TY - JOUR
T1 - Part I
T2 - A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers
AU - De Marchis, Emilia H.
AU - Hessler, Danielle
AU - Fichtenberg, Caroline
AU - Adler, Nancy
AU - Byhoff, Elena
AU - Cohen, Alicia J.
AU - Doran, Kelly M.
AU - Ettinger de Cuba, Stephanie
AU - Fleegler, Eric W.
AU - Lewis, Cara C.
AU - Lindau, Stacy Tessler
AU - Tung, Elizabeth L.
AU - Huebschmann, Amy G.
AU - Prather, Aric A.
AU - Raven, Maria
AU - Gavin, Nicholas
AU - Jepson, Susan
AU - Johnson, Wendy
AU - Ochoa, Eduardo
AU - Olson, Ardis L.
AU - Sandel, Megan
AU - Sheward, Richard S.
AU - Gottlieb, Laura M.
N1 - Funding Information:
Publication of this article was supported by the Agency for Healthcare Research and Quality (AHRQ), under HHS contract [1R13HS026664], Kaiser Permanente [CRN5374-7544-15320], and the Robert Wood Johnson Foundation [75922]. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of any of the sponsors. We thank the research staff at each of our 10 study sites for their assistance with data collection. We thank José Parra and Catherine Arevalo of University of California, San Francisco (UCSF) for their assistance with study launch and organization of study sites. We thank Remi Frazier and Glenda Sharp of the UCSF Academic Research Systems for their assistance with inputting the study survey into REDCap. We would like to acknowledge Emily Abramsohn, Megan DePumpo, and Kelsey Paradise from the University of Chicago for their assistance with training, safety protocols, and data collection efforts. This work was supported by The Commonwealth Fund (CWF), a national, private foundation based in New York City that supports independent research on healthcare issues and makes grants to improve health care practice and policy. The views presented here are those of the authors and not necessarily those of CWF, its directors, officers, or staff. CWF had no role in study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the report for publication. EHD was additionally supported by a fellowship training grant, National Research Service Award (NRSA) T32HP19025. CCL's time was supported by the Social Needs Network for Evaluation and Translation (SONNET). SONNET is funded by Kaiser Permanente National Community Health. The manuscript's contents are solely the responsibility of the authors and do not represent the official views of the CWF, NRSA, SONNET, or Kaiser Permanente. The study was approved by the UCSF IRB (17–23,110); per their own institutional requirements, 7 of the study sites also obtained site-specific IRB approvals (University of Arkansas, 217767; Boston Medical Center, H-37489; University of Chicago, 18-0139; University of Colorado, 17–2,434; Dartmouth College, STUDY00031049; Hennepin Health, 18–4,482; New York University, i18-00004). Author contributions are as follows: Study concept and design: EHD, DH, CF, NA, AJC, SE, EWF, CCL, STL, AAP, MS, RSS, and LMG. Acquisition of data: EHD, KMD, SE, STL, ELT, AGH, MR, NG, SJ, WJ, ALO, EO, MS, RSS, and LMG. Analysis and interpretation of data: all authors. Drafting of the manuscript: EHD, DH, NA, and LMG. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: EHD, DH, and CF. Obtaining funding: CF, NA, and LMG. Administrative, technical, or material support and supervision: LMG. Final approval of the version to be published: all authors. Earlier data from this study were presented at the State of the Science: A National Research Meeting on Medical & Social Care Integration, in February 2019 in Portland, OR. Conference slides from the State of the Science meeting have been published online: http://sirenetwork.ucsf.edu/sites/sirenetwork.ucsf.edu/files/SIREN19_DeMarchis.pdf. EWF is a consultant for Veta Health, which is a company that develops software for chronic disease management. Veta Health also supports HelpSteps, a system for connecting families to social services developed by EWF. In the future, it is possible that this technology will be sold commercially. If this were to occur, EWF and Boston Children's Hospital might receive financial benefits in the form of compensation. As in all research studies, the Boston Children's Hospital has taken steps designed to ensure that this potential for financial gain does not endanger research subjects or undercut the validity and integrity of the information learned by this research. The research published in this paper is not related to any of the above consulting work and was conducted prior EWF working with Veta Health. STL directed a Center for Medicare and Medicaid Innovation Health Care Innovation Award (1C1CMS330997-03) called CommunityRx. This award required development of a sustainable business model to support the model test after award funding ended. To this end, STL is founder and co-owner of NowPow, LLC. Neither the University of Chicago nor the University of Chicago Medicine is endorsing or promoting any NowPow entity or its business, products, or services. No other financial disclosures were reported by the authors of this paper.
Funding Information:
Publication of this article was supported by the Agency for Healthcare Research and Quality (AHRQ), under HHS contract [1R13HS026664], Kaiser Permanente [CRN5374-7544-15320], and the Robert Wood Johnson Foundation [75922]. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of any of the sponsors.
Funding Information:
This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
Funding Information:
This work was supported by The Commonwealth Fund (CWF), a national, private foundation based in New York City that supports independent research on healthcare issues and makes grants to improve health care practice and policy. The views presented here are those of the authors and not necessarily those of CWF, its directors, officers, or staff. CWF had no role in study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the report for publication. EHD was additionally supported by a fellowship training grant, National Research Service Award (NRSA) T32HP19025. CCL's time was supported by the Social Needs Network for Evaluation and Translation (SONNET). SONNET is funded by Kaiser Permanente National Community Health. The manuscript's contents are solely the responsibility of the authors and do not represent the official views of the CWF, NRSA, SONNET, or Kaiser Permanente. The study was approved by the UCSF IRB (17–23,110); per their own institutional requirements, 7 of the study sites also obtained site-specific IRB approvals (University of Arkansas, 217767; Boston Medical Center, H-37489; University of Chicago, 18-0139; University of Colorado, 17–2,434; Dartmouth College, STUDY00031049; Hennepin Health, 18–4,482; New York University, i18-00004).
Publisher Copyright:
© 2019 American Journal of Preventive Medicine
PY - 2019/12
Y1 - 2019/12
N2 - Introduction: Despite recent growth in healthcare delivery-based social risk screening, little is known about patient perspectives on these activities. This study evaluates patient and caregiver acceptability of social risk screening. Methods: This was a cross-sectional survey of 969 adult patients and adult caregivers of pediatric patients recruited from 6 primary care clinics and 4 emergency departments across 9 states. Survey items included the Center for Medicare and Medicaid Innovation Accountable Health Communities’ social risk screening tool and questions about appropriateness of screening and comfort with including social risk data in electronic health records. Logistic regressions evaluated covariate associations with acceptability measures. Data collection occurred from July 2018 to February 2019; data analyses were conducted in February‒March 2019. Results: Screening was reported as appropriate by 79% of participants; 65% reported comfort including social risks in electronic health records. In adjusted models, higher perceived screening appropriateness was associated with previous exposure to healthcare-based social risk screening (AOR=1.82, 95% CI=1.16, 2.88), trust in clinicians (AOR=1.55, 95% CI=1.00, 2.40), and recruitment from a primary care setting (AOR=1.70, 95% CI=1.23, 2.38). Lower appropriateness was associated with previous experience of healthcare discrimination (AOR=0.66, 95% CI=0.45, 0.95). Higher comfort with electronic health record documentation was associated with previously receiving assistance with social risks in a healthcare setting (AOR=1.47, 95% CI=1.04, 2.07). Conclusions: A strong majority of adult patients and caregivers of pediatric patients reported that social risk screening was appropriate. Most also felt comfortable including social risk data in electronic health records. Although multiple factors influenced acceptability, the effects were moderate to small. These findings suggest that lack of patient acceptability is unlikely to be a major implementation barrier. Supplement information: This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
AB - Introduction: Despite recent growth in healthcare delivery-based social risk screening, little is known about patient perspectives on these activities. This study evaluates patient and caregiver acceptability of social risk screening. Methods: This was a cross-sectional survey of 969 adult patients and adult caregivers of pediatric patients recruited from 6 primary care clinics and 4 emergency departments across 9 states. Survey items included the Center for Medicare and Medicaid Innovation Accountable Health Communities’ social risk screening tool and questions about appropriateness of screening and comfort with including social risk data in electronic health records. Logistic regressions evaluated covariate associations with acceptability measures. Data collection occurred from July 2018 to February 2019; data analyses were conducted in February‒March 2019. Results: Screening was reported as appropriate by 79% of participants; 65% reported comfort including social risks in electronic health records. In adjusted models, higher perceived screening appropriateness was associated with previous exposure to healthcare-based social risk screening (AOR=1.82, 95% CI=1.16, 2.88), trust in clinicians (AOR=1.55, 95% CI=1.00, 2.40), and recruitment from a primary care setting (AOR=1.70, 95% CI=1.23, 2.38). Lower appropriateness was associated with previous experience of healthcare discrimination (AOR=0.66, 95% CI=0.45, 0.95). Higher comfort with electronic health record documentation was associated with previously receiving assistance with social risks in a healthcare setting (AOR=1.47, 95% CI=1.04, 2.07). Conclusions: A strong majority of adult patients and caregivers of pediatric patients reported that social risk screening was appropriate. Most also felt comfortable including social risk data in electronic health records. Although multiple factors influenced acceptability, the effects were moderate to small. These findings suggest that lack of patient acceptability is unlikely to be a major implementation barrier. Supplement information: This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
UR - http://www.scopus.com/inward/record.url?scp=85075019167&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075019167&partnerID=8YFLogxK
U2 - 10.1016/j.amepre.2019.07.010
DO - 10.1016/j.amepre.2019.07.010
M3 - Article
C2 - 31753277
AN - SCOPUS:85075019167
SN - 0749-3797
VL - 57
SP - S25-S37
JO - American journal of preventive medicine
JF - American journal of preventive medicine
IS - 6
ER -