As part of our mission to advance high quality research on health care sector strategies to improve social conditions, we periodically fund research projects that fill key research gaps.
2019 Funding Cycle
With support from the Robert Wood Johnson Foundation and Kaiser Permanente, in the summer of 2019 SIREN issued a call for proposals specifically exploring why some patients who screen positive for social risks in health care settings subsequently decline social risks assistance offered by health care delivery settings. We funded four $50,000 1-year projects focused on understanding patient interest in social care assistance, and two $150,000 2-year projects focused on identifying social risk screening and assistance strategies that can increase patient interest in assistance. Projects ran from early 2020 through late 2021.
Understanding patient interest and engagement with social care assistance offered through guided online self-navigation or in-person assistance
PI: Minal Patel (Michigan); Co-PI: Alicia Cohen (Brown)
- The goal of this project is to test the following mixed methods aims: Aim 1- Describe demographic, clinical and psychosocial characteristics of individuals who do and do not engage with offered social care assistance through either guided online self-navigation or in-person assistance. Aim 2- Understand motivators and barriers to engagement with and uptake of offered assistance through guided online self-navigation or in-person assistance. This proposal employs an explanatory sequential mixed methods design—such that quantitative data will inform the sampling strategy for subsequent qualitative interviews—embedded within a larger randomized controlled trial (RCT).
From screening to the receipt of services: a multimethod qualitative approach to understanding the factors that influence patient acceptance of healthcare-based social risk assistance
PI: Antoinette Schoenthaler (NYU); Co-PI: Rebecca Gallager (NYU)
Location: New York City
- This proposal is a partnership between NYU Langone Health (NYULH) researchers in the Department of Population Health and the Family Health Centers (FHC) at NYULH, a large Federally Qualified Health Center (FQHC) located in Sunset Park, Brooklyn, NY serving predominantly low-income and immigrant patients. It is a one-year multimethod qualitative study that will allow study team members to become immersed in the daily life of the FHC. Our approach will combine four data collection techniques: ethnographic observations; document analyses; focus group sessions; and one-on-one interviews.
Exploring and Describing the Barriers and Facilitators of Patient Interest in Acceptance of Health Care-Based Assistance in Addressing Social Needs within Urban Federally Qualified Health Centers: An Implementation Sciences Approach
PI: Elizabeth Pfeiffer (Rhode Island College); Co-PI: Chelsea De Paula (Providence Community Health Centers)
Location: Providence, RI
- Using an implementation sciences approach, as well as qualitative research methods, the proposed research aims to explore, understand and describe why it is that people decline or accept social assistance after they screen positive for a social determinant health need. Data collected will provide a more holistic understanding of staff and patient interest in the importance of screening and addressing SDH within primary care while also providing new insights into the design of novel interventions that can be implemented and used to improve the rates of the acceptance of social services interventions.
Understanding Barriers to Use of Health Center-Based Food Access Interventions
PI: Rachel Zack (The Greater Boston Food Bank) Co-PI: Rachel Weil
Location: Boston, MA
- The primary aim of the PRODUCE Study currently being conducted by The Greater Boston Food Bank is to measure the impact of free produce distribution and free nutrition coaching on patients' diet, health outcomes, and healthcare costs. The purpose of this project would be to examine using quantitative and qualitative methods, why this 60% of patients enrolled in the PRODUCE study have not attended the Mobile Market and why this 80% of patients have not utilized nutrition coaching.
Topic 2 Projects:
Two year, $150,000 projects focused on identifying approaches that can improve interest in assistance.
Connecting to RainbowConnects: Followup Strategies to Engage Patients in a Social Risks Assistance Intervention
PI: Sarah Ronis (University Hospitals Cleveland Medical Center) ; Co-PI: Marie Masotya (University Hospitals Cleveland Medical Center)
Location: Cleveland, OH
- The goal of this project is to determine what program design features optimize patient engagement to the point of resource connection for a social care assistance program embedded in an urban ambulatory medical home that serves predominately low-income women and children. Researchers will conduct a randomized intervention trial to compare drop-off rates, explore association between patient experience related to drop-off rates and assess time-to-resolution by need domain. The project is anticipated to produce patient informed follow-up strategies, as well as predictive models for program staff to identify patients requiring additional engagement effort.
Improving Messaging Around Gaps In Needs and rEferrals (IMAGINE)
PI: Andrea Nederveld (The University of Colorado Denver); Co-PI: Elena Broaddus (The University of Colorado Denver)
Location: Denver, CO
- This study aims to identify effective communication and messaging strategies that can increase patient interest in healthcare-based assistance with social needs. Researchers will explore reasons why patients accept or decline referrals for services and develop and test alternate messages and strategies using a community based participatory approach. The project will be carried out in three phases and will be implemented in two western Colorado primary care practices that currently use the Accountable Health Community (AHC) Health-Related Social Needs (HRSN) Screening Tool.
2017 Funding Cycle
In spring 2017, SIREN put out a first call for proposal with funding from the Robert Wood Johnson Foundation and Kaiser Permanente, with a focus on projects that added to our understanding of health care cost and utilization impacts of interventions initiated in the context of health care delivery that targeted patients’ social and economic hardships. Two projects outlined below were selected for funding that year.
Cost-benefit Analysis of Housing Prescriptions as Health Care, A Pilot Study
PI: Megan Sandel MD, MPH
- The research team will conduct a cost-benefit analysis of an existing 3-year pilot study, Housing Prescriptions as Health Care (HPHC). HPHC is an innovative project aims to alleviate housing instability, a known risk factor for negative child health and developmental outcomes. The study uses a randomized control trial (RCT) design wherein families are screened for eligibility by CHW staff in the Emergency Department and Primary Care clinics at Boston Medical Center and randomly assigned to an intervention group or a control group. Families in the control group receive a packet of outreach resources with information on housing and housing supports. Families in the intervention group are referred to a housing case manager and receive a combination of at least three of the six housing-related support services offered through the program. Project partners tailor interventions to families’ specific needs and include the Boston Housing Authority, Project Hope, Nuestra Comunidad Development Corporation, and Medical-Legal Partnership | Boston. The goal of the proposed project is to examine the cost-benefit ratio of the HPHC pilot study comparing economic costs, including health care utilization and homelessness services, to the implementation costs for the intervention. The results of this pilot will be used as a foundation for a larger RCT in the future.
Targeting Social Needs to Reduce the Total Cost of Care: Evaluating the Impact of a Clinic-Based Community Resource Desk Intervention
PI: Bill Wright PhD
- This prospective longitudinal panel study will assess whether embedding an onsite community resource desk (CRD) staffed by community partner agencies and designed to help patients with a range of basic needs impacts the short-term health care utilization and cost patterns of patients with such challenges. The project team will leverage an existing evaluation that compares clinics with and without an embedded CRD and that prospectively follows patients with identified social needs for one year. Under this proposal, the existing study’s patient survey outcomes will be enhanced with a health care claims analysis designed to assess near-term utilization and cost impacts of the intervention by comparing claims for patients with and without access to the CRD over time. Findings will directly address the potential impacts of the program and may help drive the operationalization and spread of similar programs. In addition, because the intervention deals with a broad range of social determinants, this study will be in a position to assess which unmet social needs are most strongly associated with higher utilization and costs, potentially helping prioritize future interventions toward the specific issues most likely to produce cost savings.