May 2019 Research Round-Up

Below we highlight recent literature on screening for and/or addressing social needs in clinical settings. To receive the Research Round-Up in your email, sign up for our monthly newsletter.

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

Journal Articles

Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems
H. Alderwick & L.M. Gottlieb
Milbank Q
The authors highlight key terms being used in work related to social determinants of health in US health care settings. They propose an initial set of definitions for these terms and make distinctions between concepts commonly conflated or confused.

Medicaid Investments to Address Social Needs in Oregon and California
H. Alderwick, C.M. Hood-Ronick, & L.M. Gottlieb
Health Affairs
The authors of this qualitative study examine how Oregon and California support social interventions-including direct services like housing, food, and legal assistance as well as capacity-building programs for health care and community-based organizations.

Association between Receipt of a Medically Tailored Meal Program and Health Care Use
S.A. Berkowitz, J. Terranova, L. Randall, K. Cranston, D.B. Waters, & J. Hsu
JAMA Internal Medicine
In this cohort study of 1,020 adults that used a combined instrumental variable analysis and matching approach, participation in a medically tailored meal delivery program was associated with reduced inpatient admissions. Also see the accompanying commentary, Food is Medicine – The Promise and Challenges of Integrating Food and Nutrition into Health Care by D. Mozaffarian, J. Mande, & R. Micha.

Implementing an EHR-Based Screening and Referral System to Address Social Determinants of Health in Primary Care
P. Buitron de la Vega, S. Losi, L. Sprague Martinez, et al.
Medical Care
This study assessed the feasibility of implementing THRIVE, a social risk screening and referral program, in General Internal Medicine Clinics at Boston Medical Center. Unemployment, food insecurity, and affording medications were the most commonly reported social risks. Patients and providers were willing to participate in the screening activities.

Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients
E. Byhoff, A. Garg, M. Pellicer, et al.
Journal of the American Board of Family Medicine
This mixed methods study of Boston-area community health centers found all screened for some social risks, but there was little consistency in domains covered across centers. Barriers and/or facilitators to screening were seen in five areas: 1) provider perspectives, 2) work flow, 3) prior experience, 4) site resources and staffing, and 5) sustainability.

Screening for Housing Instability: Providers' Reflections on Addressing a Social Determinant of Health
M. Chhabra, A.E. Sorrentino, M. Cusack, et al.
Journal of General Internal Medicine
This qualitative study of VA providers found that integrating housing instability screening into electronic medical records increased providers’ attention to housing instability. The authors also report that positive screens often impacted care plans.

Social Prescribing
C. Drinkwater, J. Wildman, & S. Moffatt
BMJ
This clinical update outlines what social prescribing is and offers suggestions around best practices for embedding social prescribing in healthcare delivery.

Bringing Social Context into Diabetes Care: Intervening on Social Risks Versus Providing Contextualized Care
D. Hessler, V. Bowyer, L. Shields-Zeeman, et al.
Current Diabetes Reports
This review examines evidence supporting social risk-targeted and social risk-informed approaches to diabetes care.

Association of Social and Behavioral Risk Factors with Earlier Onset of Adult Hypertension and Diabetes
M.S. Pantell, A.A. Prather, J.M. Downing, N.P. Gordon, & N.E. Adler
JAMA Network
This prospective cohort study examining National Academy of Medicine-recommended social and behavioral risk factor domains to incorporate in EHRs found cumulative social and behavioral risk was significantly associated with earlier onset of hypertension and diabetes.

A 60-Second Survey to Identify Patients’ Unmet Social Needs
S.R. Reves, J.P. O’Neal, M.M. Gonzalez, et al.
Annals of Family Medicine
A brief social risk screener deployed in both a General Internal Medicine inpatient unit and Emergency Department had high uptake among patients and caused minimal disruption to nursing workflow.

Clinician Experiences and Attitudes Regarding Screening for Social Determinants of Health in a Large Integrated Health System
A. Schickedanz, C. Hamity, A. Rogers, A.L. Sharp, & A. Jackson
Medical Care
In this survey of 258 clinicians working in a large integrated health system, most respondents (84%) supported social needs screening in clinical settings but fewer (41%) expressed confidence in their ability to address social needs. Less than a quarter of respondents currently screen routinely for social needs.

Necessary but Not Sufficient: Why Health Care Alone Cannot Improve Population Health and Reduce Health Inequities
S.H. Woolf
Annals of Family Medicine
The author describes three current levels of health system engagement in addressing social needs (assessment, connection to resources, and community investments) and argues for greater societal investment in social care and supportive public policies.

Reports

Making the Case for Hospitals to Invest in Housing
American Hospital Association
This brief focuses on how hospitals address social determinants through investments in affordable housing and outlines a framework to help health care organizations assess their local community investments.