Margaret Greenwood-Ericksen1, Melissa DeJonckheere2,3, Faiyaz Syed4, Nashia Choudhury5, Alicia J Cohen2,6,7, Renuka Tipirneni3,8. 1. Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico mgreenwoodericksen@salud.unm.edu. 2. Department of Family Medicine, University of Michigan, Ann Arbor, Michigan. 3. Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan. 4. Michigan Primary Care Association, Lansing, Michigan. 5. MyCare Health Center, Center Line, Michigan. 6. Center of Innovation in Long Term Services and Supports for Vulnerable Populations, Providence VA Medical Center, Providence, Rhode Island. 7. Departments of Family Medicine and Health Services, Policy, and Practice, Brown University, Providence, Rhode Island. 8. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Abstract
PURPOSE: Federally qualified health centers (FQHCs) are leaders in screening for and addressing patient's health-related social needs but variation exists in screening practices. This variation is relatively unexplored, particularly the influences of organizational and state policies. We employed a qualitative descriptive approach to study social needs screening practices at Michigan FQHCs to characterize screening processes and identify drivers of variation in screening implementation. METHODS: Site visits and semistructured interviews were conducted from October 2016 through March 2017, to explore implementation of social needs screening in clinical practice. Five FQHCs were selected through maximum variation sampling. Within each site, snowball sampling identified care team members highly knowledgeable about social needs screening. We conducted 4 to 5 interviews per site. Transcripts were analyzed using a thematic approach. RESULTS: We interviewed 23 participants from 5 sites; these sites varied by geography, age distribution, and race/ethnicity. We identified 4 themes: (1) statewide initiatives and local leadership drove variation in screening practices; (2) as community health workers (CHWs) played an integral role in identifying patients' needs, their roles often shifted from that of screener to implementer; (3) social needs screening data was variably integrated into electronic health records and infrequently used for population health management; and (4) sites experienced barriers to social needs screening that limited the perceived impact and sustainability. CONCLUSIONS: FQHCs placed value on the role of CHWs, on sustainable initiatives, and on funding to support continued social needs screening in primary care settings.
PURPOSE: Federally qualified health centers (FQHCs) are leaders in screening for and addressing patient's health-related social needs but variation exists in screening practices. This variation is relatively unexplored, particularly the influences of organizational and state policies. We employed a qualitative descriptive approach to study social needs screening practices at Michigan FQHCs to characterize screening processes and identify drivers of variation in screening implementation. METHODS: Site visits and semistructured interviews were conducted from October 2016 through March 2017, to explore implementation of social needs screening in clinical practice. Five FQHCs were selected through maximum variation sampling. Within each site, snowball sampling identified care team members highly knowledgeable about social needs screening. We conducted 4 to 5 interviews per site. Transcripts were analyzed using a thematic approach. RESULTS: We interviewed 23 participants from 5 sites; these sites varied by geography, age distribution, and race/ethnicity. We identified 4 themes: (1) statewide initiatives and local leadership drove variation in screening practices; (2) as community health workers (CHWs) played an integral role in identifying patients' needs, their roles often shifted from that of screener to implementer; (3) social needs screening data was variably integrated into electronic health records and infrequently used for population health management; and (4) sites experienced barriers to social needs screening that limited the perceived impact and sustainability. CONCLUSIONS: FQHCs placed value on the role of CHWs, on sustainable initiatives, and on funding to support continued social needs screening in primary care settings.
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