July 2017 Research Round-Up

See below for publications recently added to the 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!

Student Hotspotting: Teaching the Interprofessional Care of Complex Patients
P. Bedoya, K. Neuhausen, A. Dow, E.M. Brooks, D. Mautner, R.S. Etz
Academic Medicine
Presented in this paper are reflections from the five-student Virginia Commonwealth University (VCU) hotspotting team participating in the Camden Coalition of Healthcare Providers and the Association of American Medical Colleges Interprofessional Student Hotspotting Learning Collaborative. VCU students indicated that the program was successful in teaching students how social determinants affect health and the benefits of interprofessional teamwork for addressing the unmet health and social needs of complex patients.

Screening for Social Determinants of Health in Michigan Health Centers
E. Byhoff, A.J. Cohen, M.C. Hamati, et al.
Journal of the American Board of Family Medicine

This authors of this study investigate and characterize how social determinants of health (SDH) screening is incorporated into routine clinical practice in health centers that serve disadvantaged patient populations. Broad empiric consensus on a core set of 13 SDH screening domains that align with nationally recommended screening guidelines was observed.

A Social Needs Assessment Tool for an Urban Latino Population
B.A. Careyva, R. Hamadani, T. Friel, C.A. Coyne
Journal of Community Health

The authors of this study present results of focus groups that explored priority social needs, images to depict social need categories, and acceptability of a computer-based program to identify these needs. Though unmet social needs were identified across all groups, 36-64 year olds and Spanish-speaking Hispanic patients were disproportionately impacted by unmet social needs. Most participants noted that a tablet computer was an acceptable venue to share social needs, though a tutorial may be needed for patients in the 65 and older group.

Replicating Effective Models of Complex Care Management for Older Adults
K. Coburn, C. Grinberg, S. Demuynck, M. Hawthorne
Health Affairs Blog

The authors of this commentary discuss challenges and opportunities to innovating and replicating effective models of care for older adults with complex health and social needs. Authors note that models of care that are readily scalable have limited effectiveness, and effective models of complex care management are difficult to scale. The authors highlight the need for robust evaluation in order to learn how to spread effective programs.

A community resource map to support clinical-community linkages in a randomized controlled trial of childhood obesity, eastern Massachusetts, 2014-2016
L. Fiechtner, G.C. Puente, M. Sharifi, et al.
Preventing Chronic Disease

This study describes the development and validation of an online interactive community resources map to improve outcomes for children at high risk for obesity. Parents reported that they were very satisfied with the information they received. Parent resource knowledge, ability to access resources, and use of community resources increased over time, and did not differ by whether participants received the online map or a mailed paper list of community resources.

Patient Engagement at the Margins: Health Care Providers' Assessments of Engagement and the Structural Determinants of Health in the Safety-Net
M.D. Fleming, J.K. Shim, I.H. Yen, et al.
Social Science & Medicine

This ethnographic study found that health care providers serving high cost patients, who often face complex social and economic hardships, consider patient engagement assessments to be highly challenging and oftentimes inaccurate, because they understood low patient engagement to be the result of difficult socioeconomic conditions. For marginalized patients, providers often looked for more subtle and intuitive signs of engagement.

Developing electronic health record (EHR) strategies related to health center patients' social determinants of health
R. Gold, E. Cottrell, A. Bunce, et al.
The Journal of American Board of Family Medicine

Standardizing social determinants of health (SDH) data collection and presentation in electronic health records (EHRs) could lead to improved patient and population health outcomes in community health centers (CHCs) and other care settings. This authors of this article present an example of a process through which stakeholder input informed the development of a preliminary set of EHR-based SDH data collection, summary and referral tools for CHCs.

A Systematic Review of Interventions on Patients' Social and Economic Needs
L.M. Gottlieb, H. Wing, N.E. Adler
American Journal of Preventive Medicine

This systematic review is a comprehensive picture of the evaluation landscape of nonmedical social needs interventions integrated into U.S. health care delivery systems. To date, evaluations have focused primarily on process and social outcomes and are often limited by poor study quality. Higher-quality studies that include common health and health care utilization outcomes would advance effectiveness research in this rapidly expanding field.

In focus: Creating Pathways and Partnerships to Address Patients’ Social Needs. Transforming Care: Reporting on Health System Improvement
M. Hostetter & S. Klein
The Commonwealth Fund

The authors of this e-newsletter introduction provide an overview of how new technologies and payment models can support efforts by health care providers and health care plans to assess patients’ nonmedical risks and work with nonprofit agencies, social services providers, and other community partners to help address them.

Leveraging Technology to Find Solutions to Patients’ Unmet Social Needs. Transforming Care: Reporting on Health System Improvement
S. Klein & M. Hostetter
The Commonwealth Fund

In this newsletter item Klein & Hostetter highlight the emergence of electronic community resource locators and referral systems designed to enable providers to connect patients to needed community resources and to track referrals to these resources. The authors describe two of the vendors in this space: One Degree and NowPow.

Effective Care for High-Needs Patients - Opportunities for Improving Outcomes, Value, and Health
P. Long, M. Abrams, A. Milstein, et. al.
National Academy of Medicine

This National Academy of Medicine Special Publication presents the results of three workshops on improving care for high-needs patients. As part of the attributes of promising care models, the report identifies the need to carry out a multidimensional patient assessment that includes social needs, to extend care to the community and the home.

The Highland Health Advocates: A Preliminary Evaluation of a Novel Programme Addressing the Social Needs of Emergency Department Patients
L.I. Losonczy, D. Hsieh, M. Wang, et al.
Emergency Medicine Journal

This study examines the patient acceptability and impact of an ED-based help desk and medical-legal partnership staffed by undergraduate volunteers. The majority of patients who accessed the help desk found it helpful and were more often linked to a resource (59% vs 37%) and a medical home (92% vs 76%) than patients who received usual care on days with no help desk. There was no difference found in ED utilization, primary need resolution, or self-reported health status during this preliminary, quasi-experimental study.

Community Health Workers Bring Cost Savings to Patient-Centered Medical Homes
M.L. Moffett, A. Kaufman, A. Bazemore
Journal of Community Health

This study estimates the cost impacts of the Patient Centered Medical Home (PCMH) and the Integrated Primary Care and Community Support (I-PaCS) model, which uses community health workers (CHWs) to both coordinate care and help address patients’ social determinants of health. The programs were found to be complementary, with the I-PaCS program enhancing the cost reduction capability of the PCMH.

Does the Supplemental Nutrition Assistance Program Affect Hospital Utilization Among Older Adults? The Case of Maryland
L.J. Samuel, S.L. Szanton, R. Cahill, et al.
Population Health Management

In an examination of dually enrolled Maryland residents, the authors of this study found that Supplemental Nutrition Assistance Program (SNAP) participation was associated with reduced hospitalization, but not emergency department use. Further, the authors estimate that enrolling the 47% of the 2012 population who were eligible nonparticipants in SNAP could have saved $19 million in hospital costs.

Adding Social Determinant Data Changes Children's Hospitals' Readmissions Performance
M.R. Sills, M. Hall, G.J. Cutler, et al.
Journal of Pediatrics

This study tests whether social determinants of health (SDH) risk adjustment changes hospital-level performance on the 30-day Pediatric All-Condition Readmission (PACR) measure. Adjustment for SDH made small but significant improvements in fit and accuracy of discharge-level PACR models, with a larger effect at the hospital level, changing decile-rank for 17 of 47 hospitals.

ICD Social Codes: An Underutilized Resource for Tracking Social Needs
J.M. Torres, J. Lawlor, J.D. Colvin, et al.
Medical Care

ICD-9 V codes could be used to capture social determinants of health data in electronic health records. The authors of this study explored how ICD-9 SDH V codes were used in a national inpatient discharge database. The authors found that SDH V codes were used in less than 2% of discharges overall. Use was highest for diagnostic categories related to mental health and alcohol/substance use.