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January 2024 Research Round-Up

 - SIREN Staff
Medical Professionals

Below is a list of recently published research related to integrating social and medical care (and in some cases we have provided summaries of the results). See more articles like these in the searchable SIREN Evidence Library. As always, if you are aware of resources you think should be added to the Evidence Library, please send them our way!

Peer-Reviewed Articles


Leveraging Technology and Workflow Optimization for Health-Related Social Needs Screening: An Improvement Project at a Large Health System Angah N, Meedzan B, Pruzinsky N, et al. | Joint Commission Journal on Quality and Patient Safety

Health-Related Social Needs Screening: Promising Practices From the Accountable Health Communities Model Bosold A, Abrams Weintraub T, Cowen K, Talwar-Hebert M, Abowd Johnson K, Barolín N | Health Promotion Practice

Evaluation of a Clinic-Based, Electronic Social Determinants of Health Screening and Intervention in Primary Care Pediatrics Stark K, Mathur M, Fok C, et al. | Academic Pediatrics

Screening for Social Determinants of Health During Primary Care and Emergency Department Encounters Vilendrer S, Thomas SC, Belnap T, et al. | JAMA Network Open

Missed Screening for Adverse Social Determinants of Health and Emergency Department Utilization Samuels-Kalow ME, Mayes K, Cash RE, et al. | Annals of Emergency Medicine

ParallelED—A Novel Screening and Referral Intervention using Emergency Department Wait Times to Identify and Address Unmet Social Needs Purakal J, Moon G, Lee G, et al. | Journal of the American College of Emergency Physicians Open

Finding Social Need-les in a Haystack: Ascertaining Social Needs of Medicare Patients Recorded in the Notes of Care Managers Shafer PR, Davis A, Clark JA | BMC Health Services Research

Prevalence of Homelessness Among Hospitalized Patients: A Point-In-Time Survey Mistry N, Knoeckel J, McBeth L, et al. | Journal of Hospital Medicine

See accompanying commentary here

Prevalence and Correlates of Unmet Medical and Social Needs in Virginia's Medicaid Managed Long Term Services and Supports Program Marks SJ, Saunders H, Shadowen H, et al. | Medical Care


The Camden Coalition Care Management Program Improved Intermediate Care Coordination: A Randomized Controlled Trial Finkelstein A, Cantor JC, Gubb J, et al. |  Health Affairs 

This re-analysis of data from the Camden hotspotting RCT found that the Camden care management program increased the % of patients with an ambulatory care visit within 14 days of discharge. This suggests that care coordination alone may be insufficient to reduce readmissions for patients with high rates of hospital admissions and medically and socially complex conditions. 

Want to learn more about this topic? Stay tuned for a SIREN webinar later this year. 

Addressing Social Needs in Clinical Settings: Implementation and Impact on Health Care Utilization, Costs, and Integration of Care Chuang E, Safaeinili N | Annual Review of Public Health 

This review found that current evidence regarding the effectiveness of HRSN interventions in clinical settings remains limited and mixed.

Phone Versus In-Person Navigation of Social Needs and Caregivers' Desire for Resources in the Pediatric Emergency Department Messineo E, Bouchelle Z, Strange A, et al. | Academic Pediatrics 

Within a large, urban peds-ED, caregivers' desires for community-based resources did not differ based on whether they were engaged in-person or by phone.

Social Workers Roles in Achieving Health Quality Metrics in Primary Care: A Quality Improvement Case Study Lombardi BM, de Saxe Zerden L, Prentice A, Downs SG | Social Work in Health Care

Addressing Health-Related Social Needs and Mental Health Needs in the Neonatal Intensive Care Unit: Exploring Challenges and the Potential of Technology van de Kamp E, Ma J, Monangi N, et al. | International Journal of Environmental Research and Public Health

The Social Determinants of Health, Social Work, and Dental Patients: A Case Study Burgess-Flowers J, de Saxe Zerden L, Yokovich K |  Social Work in Health Care

Caregivers' and Providers' Perspectives of Social and Medical Care after Pediatric Liver Transplant: Results from the Multi-center SOCIAL-Tx Study Wadhwani SI, Alvarado A, Shifman HP, et al. | Liver Transplantation

Food interventions

Effect of an Intensive Food-as-Medicine Program on Health and Health Care Use: A Randomized Clinical Trial Doyle J, Alsan M, Skelley N, Lu Y, Cawley J | JAMA Internal Medicine 

In this randomized clinical trial among adult participants, an intensive food-as-medicine program increased engagement with preventive health care but did not improve glycemic control compared with usual care.

Healthcare-Based Food Assistance Programmes in the United States: A Scoping Review and Typology Rudel RK, Byhoff E, Strombotne KL, Drainoni ML, Greece JA | Journal of Nutritional Science

Risk Adjustment and Payment Models 

Latent Class Analysis of Social Needs in Medicaid Population and its Impact On Risk Adjustment Models Pandya CJ, Wu J, Hatef E, Kharrazi H | Medical Care

Investing in Child Health Through Alternative Payment Models: Lessons From North Carolina Integrated Care for Kids James G, Kasper E, Wong CA, et al. | Medical Care Research and Review

Commentaries & Blogs

Measured Twice: Time for the Expansion of Social Care Interventions and Patient-Centered Outcomes Cullen D, Samuels-Kalow ME | Annals of Emergency Medicine

Social Workers are Key to Addressing Social Determinants of Health in Integrated Care Settings Petruzzi L, Milano N, Chen Q, Noel L, Golden R, Jones B | Social Work in Health Care

Balancing Investments in Health Care and Social Determinants—The Need for Benefit-Cost Analysis Glied S, Robinson LA | JAMA Health Forum

Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health Berkowitz SA | Milbank Quarterly  

Note that Drs. Glied and Berkowitz will be panelists in our Feb 28th webinar on Health Sector's Role in Social Care”

Interventions Addressing Health-Related Social Needs Among Patients with Cancer Graboyes EM, Lee SC, Lindau ST, et al. | Journal of the National Cancer Institute

Reports & Policy Briefs

Consumers’ Perceptions of Their Health-Related Social Needs Baer T, Esho A, Leonard S, Mandel A, VanLare J | McKinsey’s Healthcare Practice 

Assessing Social Drivers of Health | The Root Cause Coalition