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. 2021 Jan-Dec:12:21501327211024390.
doi: 10.1177/21501327211024390.

Factors Associated with Patients' Connection to Referred Social Needs Resources at a Federally Qualified Health Center

Tyler Lian  1 , Kate Kutzer  2 , Diwas Gautam  2 , Howard Eisenson  3 , Jane C Crowder  3 , Emily Esmaili  3 , Sahil Sandhu  2 , Lawrence Trachtman  3 , Janet Prvu Bettger  4   5 , Connor Drake  1
Affiliations

Factors Associated with Patients' Connection to Referred Social Needs Resources at a Federally Qualified Health Center

Tyler Lian et al. J Prim Care Community Health. 2021 Jan-Dec.

Abstract

Introduction: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study aimed to identify factors associated with the successful connection (ie, services started) to social needs resources, as well as factors associated with an attempt to connect as a secondary, intermediate outcome.

Methods: This retrospective cohort study included patients who had been screened, referred, and subsequently reached for follow-up navigation from March 2019 to December 2020, as part of a social needs intervention at a federally qualified health center (FQHC). Measures included demographic and social needs covariates collected during screening, as well as resource-related covariates that characterized the referred resources, including service domain (area of need addressed), service site (integration relative to the FQHC), and access modality (means of accessing services).

Results: Of the 501 patients in the analytic sample, 32.7% had started services with 1 or more of their referred resources within 4 weeks of the initial referral, and 63.3% had at least attempted to contact 1 referred resource, whether or not they were able to start services. Receiving a referral to resources that patients could access via phone call or drop-in visit, as opposed to resources that required additional appointments or applications prior to accessing services, was associated with increased odds (aOR 1.95, 95% CI 1.05, 3.61) of connection success, after adjusting for age, sex, race, ethnicity, education, number of social needs, and resource-related characteristics. This study did not find statistically significant associations between connection attempt and any variable included in adjusted analyses.

Conclusion: These findings suggest that referral pathways may influence the success of patients' connection to social needs resources, highlighting opportunities for more accessible solutions to addressing patients' unmet social needs.

Keywords: access to care; community health centers; needs assessment; primary care; referral and consultation; social determinants of health; underserved communities.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CD reports a financial relationship with ZealCare, Inc.

Figures

Figure 1.
Figure 1.
Eligibility of screened patients for inclusion in analysis.
See this image and copyright information in PMC

References

    1. Social Determinants of Health Literature Summaries. Healthy People 2030, U.S. Department of Health and Human Services. Accessed March 25, 2021. https://health.gov/healthypeople/objectives-and-data/social-determinants...
    1. Adler NE, Stewart J. Health disparities across the lifespan: meaning, methods, and mechanisms. Ann N Y Acad Sci. 2010;1186:5-23. - PubMed
    1. Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381-398. - PubMed
    1. Adler NE, Cutler DM, Fielding JE, et al.. Addressing social determinants of health and health disparities: a vital direction for health and health care. NAM Perspect. 2016;6:1-16.
    1. Alley DE, Asomugha CN, Conway PH, Sanghavi DM. Accountable health communities—addressing social needs through medicare and medicaid. N Engl J Med. 2016;374:8-11. - PubMed

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