November 2018 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.

US Preventive Services Task Force Research Article

Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation statement
US Preventive Services Task Force, S.J. Curry, A.H. Krist, et al.
JAMA
The USPSTF recommends that clinicians screen for IPV in women of reproductive age and provide or refer women who screen positive to ongoing support services (B recommendation).

Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: Evidence report and systematic review for the US Preventive Services Task Force
C. Feltner, I. Wallace, N. Berkman, et al.
JAMA
In this evidence review conducted to inform the recommendations of the USPTF on screening and interventions for IPV, elder abuse, and abuse of vulnerable adults, the authors found that while screening could correctly identify IPV, it did not improve IPV or quality of life.

Addressing intimate partner violence and abuse of older or vulnerable adults in the health care setting-beyond screening
E. Miller, S.R. Beach, & R.C. Thurston
JAMA Intern Med
This editorial reacts to the updated USPTF recommendations and the supporting evidence review. The authors argue for moving beyond a checklist approach to screening and referral for IPV, writing that universal education should be combined with routine inquiry and a care plan for survivors that considers their personal safety and connection to support.

Permanente Journal Supplement: Addressing Basic Resource Needs in Health Care Settings

• Toward addressing social determinants of health: A health care system strategy
  N.L. Friedman & M.P. Banegas
• Uses and misuses of patient- and neighborhood-level social determinants of health data
  L.M. Gottlieb, D.E. Francis, A.F. Beck
• Professional medical association policy statements on social health assessments and interventions
  G. Gusoff, C. Fichtenberg, & L.M. Gottlieb
• Perceptions and experience of patients, staff, and clinicians with social needs assessment
  C. Hamity, A. Jackson, L. Peralta, & J. Bellows
• Evaluation of the learning to integrate neighborhoods and clinical care project: Findings from implementing a new lay role into primary care teams to address social determinants of health
  C. Hsu, E. Hertel, E. Johnson, et al.
• Health care steps up to social determinants of health: Current context
  L. Solomon & M.H. Kanter
• Interventions to address basic resource needs in Kaiser Permanente: A care continuum and an outcomes wheel
  J.F. Steiner, J. Bellows, M.P. Banegas, et al.
• Measuring patients’ basic resource needs: The role of a small survey to guide operational decisions
  J.F. Steiner, T.K. Kimpo, C.I. Lawton, et al.
• Lessons Learned from Implementation of the Food Insecurity Screening and Referral Program at Kaiser Permanente Colorado
  S.H. Stenmark, J.F. Steiner, S. Marpadga, M. Debor, K. Underhill, & H. Seligman
• Universal screening for social needs in a primary care clinic: A quality improvement approach using the your current life situation survey
  K.R. Sundar
• The best year of Angela's life
  K.R. Sundar

Other Research Articles

Medical-legal partnership: Lessons from five diverse MLPs in New Haven, Connecticut
E.A. Benfer, A.R. Gluck, & K.L. Kraschel
J Law Med Ethics
This article examines five Medical-Legal Partnerships (MLPs) in New Haven working with distinct patient populations and proposes a research agenda that explores the full extent of the value of the lawyers in the MLP.

Better clinical care for obesity and diet-related diseases requires a focus on social determinants of health
S. Bleich & C.G. Dunn
NEJM Catalyst
This comprehensive piece summarizes why and how health systems should address health-related social needs to improve obesity treatment outcomes and identifies evidence gaps that need to be filled to facilitate health system transformation.

The role of community health needs assessments in medicalizing poverty
A. Caffrey, C.Pointer, D. Steward, et al.
J Law Med Ethics
This paper examines the history of community benefit legislation, how community benefit dollars are allocated, and innovative practices by a few hospitals and communities that are addressing primarily non-medical factors that influence health such as social disadvantage, attitudes, beliefs, risk exposure, and social inequalities.

Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities A randomized clinical trial
S. Kangovi, N. Mitra, L. Norton, et al.
JAMA Intern Med
This multicenter randomized clinical trial among low income patients with 2 or more chronic diseases found that 6 months of tailored support by a community health worker increased patient reports of high-quality primary care and reduced hospitalizations. No differences were observed in patient self-reported health.

Data collection, EHRs, and poverty determinations
C. Konnoth
J Law Med Ethics
This article examines how poverty-related data for use in precision medicine are collected, how to incentivize collection, and how to improve the quality of data collected.

The time is now: Fostering relationship-centered discussions about patients' social determinants of health
A. Schoenthaler, I. Hassan, & K. Fiscella
Patient Educ Couns
This paper uses the relationship-centered care framework to provide recommendations for how to foster meaningful discussions about SDOH at three points in the care process: 1) at the initial screening; 2) once an unmet social need has been identified; and 3) when exchanging SDOH data with team members and external organizations.

Screening for toxic stress risk factors at well-child visits: The Addressing Social Key Questions for Health study
K. Selvaraj, M.J. Ruiz, J. Aschkenasy, et al.
J Pediatr
This article reports on the use of a new 13-question screen of adverse childhood experiences and unmet social needs at well-child visits. Among 2,569 families screened, 47% reported one or more unmet need but only 6% reported one or more ACE. Community referral rates increased after screening implementation. Nearly 9 in 10 families among a subsample want clinics to continue screening.

Identifying opportunities to improve intimate partner violence screening in a primary care system
L. Sharples, C. Nguyen, B. Singh, et al.
Fam Med
This retrospective chart review at five primary care clinics within a university-based network in Northern California found a 22% rate of screening for IPV with wide variations between clinics. Screening initiated by medical assistants resulted in significantly more documented screens than screening delivered by physicians (74% vs. 9%).

Capturing social health data in electronic systems: A systematic review
A.Venzon, T.B. Le, & K. Kim
Comput Inform Nurs
This systematic review explored the current state of social determinants of health data in electronic systems in the literature, specifically (1) how the data are currently collected, captured, and coded; (2) the modes employed to capture these data; and (3) the electronic systems used to acquire data. Social health data were rarely found in electronic health records. When these data were captured they were often manually captured in a structured format.

Reports

Inclusion and Exclusion Criteria for Complex Care Programs: Survey of Approaches
Center for Health Care Strategies
This technical assistance tool shares criteria used in 10 complex care programs to identify patients who can benefit from enhanced care coordination for health and social needs and also determine when to “graduate” patients out of their programs.

Decoding social determinants of health
M. Reidhead
Missouri Hospital Association
This policy brief evaluates the frequency and consistency of ICD-10 social needs coding for Missouri patients, uses data on codes to characterize socially complex patients compared to the larger population, and describes predictive properties of the codes in standard risk adjustment models of MO hospital superutilization.