Social risk-informed decision support and blood pressure control in a primary care cluster randomized controlled trial

PURPOSE: Health care systems increasingly incorporate social risk data into electronic health records (EHRs) to address needs like food, housing, and transportation insecurity. This study evaluated whether EHR-integrated social clinical decision support (SCDS) tools improved control of blood pressure (BP) and hemoglobin A(1c) (HbA(1c)) and increased social risk-informed care and documentation in community-based clinics. 

METHODS: We conducted a cluster randomized trial in a large primary care network. This pragmatic trial was designed to assess tool impact in real-world clinic conditions. Six clinics received SCDS tools embedded in the EHR; 44 clinics served as controls. The tools supported clinic-wide workflows and targeted decision support. A screening alert was triggered for adult patients lacking up-to-date social risk screening. Additional components were activated for patients with uncontrolled hypertension or diabetes, or with a diagnosis of either condition combined with a visit no-show rate of at least 50%. Primary outcomes were BP and HbA(1c) control. Secondary outcomes included social risk screening and documentation. Generalized linear mixed models accounted for patient clustering. We also examined use patterns of individual tool components. 

RESULTS: Blood pressure control improved over 12 months in both arms, with significantly greater improvement in intervention clinics. Control of HbA(1c) showed no significant differences. Intervention clinics had significantly greater odds of social risk screening and documentation. Use of individual SCDS tool components varied widely across clinics. 

CONCLUSION: Access to EHR-integrated SCDS tools was associated with increased documentation of social risks and greater improvements in BP control. These findings support embedding social risk data into clinical workflows to enhance chronic disease management in primary care.