Evidence & Resource Library

Search through our entire Evidence & Resource Library

The SIREN Evidence & Resource Library has expanded to include both peer-reviewed publications and other types of resources such as webinars and screening tools/toolkits on medical and social care integration. To limit your search to peer-reviewed articles, select Peer Reviewed Research under Resource Type. If you have questions about how to use the library or suggestions about additional resources, view this help document or write us at siren@ucsf.edu.

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Purpose of Study: To evaluate whether screening for homelessness during hospitalization and deploying outpatient care managers (CMs) to the inpatient setting to rapidly connect patients to community social services reduce hospital readmissions.

Publication year
2021
Resource type
Peer Reviewed Research

Social determinants matter for hospital readmission policy: Insights from New York City

M.C. Baker, P.M. Alberti, T.Y. Tsao, K. Fluegge, R.E. Howland, & M. Haberman
Health Aff

This study assessed the impact of individual social risk factor variables and social determinants of health (SDOH) measures on hospital readmission rates and penalties used in the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP).

Keywords: Risk adjustment
Publication year
2021
Resource type
Peer Reviewed Research

Background: Permanent supportive housing (PSH) programs have the potential to improve health and reduce Medicaid expenditures for beneficiaries experiencing homelessness. However, most research on PSH has been limited to small samples of narrowly defined populations.

Keywords: Primary care
Publication year
2021
Resource type
Peer Reviewed Research

Vulnerable populations have been identified as having higher infection rates and poorer COVID-19–related outcomes, likely due to their inability to readily access primary care, follow public health directives, and adhere to self-isolation guidelines.

Publication year
2021
Resource type
Peer Reviewed Research

Use of social determinants of health codes in home-based primary care

D. Coppa, S.B. Winchester, E. McAlvin, M.B. Roberts, & X. Maestri
J Am Assoc Nurse Pract

Background: The Affordable Care Act created funding for nurse practitioner education programs to transform the primary health care workforce through student awareness of how social, political, economic, and environmental factors influence individual and population health.

Publication year
2021
Resource type
Peer Reviewed Research

As payers are increasingly holding providers financially accountable for outcomes under value-based payment arrangements, there is growing concern that organizations caring for populations with greater social risk factors are unfairly penalized.

Keywords: Risk adjustment
Publication year
2021
Resource type
Commentaries & Blogs

Using malnutrition and food insecurity screening to identify broader health-related social needs amongst older adults receiving emergency department care in the Southeastern United States: A cross-sectional study

A.F. Aylward, J. Engelberg Anderson, A. Morris, M. Bush, B. Schmitthenner, R.B. Shams, F. Omofoye, S. Bodepudi, H. Roche, J. Cimpian, L. Wardlow, T.F. Platts-Mills
Health Soc Care Community

Unmet health‐related social needs are common amongst older US adults and impact both quality of life and health outcomes.

Publication year
2021
Resource type
Peer Reviewed Research