Elena Byhoff1, Emilia H De Marchis2, Danielle Hessler2, Caroline Fichtenberg3, Nancy Adler4, Alicia J Cohen5, Kelly M Doran6, Stephanie Ettinger de Cuba7, Eric W Fleegler8, Nicholas Gavin9, Amy G Huebschmann10, Stacy Tessler Lindau11, Elizabeth L Tung12, Maria Raven13, Susan Jepson14, Wendy Johnson15, Ardis L Olson16, Megan Sandel7, Richard S Sheward17, Laura M Gottlieb2. 1. Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts. Electronic address: ebyhoff@tuftsmedicalcenter.org. 2. Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California. 3. Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, San Francisco, California. 4. Lisa and John Pritzker Professor of Medical Psychology, Center for Health and Community, University of California, San Francisco, San Francisco, California. 5. Providence VA Medical Center, Providence, Rhode Island; Department of Family Medicine, Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island. 6. Ronald O. Perelman Department of Emergency Medicine, New York University, New York, New York; Department of Population Health, New York University, New York, New York. 7. Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts. 8. Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts. 9. Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York. 10. Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado; Center for Women's Health Research, University of Colorado School of Medicine, Aurora, Colorado. 11. Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine-Geriatrics, University of Chicago, Chicago, Illinois. 12. Section of General Internal Medicine, University of Chicago, Chicago, Illinois. 13. Department of Emergency Medicine, University of San Francisco, San Francisco, California. 14. Upstream Health Innovations, Hennepin County Medical Center, Minneapolis, Minnesota. 15. La Familia Medical Center, Santa Fe, New Mexico. 16. Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. 17. Children's HealthWatch, Boston, Massachusetts.
Abstract
INTRODUCTION: This study aimed to better understand patient and caregiver perspectives on social risk screening across different healthcare settings. METHODS: As part of a mixed-methods multisite study, the authors conducted semistructured interviews with a subset of adult patients and adult caregivers of pediatric patients who had completed the Center for Medicare and Medicaid Innovation Accountable Health Communities social risk screening tool between July 2018 and February 2019. Interviews, conducted in English or Spanish, asked about reactions to screening, screening acceptability, preferences for administration, prior screening experiences that informed perspectives, and expectations for social assistance. Basic thematic analysis and constant comparative methods were used to code and develop themes. RESULTS: Fifty interviews were conducted across 10 study sites in 9 states, including 6 primary care clinics and 4 emergency departments. There was broad consensus among interviewees across all sites that social risk screening was acceptable. The following 4 main themes emerged: (1) participants believed screening for social risks is important; (2) participants expressed insight into the connections between social risks and overall health; (3) participants emphasized the importance of patient-centered implementation of social risk screening; and (4) participants recognized limits to the healthcare sector's capacity to address or resolve social risks. CONCLUSIONS: Despite gaps in the availability of social risk-related interventions in healthcare settings, patient-centered social risk screening, including empathy and attention to privacy, may strengthen relationships between patients and healthcare teams. 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.
INTRODUCTION: This study aimed to better understand patient and caregiver perspectives on social risk screening across different healthcare settings. METHODS: As part of a mixed-methods multisite study, the authors conducted semistructured interviews with a subset of adult patients and adult caregivers of pediatric patients who had completed the Center for Medicare and Medicaid Innovation Accountable Health Communities social risk screening tool between July 2018 and February 2019. Interviews, conducted in English or Spanish, asked about reactions to screening, screening acceptability, preferences for administration, prior screening experiences that informed perspectives, and expectations for social assistance. Basic thematic analysis and constant comparative methods were used to code and develop themes. RESULTS: Fifty interviews were conducted across 10 study sites in 9 states, including 6 primary care clinics and 4 emergency departments. There was broad consensus among interviewees across all sites that social risk screening was acceptable. The following 4 main themes emerged: (1) participants believed screening for social risks is important; (2) participants expressed insight into the connections between social risks and overall health; (3) participants emphasized the importance of patient-centered implementation of social risk screening; and (4) participants recognized limits to the healthcare sector's capacity to address or resolve social risks. CONCLUSIONS: Despite gaps in the availability of social risk-related interventions in healthcare settings, patient-centered social risk screening, including empathy and attention to privacy, may strengthen relationships between patients and healthcare teams. 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.
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