February 2018 Research Round-Up

Below we highlight recent literature on screening for and/or addressing social needs in clinical settings.

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

Mothers' Opinions on Being Asked About Exposure to Intimate Partner Violence in Child Healthcare Centres in Sweden
K. Almqvist, A. Kallstrom, P. Appell, & A. Anderzen-Carlsson
Journal of Child Health Care
This Swedish study found that mothers were comfortable being asked about intimate partner violence at regular baby check-up visits, so long as questioning was routed and conducted without the partner being present.

Navigation Delivery Models and Roles of Navigators in Primary Care: A Scoping Literature Review
N. Carter, R.K. Valaitis, A. Lam, J. Feather, J. Nicholl, & L. Cleghorn
BMC Health Services Research
This scoping review describes models of care and characteristics of navigators in studies about the delivery of navigation services in primary care settings that include linkages to community-based social services.

Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial
K.H. Chaiyachati, R.A. Hubbard, A. Yeager, et al.
JAMA Internal Medicine

Rideshare-Based Medical Transportation for Medicaid Patients and Primary Care Show Rates: A Difference-in-Difference Analysis of a Pilot Program
K.H. Chaiyachati, R.A. Hubbard, A. Yeager, et al.
Journal of General Internal Medicine
The authors of these two studies evaluated the impact of rideshare-based non-emergency medical transportation services for Medicaid beneficiaries. A difference-in-difference analysis of a pilot program found no-shows decreased more in a practice with the rideshare program than in a control practice with usual care. However, in a subsequent quasi-randomized clinical trial, access to the rideshare-based transportation program did not impact missed appointment rates, possibly because uptake of ridesharing was low.

An Overview of Food Insecurity Coding in Health Care Settings: Existing and Emerging Opportunities
S. DeSilvey, A. Ashbrook, R. Sheward, H. Hartline-Grafton, S. Ettinger de Cuba, & L. Gottlieb
Hunger Vital Sign National Community of Practice
This report reviews existing and emerging opportunities to document food insecurity screening, assessment, intervention, and billing for each part of a patient visit using discrete codes and language from standardized EHR medical vocabularies.

Patient Predictors and Utilization of Health Services within a Medical Home for Homeless Persons
A.L. Jones, R. Thomas, D.O. Hedayati, S.K. Saba, J. Conley, & A.J. Gordon
Substance Abuse
This observational study examined changes in health services utilization following implementation of a Veterans Health Administration (VHA) Homeless Patient Aligned Care Team (HPACT). It found that primary care utilization increased and emergency department and hospitalizations decreased in the 12 months following implementation, although women and self-housed individuals did not experience these changes.

Implementing a Produce Prescription Program for Hypertensive Patients in Safety Net Clinic
K. Joshi, S. Smith, S.D. Bolen, A. Osborne, M. Benko, & E.S. Trapl
Health Promotion Practice
This paper describes the framework used for implementing a produce prescription community-clinical linkage program between safety-net clinics and farmers markets for patients with hypertension. Strategies for successful implementation included involving multiple stakeholders throughout the process and limiting dependence on doctors and nurse practitioners in program execution.

Integrating the Social Determinants of Health into Two Interprofessional Courses: Findings from a Pilot Study
S.D. Lane, R.H. Keefe, R.A. Rubinstein, et al.
Journal of Interprofessional Care
This study describes the efforts of five colleges and universities in upstate New York to implement the Institute of Medicine's (IOM) Framework for Educating Health Professionals to Address the Social Determinants of Health.

Community-Clinical Linkages with Community Health Workers in the United States: A Scoping Review
A.M. Lohr, M. Ingram, A.V. Nunez, K.M. Reinschmidt, & S.C. Carvajal
Health Promotion Practice
This scoping review synthesizes the evidence concerning the role of community health workers (CHWs) in creating and sustaining community-clinical linkages aimed at improving individual health outcomes, including through addressing social determinants of health. The authors found that community-clinical linkages with CHWs positively affect the delivery of both clinical care and community resources, although the full breadth and depth of CHWs linking capabilities were underutilized.

Paying for Population Health: Case Studies on the Role of the Health System in Addressing Social Determinants of Health
J. McGuire
AcademyHealth
This report focuses on four case study sites where health systems are actively involved in addressing social determinants of health to identify opportunities and challenges associated with linking payment reform to population health. Each case study includes a detailed description of the intervention, outlines enabling factors, and provides considerations for the future.

A Framework for Medicaid Programs to Address Social Determinants of Health: Food Insecurity and Housing Instability
National Quality Forum
This report presents a framework for state Medicaid programs to support the collection of social determinants of health data and the integration of health and non-health services, using food insecurity and housing instability as illustrative examples.

Measuring Social Exclusion in Healthcare Settings: A Scoping Review
P. O'Donnell, D. O'Donovan, & K. Elmusharaf
International Journal of Equity in Health
This scoping review identified 22 measurement tools of social exclusion or social inclusion in healthcare settings. The majority of tools were designed for patients in mental health settings and varied greatly in design and in the definitions of the concepts they were measuring.

Integrating Social Needs into Health Care: A Twenty-Year Case Study of Adaptation and Diffusion
R.D. Onie, R. Lavizzo-Mourey, T.H. Lee, J.S. Marks, & R.J. Perla
Health Affairs
This article presents a twenty-year qualitative case study of Health Leads, a social enterprise that partners with health care institutions and communities to address patients’ basic resource needs, its funders, and their interaction with the market and policy landscape, describing five stages of diffusion of an approach for integrating social needs into clinical care.

Facilitators and Barriers of Implementing and Delivering Social Prescribing Services: A Systematic Review
J.V. Pescheny, Y. Pappas, & G. Randhawa
BMC Health Services Research
This systematic review identified eight studies focused on facilitators and barriers to the implementation of social prescribing models in the UK. Facilitators and barriers included the implementation approach, legal agreements, leadership, management and organization, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure.

Focusing on Employment in Primary Mental Health Care: A Scoping Review
K. Reed & H. Kalaga
Work
This scoping review describes interventions used in primary care settings to support employment among people with mental health issues. Results suggest a need for research about both implementation and effectiveness of these interventions.

Unstable Housing and Caregiver and Child Health in Renter Families
M. Sandel, R. Sheward, S. Ettinger de Cuba, et al.
Pediatrics
This study evaluated the relationship between caregiver and child health and three measures of housing instability: homelessness in the child’s lifetime, being behind on rent in the past 12 months, and moving multiple times in the past 12 months. Although overlap between the three measures was limited, each measure was associated with similar increased risks of adverse caregiver and child health status.

Teaching the Social Determinants of Health: A Path to Equity or a Road to Nowhere?
M. Sharma, A.D. Pinto, & A.K. Kumagai
Academic Medicine
The authors of this commentary argue that medical education needs to change how it presents social determinants of health, from "facts to be known" to "conditions to be challenged and changed," in order to foster an active commitment to social justice among medical trainees.