September 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.

Research Articles

Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: Updated modelling based on an MRC phase IV observational pragmatic implementation study
E.C. Barbosa, T.I. Verhoef, S. Morris, et al.
BMJ Open
This study modeled the cost effectiveness and quality-adjusted-life-year (QALY) impacts of a UK-based intervention to train primary care physicians in screening and referral for domestic violence and abuse. Using real world cost and effectiveness data, the authors found the intervention saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval −£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval −0.005 to 0.006), although there is considerable uncertainty surrounding these results.

Using health information technology to bring social determinants of health into primary care: A conceptual framework to guide research
E.K. Cottrell, R. Gold, S. Likumahuwa, et al.
Journal of Health Care Poor for the Poor and Underserved
The authors describe how a conceptual framework illustrating the ways HIT can be used to bring SDH information into primary care was put into practice within the OCHIN network of community health centers.

Development and evaluation of sexual assault training for emergency department staff in Ontario, Canada
J. Du Mont, S. Solomon, S.D. Kosa, et al.
Nurse Education Today
Emergency room staff who participated in either an online or in-person training program to improve competence to address sexual assault reported improved perceived competence in responding to victims/survivors of sexual assault. Gains in competence were higher for in-person than online training participants.

Physician experiences and barriers to addressing the social determinants of health in the Eastern Mediterranean Region: A qualitative research study
L. Girgis, G. Van Gurp, D. Zakus, et al.
BMC Health Services Research
This qualitative study of physicians trained in Eastern Mediterranean countries found a awareness of social needs and willingness to help patients address them. Common barriers to addressing patients' social needs included cultural constraints, lack of time, and lack of referral resources.

Adoption of Social Determinants of Health EHR Tools by Community Health Centers
R. Gold, A. Bunce, S. Cowburn, et al.
The Annals of Family Medicine
This mixed methods study assessed the feasibility of implementing EHR tools for collecting, reviewing, and acting on SDH data into three community health centers. Lessons learned on adoption of EHR SDH tools indicate that clinics should: consider how to best integrate tools into existing workflow processes; ensure that staff tasked with SDH efforts receive adequate tool training and access; and consider that timing of data entry impacts how and when SDH data can be used.

Uses and misuses of patient- and neighborhood-level social determinants of health data
L.M. Gottlieb, D.E. Francis, A.F. Beck
The Permanente Journal
The authors present four case examples from different health care organizations to illustrate strengths and limitations of using patient- or neighborhood-level social and economic needs data to inform a range of interventions related to patients’ social determinants of health.

Implementation of a comprehensive program to improve coordination of care in an urban academic health care system
Y.L. Hsiao, E.B. Bass, A.W. Wu, et al.
Journal of Health Organization and Management
This paper describes design and implementation of the Johns Hopkins Community Health Partnership (J-CHiP), a care coordination program that included building partnerships with community-based organizations.

The Importance of Governmental and Nongovernmental Investments in Public Health and Social Services for Improving Community Health Outcomes
J.M. McCullough, S.R. Singh, J.P. Leider
Journal of Public Health Management and Practice
This longitudinal observational study of US counties found that hospitals' provision of community health services contributed to improved health outcomes.

Social Determinants As Public Goods: A New Approach To Financing Key Investments In Healthy Communities
L.M. Nichols, L.A. Taylor
Health Affairs
The authors propose a collaborative approach to financing investments in social determinants of health to enable self-interested stakeholders to earn a financial return on their investments.

Employment interventions in health settings: A systematic review and synthesis
A.D. Pinto, N. Hassen, A. Craig-Neil
The Annals of Family Medicine
The authors of this systematic review of employment interventions implemented in health care settings found that most interventions targeted people with mental illness and three-quarters improved employment. The authors identified 5 key features of successful interventions: (1) a multidisciplinary team that communicates regularly and collaborates, (2) a comprehensive package of services, (3) one-on-one and tailored components, (4) a holistic view of health and social needs, and (5) prospective engagement with employers.

Screening pediatric patients for food insecurity: A retrospective cross-sectional study of comorbidities and demographic characteristics
R. Rongstad, M. Neuman, P. Pillai, et al.
Wisconsin Medical Society
This paper describes results of food-insecurity screening in the UW Health Pediatrics Department. Over the course of 8 months, 30/1330 (2%) patients screened positive for food insecurity. Food insecurity was associated with public or no insurance and diagnoses of anemia and ADD/ADHD.

Implementation of routine electronic health record-based child abuse screening in general emergency departments
J. Rumball-Smith, J. Fromkin, B. Rsosenthal, et al.
Child Abuse & Neglect
This paper reports on the implementation of an EHR-based child abuse screen in emergency departments.

The effects of five social determinants on the health of children with chronic diseases in British Columbia
M. Seear, S. Amed, J. Dionne, et al.
Pediatrics & Child Health
To inform the integration of social needs screening into routine multidisciplinary outpatient clinics, the authors investigated the association of five social determinants (distance from care, family income, gender, ethnicity, and caregiver education), with health outcomes in children with cystic fibrosis, type 1 diabetes, and chronic kidney disease. They found low family income was associated to worse health outcomes in all three groups and lower caregiver education to two groups' health outcomes.

Self-Identified Social Determinants of Health during Transitions of Care in the Medically Underserved: a Narrative Review
A. Virapongse, G.J. Misky
Journal of General Internal Medicine
This review of the literature examined and categorized social barriers to care transitions following an episode of acute care. Common social factors affecting care transitions were cost of medications, access to care, housing instability, and transportation.

Reports

Safe & Affordable Housing: Social Determinants of Health
America’s Health Insurance Plans
This issue brief gives an overview of strategies used by health insurance providers to provide access to affordable housing and how providers can collaborate with community partners.

Supporting social service and health care partnerships to address health-related social needs: Case study series
Center for Health Care Strategies
These case studies illustrate different models of collaboration between CBOs and health care organizations and provide examples of how successful partnerships deliver services, share information, secure funding, engage their communities, and evaluate success.

Data support considerations in Medicaid accountable care organization programs
J. Lloyd
Center for Health Care Strategies
Medicaid accountable care organizations (ACOs) need data on their attributed populations to successfully improve health outcomes and manage patients’ total cost of care.

Using the law to inform empowered patient care: The story of the evolving medical-legal partnership at People's Community Clinic with Texas Legal Services Center
K. Marple
National Center for Medical Legal Partnership
This report describes the development of a medical legal partnership at the People's Community Clinic, an Austin, TX FQHC, in partership with the Texas Legal Services Center, a non-profit legal aid agency.

Permanent supportive housing: Evaluating the evidence for improving health outcomes among people experiencing chronic homelessness
National Academies of Sciences, Engineering, and Medicine
This National Academies report on permanent supportive housing (PSH) finds that, except for some evidence that PSH improves health outcomes among individuals with HIV/AIDS, there is no substantial published evidence as yet to demonstrate that PSH improves health outcomes or reduces health care costs.

Policy leadership for health care transformation
Nemours Children’s Health System, Public Health Institute
Moving Healthcare Upstream
This report summarizes the work of Policy Leadership for Health Care Transformation, a year-long project focused on identifying institutional policies and civic engagement strategies that can be used by hospitals and health systems to sustain and scale practices that address social determinant of health challenges in local communities.