The combined and comparative impacts of financial incentives versus practice facilitation implementation support for social risk screening in community health centers

OBJECTIVE: To examine the impact of two interventions aimed at increasing the adoption of social risk screening in community health centers (CHCs). 

STUDY SETTING AND DESIGN: Intervention CHCs were in one of three groups, which received either: (1) tailored practice facilitation-focused social risk screening implementation supports; (2) financial incentives for screening; and (3) both practice facilitation and financial incentives in staggered order. A group of control clinics was identified through propensity score matching and a difference-in-difference analysis compared effects across groups. 

DATA SOURCES AND ANALYTIC SAMPLE: Using electronic health record data, we calculated monthly rates of social risk screening (per 100 adult patients) at 32 intervention clinics (19 practice facilitation supports only, 6 financial incentives only, 7 both financial incentives and practice facilitation supports), and 32 control clinics. 

PRINCIPAL FINDINGS: Compared to control clinics, clinics in any intervention group had a greater increase in average monthly social risk screenings from pre- to post-intervention that was maintained over the 24 months following intervention (difference-in-difference: 4.66, 95% CI: 0.89, 8.43). In the primary analysis, clinics engaged in both interventions increased screening rates when practice facilitation implementation supports were added to financial incentives (12 months 3.70, 95% CI: 0.34, 7.07; 24 months 4.18, 95% CI: -0.01, 8.87); adding financial incentives to practice facilitation supports resulted in increased screening rates but did not reach statistical significance. 

CONCLUSIONS: This study is the first to compare different interventions intended to bolster CHCs' social risk screening activities. As social risk screening becomes increasingly tied to US policy and payment structures, it is critical to identify strategies that can support implementation in settings serving underserved populations. Our findings suggest modest impacts of both financial incentives and practice facilitation supports.