screening
W.C. Lee, S. Guillot-Wright, & P. Patel
Texas Public Health Journal
This paper describes the design and implementation of a Texas 1115 waiver-funded pilot program that trains medical students to screen patients for social determinants of health and participate in collaborations with community organizations to refer patients with identified needs.

Living in "Cold Spot" Communities Is Associated with Poor Health and Health Quality
W. Liaw, A.H. Krist, S.T. Tong, et al.
The Journal of the American Board of Family Medicine
This cross-sectional analysis found that living in census tracts with worse income, education, and composite deprivation is associated with somewhat worse chronic conditions and screening rates for some tests, suggesting neighborhood data may help identify those most at risk for poor health care outcomes.

A Practical Approach to Screening for Social Determinants of Health
D.T. O'Guerk & C. Henke
Family Practice Management

Screening for Social Determinants of Health: An Opportunity or Unreasonable Burden?
K.G. Adler
Family Practice Management
This opinion piece makes the case for systematic screening for social needs in primary care, while cautioning that screening without first equipping the practice to address identified needs would be ineffective and unethical. The authors also concede that the research supporting the benefits of screening in primary care is still limited. The accompanying editorial voices concerns about whether this work should be the responsibility of primary care.

Caregiver Perceptions of a Fruit and Vegetable Prescription Programme for Low-Income Paediatric Patients
A. Saxe-Custack, H.C. Lofton, M. Hanna-Attisha, et al.
Public Health Nutrition
This retrospective qualitative study found that caretakers at a pediatric clinic that relocated into a farmers' market building and implemented a fruit and vegetable prescription program reported increased access to high quality produce and improved food security.

Clinician Experiences with Screening for Social Needs in Primary Care
S.T. Tong, W.R. Liaw, P.L. Kashiri, et al.
The Journal of the American Board of Family Medicine
In this observational study, 71% of patients screened in low-income communities in Virginia reported a social need but only 3% wanted help. Clinicians reported that knowing the patient had a social need changed care delivery in 23% of patients and helped improve interactions with and knowledge of the patient in 53%.

Addressing Racism in Medical Education an Interactive Training Module
T. White-Davis, J. Edgoose, J.S. Brown Speights, et al.
Family Medicine
This pre-post study found that faculty development workshop on racism resulted in changes in participants’ attitude and knowledge regarding racism and in their personal commitment to address racism.

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