January 2018 Research Round-Up

Below we highlight recent literature on screening for and/or addressing social needs in clinical settings. Find these and many more in our searchable Evidence Library.

Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients
R Amarashingham, B Xie, A Karam, N Nguyen, & B Kapoor
The Commonwealth Fund
This issue brief reviews the landscape of social service – health integration efforts and identifies five common challenges: inadequate strategies to sustain cost-savings, improvement, and funding; lack of accurate and timely measurement of return on investment; lack of mechanisms to share potential savings between health care and social services providers; lack of expertise to integrate multiple data sources during health care or social services provision; and lack of a cross-sector workflow evidence base.

Addressing Population Health: Integrators in the Accountable Health Communities Model
A Billioux, PH Conway, & DE Alley
Journal of the American Medical Association
The authors of this article outline the essential functions of the community integrators at the core of the Centers for Medicare and Medicaid Services’ Accountable Health Communities model and the potential learnings from each type of awardee filling this role.

Cross-Sectoral Partnerships by Area Agencies on Aging: Associations with Health Care Use and Spending
AL Brewster, S Kunkel, J Straker, & LA Curry
Health Affairs
This study found that US counties whose Area Agencies on Aging (AAA) maintained informal partnerships with a broad range of organizations in health care and other sectors had significantly lower hospital readmission rates, compared to counties whose AAAs had informal partnerships with fewer types of organizations.

Measures of SES for Electronic Health Record-Based Research
JA Casey, J Pollak, MM Glymour, ER Mayeda, AG Hirsch, & BS Schwartz
American Journal of Preventive Medicine
This study found that receipt of medical assistance is an imperfect proxy for socio-economic status, highlighting the need for better data on socio-economic status in electronic health records.

Development of a Screening Tool Enabling Identification of Infants and Toddlers at Risk of Family Abuse and Neglect: A Feasibility Study from Three South European Countries
L Ezpeleta, R Perez-Robles, KA Fanti, et al.
Child: Care, Health, & Development
This study reports on the development of a new screening tool for the detection of child abuse in primary care in Cyprus, Greece, and Spain.

The Inherent Fallibility of Validated Screening Tools for Social Determinants of Health
A Garg, RC Sheldrick, & PH Dworkin
Academic Pediatrics
The authors of this article present the limitations of social needs screening currently implemented in clinical settings and argue for clinical approaches for addressing social determinants of health beyond validated screening tools.

Social Determinants of Health Series: Transportation and the Role of Hospitals
Health Research & Educational Trust
This guide explains the link between transportation and health and discusses the role of hospitals and health systems in improving transportation access and helping design and support better transportation options.

ED-Based Care Coordination Reduces Costs for Frequent ED Users
MP Lin, BB Blanchfield, RM Kakoza, et al.
American Journal of Managed Care
This small randomized controlled study evaluated a care coordination program involving a community health worker who assisted frequent ED users with navigating care and identifying unmet social needs and an ED-based clinical team that developed interdisciplinary acute care plans. The authors found that those assigned to the intervention had fewer ED visits and hospitalizations and lower direct costs, although differences were not statistically significant.

Addressing the Social Determinants of Health Through Medicaid Managed Care
D Machledt
The Commonwealth Fund
This issue brief analyzes the implications of the 2016 updates to the Medicaid Managed Care Rule on states’ ability to address social determinants through managed care. The author finds that several provisions in the new rule, including allowing certain nonclinical services to be included as covered services when calculating the capitated rate and medical loss ratios, signal CMS's intent to increase access to high-value nonmedical interventions.

Integrating Community Health Workers Into Medical Homes
EA Rogers, ST Manser, J Cleary, AM Joseph, EM Harwood, & KT Call
Annals of Family Medicine
This qualitative study examined facilitators and barriers to utilizing a CHW model within patient-centered medical homes (PCMHs) in Minnesota and roles played by this workforce within the PCMH team. Facilitators and barriers to utilizing a CHW model included the presence of leaders with knowledge of CHWs who championed the model, a clinic culture that favored innovation, clinic prioritization of patients' nonmedical needs, and leadership perceptions of sustainability.

Multisector Partnerships Need Further Development to Fulfill Aspirations for Transforming Regional Health and Well-Being
B Siegel, J Erickson, B Milstein, & KE Pritchard
Health Affairs
This study assessed 145 regional multisector partnerships against a set of criteria to determine how well prepared they are to lead transformative efforts to improve health and well-being in their communities. The authors found that most of these groups lacked certain characteristics that seem necessary to transform regional health systems.

Primed: Addressing Social Factors in the Health Care Safety Net
L Smith, P Sion, A Stevenson, P Kasen, & N Harstad
California Healthcare Foundation
This report, based on interviews with CA safety net hospitals, clinics, and health plans, highlights the opportunities for technological innovation to help safety net health systems and plans understand and address their patients’ medical and social needs.

Disclosing Gender-Based Violence During Health Care Visits: A Patient-Centered Approach
JR Williams, RM Gonzalez-Guarda, V Halstead, J Martinez, & L Joseph
Journal of Interpersonal Violence
This qualitative study examined victim’s perspectives regarding decisions to disclose gender-based violence to health care providers through interviews with 25 women who had experienced human trafficking or intimate partner violence. The authors identified key themes that may facilitate or impede disclosure including: patient-provider connectedness, children, and social support. Victims of human trafficking were more fearful of judgment and had a stronger desire to keep experiences private.

Health Center-Based Medical-Legal Partnerships: Where They Are, How They Work, and How They are Funded
A Williamson, J Trott, & M Regenstein
National Center for Medical Legal Partnership
This issue brief describes how and where health center-based medical-legal partnerships operate, how state primary care associations are supporting these programs, and discusses how they are financed, with a spotlight on four states that integrate financing for legal services in Medicaid payment arrangements.