Clinician and Staff Perspectives on a Social Drivers of Health Program Implementation

References

1. 1.↵
   CDC. CDC Health Disparities and Inequalities Report—U.S.; 2011. Available at: https://reducedisparity.org/site/wp-content/uploads/2014/09/CDC-Health-Disparities-and-Inequalities-Report_2013.pdf#page=186.
2. 2.↵
   WHO C on SD of H. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health: Commission on Social Determinants of Health Final Report; 2008.
3. 3.↵
   1. Shier G,
   2. Ginsburg M,
   3. Howell J,
   4. Volland P,
   5. Golden R

   . Strong social support services, such as transportation and help for caregivers, can lead to lower health care use and costs. Health Aff (Millwood) 2013;32:544–51.

   OpenUrlAbstract/FREE Full Text
4. 4.↵
   Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-Qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation. Federal Register. Published August 10, 2022. Accessed July 3, 2023. Available at: https://www.federalregister.gov/documents/2022/08/10/2022-16472/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the.
5. 5.↵
   1. Brownson RC,
   2. Royer C,
   3. Ewing R,
   4. McBride TD

   . Researchers and policymakers: travelers in parallel universes. Am J Prev Med 2006;30:164–72.

   OpenUrlCrossRefPubMedWeb of Science
6. 6.↵
   1. Byhoff E,
   2. Freund KM,
   3. Garg A

   . Accelerating the implementation of social determinants of health interventions in internal medicine. J Gen Intern Med 2018;33:223–5.

   OpenUrlPubMed
7. 7.↵
   1. Chung EK,
   2. Siegel BS,
   3. Garg A,
   4. et al

   . Screening for social determinants of health among children and families living in poverty: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care 2016;46:135–53.

   OpenUrlCrossRefPubMed
8. 8.↵
   1. Garg A,
   2. Boynton-Jarrett R,
   3. Dworkin PH

   . Avoiding the unintended consequences of screening for social determinants of health. JAMA 2016;316:813–4.

   OpenUrlCrossRefPubMed
9. 9.↵
   1. Schickedanz A,
   2. Sharp A,
   3. Hu YR,
   4. et al

   . Impact of social needs navigation on utilization among high utilizers in a large integrated health system: a quasi-experimental study. J GEN INTERN MED 2019;34:2382–9.

   OpenUrlCrossRefPubMed
10. 10.↵
    1. De Marchis EH,
    2. Hessler D,
    3. Fichtenberg C,
    4. et al

    . Part I: a quantitative study of social risk screening acceptability in patients and caregivers. Am J Prev Med 2019;57:S25–S37.

    OpenUrlCrossRefPubMed
11. 11.↵
    1. Brown EM,
    2. Loomba V,
    3. De Marchis E,
    4. Aceves B,
    5. Molina M,
    6. Gottlieb LM

    . Patient and patient caregiver perspectives on social screening: a review of the literature. J Am Board Fam Med 2023;36:66–78.

    OpenUrlAbstract/FREE Full Text
12. 12.↵
    1. Vu M,
    2. Boyd K,
    3. De Marchis EH,
    4. et al

    . Perceived appropriateness of assessing for health-related socioeconomic risks among adult patients with cancer. Cancer Res Commun 2023;3:521–31. Published online March 6.

    OpenUrlPubMed
13. 13.↵
    1. Payne R,
    2. Esse T,
    3. Qian J,
    4. et al

    . Evaluating perceptions of social determinants of health and Part D star performance of Medicare Advantage-contracted primary care providers serving a South Texas market. J Manag Care Spec Pharm 2021;27:544–53.

    OpenUrlPubMed
14. 14.↵
    1. Glied S,
    2. D'Aunno T

    . Health systems and social services—A bridge too far? JAMA Health Forum 2023;4:e233445.

    OpenUrl
15. 15.↵
    1. Andermann A

    . Screening for social determinants of health in clinical care: moving from the margins to the mainstream. Public Health Rev 2018;39:19.

    OpenUrlCrossRefPubMed
16. 16.↵
    1. Konijnendijk AAJ,
    2. Boere-Boonekamp MM,
    3. Haasnoot-Smallegange RME,
    4. Need A

    . A qualitative exploration of factors that facilitate and impede adherence to child abuse prevention guidelines in Dutch preventive child health care. J Eval Clin Pract 2014;20:417–24.

    OpenUrlPubMed
17. 17.↵
    1. Marchis EHD,
    2. Aceves BA,
    3. Brown EM,
    4. Loomba V,
    5. Molina MF,
    6. Gottlieb LM

    . Assessing implementation of social screening within US health care settings: a systematic scoping review. J Am Board Fam Med 2023;36:626–49.

    OpenUrlAbstract/FREE Full Text
18. 18.↵
    1. Boyce MB,
    2. Browne JP,
    3. Greenhalgh J

    . The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ Qual Saf 2014;23:508–18.

    OpenUrlAbstract/FREE Full Text
19. 19.↵
    1. LaForge K,
    2. Gold R,
    3. Cottrell E,
    4. et al

    . How 6 organizations developed tools and processes for social determinants of health screening in primary care. J Ambul Care Manage 2018;41:2–14.

    OpenUrlCrossRefPubMed
20. 20.↵
    FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule—CMS-1785-F and CMS-1788-F Fact Sheet. Centers for Medicare & Medicaid Services. Published August 1, 2023. Accessed February 12, 2024. Available at: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0.
21. 21.↵
    A Guide to Using the Accountable Health Communities Health-Related Social Needs Screening Tool: Updated December 2023 Promising Practices and Key Insights. Centers for Medicare & Medicaid Services. Published December 2023. Accessed February 12, 2024. Available at: https://www.cms.gov/priorities/innovation/media/document/ahcm-screeningtool-companion.
22. 22.↵
    1. De Marchis EH,
    2. Brown E,
    3. Aceves B,
    4. et al

    . State of the Science of Screening in Healthcare Settings. University of San Francisco California; 2022:140. Available at: https://sirenetwork.ucsf.edu/tools-resources/resources/screen-report-state-science-social-screening-healthcare-settings#Full-Report.
23. 23.↵
    1. Meyer D,
    2. Lerner E,
    3. Phillips A,
    4. Zumwalt K

    . Universal screening of social determinants of health at a large US academic medical center, 2018. Am J Public Health 2020;110:S219–S221.

    OpenUrlPubMed
24. 24.↵
    1. Horwitz LI,
    2. Chang C,
    3. Arcilla HN,
    4. Knickman JR

    . Quantifying health systems’ investment in social determinants of health, by sector, 2017–19. Health Aff (Millwood) 2020;39:192–8.

    OpenUrlCrossRefPubMed
25. 25.↵
    1. Gold R,
    2. Bunce A,
    3. Cowburn S,
    4. et al

    . Adoption of social determinants of health EHR tools by community health centers. Ann Fam Med 2018;16:399–407.

    OpenUrlAbstract/FREE Full Text
26. 26.↵
    1. Imran A,
    2. Rawal MD,
    3. Botre N,
    4. Patil A

    . Improving and promoting social determinants of health at a system level. Jt Comm J Qual Patient Saf 2022;48:376–84.

    OpenUrlPubMed
27. 27.↵
    Intermountain Healthcare. Utah Alliance For the Determinants of Health story. intermountainhealthcare.org. Published 2018. Accessed August 23, 2022. Available at: https://intermountainhealthcare.org/about/who-we-are/community-health/community/utah-alliance-for-the-determinants-of-health-story/.
28. 28.↵
    211info. Accessed May 11, 2023. Available at: https://www.211info.org.
29. 29.↵
    Care Process Model: Social Determinants of Health. Intermountain Healthcare. Published December 2020. Accessed June 23, 2023. Available at: https://intermountainhealthcare.org/ckr-ext/Dcmnt?ncid=529732182.
30. 30.↵
    1. Miles MB,
    2. Huberman AM,
    3. Saldana J

    . 2019. Qualitative Data Analysis, 4th ed. Los Angeles: Sage.
31. 31.↵
    1. Proctor E,
    2. Silmere H,
    3. Raghavan R,
    4. et al

    . Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health 2011;38:65–76.

    OpenUrlCrossRefPubMed
32. 32.↵
    1. Keith RE,
    2. Crosson JC,
    3. O'Malley AS,
    4. Cromp DAnn,
    5. Taylor EF

    . Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation. Implement Sci 2017;12:15.

    OpenUrlCrossRefPubMed
33. 33.↵
    1. Miles M,
    2. Huberman M,
    3. Saldana J

    . Qualitative Data Analysis. 4th ed. SAGE; 2019.
34. 34.↵
    1. Gallagher M,
    2. Hares T,
    3. Spencer J,
    4. Bradshaw C,
    5. Webb I

    . The nominal group technique: a research tool for general practice? Fam Pract 1993;10:76–81.

    OpenUrlCrossRefPubMedWeb of Science
35. 35.↵
    1. Apathy NC,
    2. Holmgren AJ

    . Opt-in consent policies: potential barriers to hospital health information exchange. Am J Manag Care 2020;26:e14–e20.

    OpenUrlPubMed
36. 36.↵
    1. Porter J,
    2. Boyd C,
    3. Skandari MR,
    4. Laiteerapong N

    . Revisiting the time needed to provide adult primary care. J Gen Intern Med 2023;38:147–55.

    OpenUrlCrossRefPubMed
37. 37.↵
    1. Shucard H,
    2. Muller E,
    3. Johnson J,
    4. et al

    . Clinical use of an electronic pre-visit questionnaire soliciting patient visit goals and interim history: a retrospective comparison between safety-net and non-safety-net clinics. Health Serv Res Manag Epidemiol 2022;9:23333928221080336.

    OpenUrlPubMed
38. 38.↵
    1. Holdsworth LM,
    2. Park C,
    3. Asch SM,
    4. Lin S

    . Technology-enabled and artificial intelligence support for pre-visit planning in ambulatory care: findings from an environmental scan. Ann Fam Med 2021;19:419–26.

    OpenUrlAbstract/FREE Full Text
39. 39.↵
    1. Bharmal N,
    2. Rennick A,
    3. Shideler A,
    4. et al

    . Health-related social needs: which patients respond to screening and who receives resources? J Gen Intern Med 2023;38:2695–702.

    OpenUrlPubMed
40. 40.↵
    1. Byhoff E,
    2. Gottlieb LM

    . When there is value in asking: an argument for social risk screening in clinical practice. Ann Intern Med 2022;175:1181–2.

    OpenUrlCrossRefPubMed
41. 41.↵
    1. Savitz ST,
    2. Nyman MA,
    3. Kaduk A,
    4. Loftus C,
    5. Phelan S,
    6. Barry BA

    . Association of patient and system-level factors with social determinants of health screening. Med Care 2022;60:700–8.

    OpenUrlPubMed
42. 42.↵
    1. De Marchis EH,
    2. Aceves B,
    3. Razon N,
    4. Chang Weir R,
    5. Jester M,
    6. Gottlieb LM

    . “Wanting the best for our folks”—a mixed methods analysis of community health center social risk screening initiatives. J Am Board Fam Med 2023;36:817–31.

    OpenUrlAbstract/FREE Full Text
43. 43.↵
    Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation’s Health. The National Academies of Sciences, Engineering, and Medicine; 2019. Accessed February 15, 2024. Available at: https://www.nationalacademies.org/our-work/integrating-social-needs-care-into-the-delivery-of-health-care-to-improve-the-nations-health.
44. 44.↵
    1. Byhoff E,
    2. De Marchis EH,
    3. Hessler D,
    4. et al

    . Part II: a qualitative study of social risk screening acceptability in patients and caregivers. Am J Prev Med 2019;57:S38–S46.

    OpenUrlCrossRefPubMed
45. 45.↵
    1. Knighton AJ,
    2. Savitz L,
    3. Belnap T,
    4. Stephenson B,
    5. VanDerslice J

    . Introduction of an area deprivation index measuring patient socioeconomic status in an integrated health system: implications for population health. EGEMS (Wash DC) 2016;4:1238.

    OpenUrlCrossRefPubMed
46. 46.↵
    1. Abir M,
    2. Hammond S,
    3. Iovan S,
    4. Lantz PM

    . Why more evidence is needed on the effectiveness of screening for social needs among high-use patients in acute care settings. Health Affairs Forefront. Health Affairs Blog, May 23, 2019. https://doi.org/10.1377/hblog20190520.243444.
47. 47.↵
    1. Vilendrer S,
    2. Thomas SC,
    3. Belnap T,
    4. et al

    . Screening for social determinants of health during primary care and emergency department encounters. JAMA Netw Open 2023;6:e2348646.

    OpenUrlPubMed
48. 48.↵
    1. Heller CG,
    2. Parsons AS,
    3. Chambers EC,
    4. Fiori KP,
    5. Rehm CD

    . Social risks among primary care patients in a large urban health system. Am J Prev Med 2020;58:514–25.

    OpenUrlPubMed
49. 49.
    1. Sundar KR

    . Universal screening for social needs in a primary care clinic: a quality improvement approach using the your current life situation survey. Perm J 2018;22:18–089.

    OpenUrlCrossRef
50. 50.
    1. Sakata T,
    2. Thomas S,
    3. Dailey C,
    4. et al

    . How health systems can address social determinants of health (SDOH): an update to improve the health of communities. Qual Manag Health Care 2023;32:65–7.

    OpenUrlPubMed
51. 51.↵
    Impact Investing: Social Determinants of Health. Intermountain Health. Accessed February 29, 2024. Available at: https://intermountainhealthcare.org/about/who-we-are/community-health/impact-investing/.