Non-clinical drivers of health outcomes, also called contextual factors influencing health outcomes or medical and non-medical health-related needs (such as housing instability or food insecurity), can negatively impact patients’ health. Screening for non-clinical drivers of health outcomes in clinical settings is a critical step towards addressing these patterns, but implementing such screening can be very challenging. To identify best practices for addressing such challenges, researchers from OCHIN partnered with the Kaiser Permanente Center for Health Research (KPCHR) and Oregon Health & Science University (OHSU) to test strategies for helping community health centers (CHCs) identify and address patients’ medical and non-medical health-related needs.

The ASCEND team published a new paper in the New England Journal of Medicine. Rachel Gold, PhD, MPH, lead research scientist at OCHIN and senior investigator at KPCHR, answered a few questions about the study, which looked at whether an implementation support intervention improved the adoption of screenings.

Q: What did you study and why?

Our contextual and financial circumstances play a crucial role in our health, and community-based clinics often screen patients for these factors to better support them. However, there are many barriers to conducting this screening process, such as navigating technological issues, determining which factors to screen for, and identifying how clinics can best support patients in need. Therefore, over the last five years, we studied whether providing six months of adaptive coaching, plus training in how to use related EHR tools, helped community-based clinics implement efforts to identify and assess patients’ non-clinical drivers of health outcomes.

Q: What did you learn?

We tracked clinics for at least six months before they received the implementation support intervention, during the six-month intervention, and at least six months after the intervention. We saw significantly increased (2.45 times) rates of screening during the support process, indicating that clinics benefitted from electronic health record (EHR) training and coaching while it was being provided. However, this increase was not sustained after the support period. Non-medical health-related needs referral rates and diabetes-related outcomes did not change.

While study results show that the provided support was effective at temporarily increasing screening, it is possible that the intervention did not adequately address all barriers to sustaining implementation or that six months was not long enough to cement this change. Giving clinics prolonged support might result in a sustained increase in screenings.

Q: Why does it matter?

It matters because many national initiatives are pushing health care providers to conduct medical and non-medical health-related needs screenings, which could impact these organizations’ reimbursement rates. For community-based clinics, this could have negative repercussions if there is an expectation that  screenings will be conducted without providing them with adequate resources to implement this practice. And since screening is a necessary prerequisite for clinics to make referrals or take any other actions on the screening results, it is really important to first get the screening (and resources to do so) dialed in.

Q: What was OCHIN’s role in this cross-organizational partnership?

OCHIN’s collaboration was huge! All of the study clinics were members of the OCHIN network. Additionally, Erika Cottrell, PhD, MPP, an investigator at OCHIN and an assistant professor at OHSU, served as the site PI and co-led the study alongside me—and many other OCHIN and OHSU scientists collaborated with us along the way.