Clusters of Health-Related Social Needs Among Adult Primary Care Patients

References

1. 1.↵
   Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation’s Health, Board on Health Care Services, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health. National Academies Press; 2019:25467.
2. 2.↵
   The Physicians Foundation. Quality ID #487: Screening for Social Drivers of Health. Quality Payment Program. Published 2022. Accessed March 25, 2024. Available at: https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2023_Measure_487_MIPSCQM.pdf.
3. 3.↵
   1. Gurewich D,
   2. Garg A,
   3. Kressin NR

   . Addressing social determinants of health within healthcare delivery systems: a framework to ground and inform health outcomes. J Gen Intern Med 2020;35:1571–5.

   OpenUrlCrossRefPubMed
4. 4.↵
   1. Reynolds A

   . Social need: new HEDIS measure uses electronic data to look at screening, intervention. NCQA. Published November 2, 2022. Accessed December 20, 2023. Available at: https://www.ncqa.org/blog/social-need-new-hedis-measure-uses-electronic-data-to-look-at-screening-intervention/.
5. 5.↵
   1. O'Gurek DT,
   2. Henke C

   . A practical approach to screening for social determinants of health. Fam Pract Manag 2018;25:7–12.

   OpenUrlPubMed
6. 6.↵
   1. Holcomb J,
   2. Highfield L,
   3. Ferguson GM,
   4. Morgan RO

   . Association of social needs and healthcare utilization among Medicare and Medicaid beneficiaries in the accountable health communities model. J Gen Intern Med 2022;37:3692–9.

   OpenUrlPubMed
7. 7.↵
   1. Kreuter MW,
   2. Garg R,
   3. Li L,
   4. et al

   . How do social needs cluster among low-income individuals? Popul Health Manag 2021;24:322–32.

   OpenUrlPubMed
8. 8.↵
   RTI International. Accountable Health Communities (AHC) Model Evaluation: Second Evaluation Report. Centers for Medicare & Medicaid Services; 2023. Available at: https://www.cms.gov/priorities/innovation/data-and-reports/2023/ahc-second-eval-rpt.
9. 9.↵
   1. Massoglia M,
   2. Remster B

   . Linkages between incarceration and health. Public Health Rep 2019;134:8S–14S.

   OpenUrlPubMed
10. 10.↵
    1. Rollins C,
    2. Glass NE,
    3. Perrin NA,
    4. et al

    . Housing instability is as strong a predictor of poor health outcomes as level of danger in an abusive relationship: findings from the SHARE study. J Interpers Violence 2012;27:623–43.

    OpenUrlCrossRefPubMed
11. 11.↵
    Consumer Financial Protection Bureau. CFPB financial well-being scale: scale development technical report. Published 2017. Accessed December 28, 2021. Available at: https://www.consumerfinance.gov/data-research/research-reports/financial-well-being-technical-report/.
12. 12.↵
    Economic Research Service, USDA. U.S. household food security survey module: six-item short form. Published 2012. Accessed March 10, 2020. Available at: https://www.ers.usda.gov/media/8282/short2012.pdf.
13. 13.↵
    1. Locatelli SM,
    2. Sharp LK,
    3. Syed ST,
    4. Bhansari S,
    5. Gerber BS

    . Measuring health-related transportation barriers in urban settings. J Appl Meas 2017;18:178–93.

    OpenUrlPubMed
14. 14.↵
    Centers for Disease Control & Prevention. 2022 BRFSS Questionnaire. BRFSS Questionnaires. Published 2023. Accessed February 15, 2024. Available at: https://www.cdc.gov/brfss/questionnaires/pdf-ques/2022-BRFSS-Questionnaire-508.pdf.
15. 15.↵
    1. McLellan AT,
    2. Kushner H,
    3. Metzger D,
    4. et al

    . The fifth edition of the addiction severity index. J Subst Abuse Treat 1992;9:199–213.

    OpenUrlCrossRefPubMedWeb of Science
16. 16.↵
    1. Elixhauser A,
    2. Steiner C,
    3. Harris DR,
    4. Coffey RM

    . Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.

    OpenUrlCrossRefPubMedWeb of Science
17. 17.↵
    1. Jain K,
    2. Dubes R

    . Algorithms for Clustering Data. Prentice Hall; 1988.
18. 18.↵
    1. Maechler M,
    2. Rousseeuw P,
    3. Struyf A,
    4. Hubert M,
    5. Hornik K

    . Cluster: cluster analysis basics and extensions. R package version 2.1.6. Published online 2023. Available at: https://cran.r-project.org/web/packages/cluster/cluster.pdf.
19. 19.↵
    1. Schiltz NK,
    2. Chagin K,
    3. Sehgal AR

    . Clustering of social determinants of health among patients. J Prim Care Community Health 2022;13:21501319221113543.

    OpenUrlPubMed
20. 20.↵
    1. Henrikson NB,
    2. Blasi PR,
    3. Dorsey CN,
    4. et al

    . Psychometric and pragmatic properties of social risk screening tools: a systematic review. Am J Prev Med 2019;57:S13–S24.

    OpenUrlCrossRefPubMed
21. 21.↵
    1. Beidler LB,
    2. Razon N,
    3. Lang H,
    4. Fraze TK

    . “More than just giving them a piece of paper”: interviews with primary care on social needs referrals to community-based organizations. J Gen Intern Med 2022;37:4160–7.

    OpenUrlPubMed
22. 22.↵
    1. Lynch EE,
    2. Malcoe LH,
    3. Laurent SE,
    4. Richardson J,
    5. Mitchell BC,
    6. Meier HCS

    . The legacy of structural racism: associations between historic redlining, current mortgage lending, and health. SSM Popul Health 2021;14:100793.

    OpenUrlPubMed
23. 23.↵
    1. Koeman J,
    2. Mehdipanah R

    . Prescribing housing: a scoping review of health system efforts to address housing as a social determinant of health. Popul Health Manag 2021;24:316–21.

    OpenUrlPubMed
24. 24.↵
    1. Marchis EHD,
    2. Torres JM,
    3. Benesch T,
    4. et al

    . Interventions addressing food insecurity in health care settings: a systematic review. Ann Fam Med 2019;17:436–47.

    OpenUrlAbstract/FREE Full Text
25. 25.↵
    1. Harle CA,
    2. Wu W,
    3. Vest JR

    . Accuracy of electronic health record food insecurity, housing instability, and financial strain screening in adult primary care. JAMA 2023;329:423–4.

    OpenUrlCrossRefPubMed