August 2019 Research Round-Up
Our Research Round-Ups highlight recent research articles, reports, and commentaries on screening for and/or addressing social needs in clinical settings.
Critical Call for Hospital-Based Domestic Violence Intervention: The Davis Challenge
M.B. Aboutanos, M. Altonen, A. Vincent, B. Broering, K. Maher, & N.D. Thomson
Journal of Trauma and Acute Care Surgery
This article describes the development and impact of an integrated hospital/trauma center-based IPV program consisting of staff education, patient screening, victim crisis fund, and interdisciplinary sexual assault/domestic violence intervention team.
Screening for Both Child Behavior and Social Determinants of Health in Pediatric Primary Care
E. Berger-Jenkins, C. Monk, K. D'Onfro, et al.
Journal of Developmental and Behavioral Pediatrics
This paper describes implementation of screening for child behavior and social determinants of health in an urban pediatric practice using quality improvement methodology. Screening rates reached 90% after introducing a tablet for screening; while provider documentation of screens averaged 62%. Among those with positive child behavior or social stressor screens, approximately 80% followed up with their primary medical doctor, and 50% completed referrals to the clinic social worker.
Linking Partner Violence Survivors to Supportive Services: Impact of the M Health Community Network Project on Healthcare Utilization
C.J. Clark, M. Wetzel, L.M. Renner, & M.E. Logeais
BMC Health Services Research
This evaluation of an IPV screening and referral intervention in a large multi-specialty outpatient health system found that patients who accepted printed or direct referrals had more social work and behavioral health visits than those who declined.
Primary Care and Food Bank Collaboration to Address Food Insecurity: A Pilot Randomized Trial
R.L. Ferrer, L.M. Neira, G.L. De Leon Garcia, K. Cuellar, & J. Rodriguez
Nutrition and Metabolic Insights
A novel partnership between a primary care practice and a municipal food bank that included bi-weekly food provision, onsite nutrition education, and home-based education, generated reductions in HbA1c and improvements in diets of food insecure patients with type 2 diabetes.
Medical-Legal Partnerships to Support Continuity of Care for Immigrants Impacted by HIV: Lessons Learned from California
S.M. Fuller, W.T. Steward, O. Martinez, & E.A. Arnold
Journal of Immigrant and Minority Health
This qualitative study describes the role of medical-legal partnerships and best practices around access to HIV care and prevention for immigrants in California—highlighting the need for additional funding and guidance on screening for and supporting patients with legal needs.
Assessing the Availability of Data on Social and Behavioral Determinants in Structured and Unstructured Electronic Health Records: A Retrospective Analysis of a Multilevel Health Care System
E. Hatef, M. Rouhizadeh, I. Tia, et al.
JMIR Medical Informatics
This study of the availability of social and behavioral data in EHRs found high availability for race, ethnicity, address, preferred language, and smoking, but very low availability (<5%) for factors such as social isolation, housing instability, and financial resource strain. Mentions of social factors were higher in unstructured than in structured data.
A Systematic Review of Reasons For and Against Asking Patients About Their Socioeconomic Contexts
A. Moscrop, S. Ziebland, N. Roberts, & A. Papanikitas
Int J Equity Health
This first summary of literature on the subject found many published reasons for why patients’ social and economic circumstances should be enquired about in healthcare settings, including benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician’s role in responding to patients’ social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals.
Utilizing PHATE: A Population Health-Mapping Tool to Identify Areas of Food Insecurity
J. Lichkus, W.R. Liaw, & R.L. Phillips
Annals of Family Medicine
This article describes one federally qualified health center’s use of a population health mapping tool to identify the geographic distribution of patients who screened positive for food insecurity.
A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting
T. Sadarangani, L. Missaelides, E. Eilertsen, H. Jaganathan, & B. Wu
Policy, Politics, & Nursing Practice
After 12 months in a Community-Based Health Home, a racially diverse sample of older adults experienced statistically significant reductions in loneliness, depression, nutritional risk, poorly controlled pain, and emergency department utilization. Key stakeholders attributed positive changes to early clinical intervention by the registered nurse navigators, communication with providers across settings, and a focus on social determinants of health.
Health Impacts of Unlimited Access to Networked Transportation in Older Adults
L. Saxon, R. Ebert, & M. Sobhani
Journal of mHealth
This study examined the impact of offering three months of free an unlimited Lyft, Inc. transportation services to older adults with chronic disease and transportation barriers. More than 9 in 10 participants (93%) used the service, with medical appointments accounting for only 12% of destinations. Participants reported less social isolation and increased quality of life.
Building a Patient-Centered Medical-Legal Home in Hawaii's Kalihi Valley
D.M. Shek & A.G. Turlington
Hawai’i J Med Public Health
This paper describes the evolution of one medical-legal partnership into a patient centered medical-legal home—highlighting the importance of fully integrating lawyers into the medical team and including the patient/client as an essential member of the medical-legal partnership.
Striving for Health Equity through Medical, Public Health, and Legal Collaboration
J.B. Teitelbaum, J. Theiss, & C.H. Boufides
Journal of Law, Medicine & Ethics
This article discusses how law functions as a determinant of health, the history of collaborations between the health and legal professions, the benefits of creating medical-public health-legal collaborations, and the health equity benefits of viewing law through a collaborative, population health lens.
Perspectives of Medicare Advantage Plan Representatives on Addressing Social Determinants of Health in Response to the CHRONIC Care Act
K.S. Thomas, S.N.M Durfey, E.A. Gadbois, et al.
JAMA Network Open
This qualitative study with representatives from 17 Medical Advantage (MA) plans (representing >65% of the MA market) revealed that MA plans are responding to the CHRONIC CARE Act in varying ways. While some MA plans have taken advantage of increased flexibility provided by the Act, others felt that providing services to address social needs was outside their purview. Factors influencing decisions about supplemental benefits include availability of evidence, estimated return on investment, strength of community partnerships, and guidance from the US Centers for Medicare & Medicaid Services.
Transportation Preferences of Patients Discharged from the Emergency Department in the Era of Ridesharing Apps
A. Tomar, S.S. Ganesh, & J.R. Richards
Western Journal of Emergency Medicine
In a survey of adult patients about to be discharged from an urban ED, patients reported an awareness of ridesharing services, but few planned to use them post-discharge. Older, less educated patients with limited income were less likely to be aware of or use ridesharing services.
Adding Social Determinants in the Electronic Health Record in Clinical Care in Hawai'i: Supporting Community-Clinical Linkages in Patient Care
C.M. Trinacty, E. LaWall, M. Ashton, D. Taira, T.B. Seto, & T. Sentell
Hawaii Journal of Medicine & Public Health
This article describes the experiences of three local health care delivery systems that integrate the identification of social needs into clinical care using the electronic health record.
Reports & Commentaries
Guiding Principles for Ethical Use of Social Determinants of Health Data
This brief recommends five uses of SDH data: multi-sector care coordination, risk prediction, identifying and addressing community resource gaps, assessing the impacts of social interventions, and customizing health services and interventions.
Determining the Shared Population Between Service Providers: How Tulsa is Preserving Privacy and Sharing Data for Social Good
A. Bean, J. Jaynes, & T.J. Sexton
Data Across Sectors for Health
This paper describes the process of using secure multi-party computation (MPC) technology to share and analyze data across service organizations.
Screening For Social Needs: What Do Parents Think?
Health Affairs Blog
In focus groups, low-income parents emphasized the need for pediatricians to build trust before engaging in discussions about social stressors and expressed concerns around discussing sensitive topics like domestic violence and parents’ mental health. Parents highlighted the need for pediatricians to make screening a standard protocol, to protect privacy, and to be able and willing to offer help.
Building Consumer Engagement in Health Care: From Transactional To Transformational
Health Affairs Blog
This blog post describes the efforts of the Center for Consumer Engagement in Health Innovation to ensure consumers, particularly those with complex health and social needs, are at the center of improving health policy and delivery, including new partnerships between health and social services.
Promising Strategies for Community Service Navigation: Lessons From Health Quality Innovators
Centers for Medicare and Medicaid Services
This case study describes key strategies that Health Quality Innovators developed to conduct community service navigation as part of the Accountable Health Communities Model.
DSRIP Promising Practices: Strategies for Meaningful Change for New York Medicaid
N. Myers, G.C. Burke, M. Sharp, M. Gilman, & C. Shearer
United Hospital Fund
This report presents case studies and learnings from the first four years of New York State’s innovative Delivery System Reform Incentive Payment (DSRIP) program. Key learnings include that DSRIP greatly accelerated partnerships between health care providers, community-based social service organizations, and other community partners, that substantial infrastructure is required to support projects with sufficient scope to drive outcome improvement across large enough populations, and that for the most complex populations, substantial care management/coordination and support for care transitions appear necessary to change patients’ trajectories.
From Siloed Systems to Ecosystem: The Evolution of the Camden Coalition's Complex Care Model
K. Noonan & K. Craig
Camden Coalition of Healthcare Providers
This brief shares the story of the Camden Coalition’s 15-plus years developing a care model that is centered around health and social complexity, including the changes they made to their care management model to better address and meet social needs, and their vision for building complex care ecosystems in the Camden region and nationwide.
Will Social Determinants Reshape Pediatrics? Upstream Clinical Prevention Efforts Past, Present, and Future
A. Schickedanz, L. Gottlieb, & P. Szilagyi
This commentary on two recent papers (Garg et al., 2019 and Morgenlander et al., 2019) draws a parallel between the still relatively nascent practice of screening and intervening on social risks and the introduction of cardiovascular risk screening in the 1960s, which was at the time considered radical.
Home Is Where Health Is: A Stable, Affordable Home Is a Prescription for Good Health
This blog post describes the importance of collaborating between sectors to promote strong housing policies that will ensure all families are stably housed and healthy.