March 23, 2023
Social risks, also called adverse social determinants of health or SDOH (such as housing instability or food insecurity), can negatively impact patients’ health. Social risk screening 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’ social risks.
The ASCEND (Approaches to CHC Implementation of SDOH Data Collection and Action) 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 social risk screenings.
Q: What did you study and why?
Our social and environmental circumstances play a crucial role in our health, and community-based clinics often screen patients for social risks to better support them. However, there are many barriers to conducting this screening process, such as navigating technological issues, determining which social risks 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’ social risks.
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 social risk 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. Social risk referrals rates and diabetes-related outcomes did not change.
While study results show that the provided support was effective at temporarily increasing social risk 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 (such as Medicaid 1115 waivers) are pushing health care providers to conduct social risk screenings, which could impact these organizations’ reimbursement rates. For community-based clinics, this could have negative repercussions if there is an expectation that social risk 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.
Learn more: Additional OCHIN research on social drivers of health
- Adoption of social determinants of health EHR tools by community health centers
- National data on social risk screening underscore the need for implementation research
- Variation in electronic health record documentation of social determinants of health across a national network of community health centers
- Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs
- Comparison of community-level and patient-level social risk data in a network of community health centers
- Initiating and implementing social determinants of health data collection in community health centers
- Cross-sectional associations: social risks and diabetes care quality, outcomes