Highlights and Areas of Inquiry in the HSR Special Issue: Social Care and the US Health Care Sector DOI Creative Commons
Margarita Alegrı́a, Carrie Fry, Momiao Xiong

et al.

Health Services Research, Journal Year: 2025, Volume and Issue: unknown

Published: March 25, 2025

Recognizing that social context influences health, over much of the last decade, federal, and state policies have encouraged healthcare institutions to identify patients without adequate access basic material goods such as food, housing, transportation develop partnerships with community-based organizations (CBOs) service support any identified gaps [1]. As an example, 27 states District Columbia active or pending Medicaid Section 1115(a) waivers include provisions related health-related need (HRSN), which Centers for Medicare & Services has described "an individual's unmet, adverse conditions contribute poor health." [2] These are based on research suggesting interventions determinants will likely improve health [3]. However, recent policy changes threaten sustainability these other "social care" activities undertaken in sector. The February 2025 Executive Order "Establishing President's Make America Healthy Again Commission" does not mention health. Instead, order emphasizes individual accountability behaviors [4]. this special issue was going press March 2025, rescinded prior guidance about using dollars address members' HRSN [5]. shifts play out, it is pertinent remember long-term outcomes shaped more by factors than [6]. country aligned how should incorporate fact. We believe disseminating what we learned care—whether at patient, community, levels—is key strengthening alignment. At very least, relevant can awareness provide insights face great uncertainty. In Special Issue, "Social Care US Health Sector," partner Social Interventions Research Evaluation Network (SIREN) elevate studies exploring care systems, CBOs, agencies aiming assessing patient- population-level attending needs. Below, highlight ways Issue build existing field, persistent knowledge. Several SIREN articles describe community policy-level medical integration. California's Medi-Cal Whole Person (WPC) program assessed through qualitative mixed-method approaches Chuang et al., Safaeinili al. [7, 8] WPC initiative a $3 billion intervention, offered California waiver demonstration. pilots programs deliver integrated across multiple sectors HRSN. Utilizing data from program, 11 improved cross-sector collaboration 15 did not. Cross-sector facilitated collaborative governance braided funding meaningful use data-sharing systems [7]. study 26 services enrollees. Twenty-two sustained model. Four sustainability: adaptability flexibility, consistent reimbursement infrastructure, leadership managed plans, contracts [8]. understanding organizational promote well-being. Other examine impacts patient level. Thompson-Lastad studied effectiveness Recipe4Health (R4H) Alameda County, CA, community-level intervention addressing food insecurity mental outcomes. part R4H, eligible participants received optional group visits trained center (CHC) staff who provided nutrition cooking education, movement relaxation techniques, coaching, weekly home delivery fresh fruits vegetables. Eligible R4H were racially ethnically diverse children adults demonstrated either nutrition-sensitive condition. Data collected between 2020 2023 four five participating CHCs suggested only deliveries, security baseline depression anxiety. For both deliveries visits, depression, anxiety, significantly improved. Qualitative interviews also showed helped reduce pervasive loneliness among participants. subgroup analyses especially interesting since those One takeaway critical better appreciating whom work under [9]. Chapman evaluated Supportive Veteran Families (SSVF) targeting short- housing veterans struggling instability. To discern SSVF's effectiveness, team examined clinical Veterans Affairs electronic records (EHRs). They used natural language processing (NLP) "assign" SSVF standard 36 simulated trials. total, 238,059 "enrolled" one "trials." authors found risk being unhoused reduced control arms but pronounced groups first 120 days. note significant limitations prone error NLP selection bias assignment [10]. article examines impact costs utilization [11]. Lovelace colleagues pre-post design dually supportive enrolled Cultivating Success (CHFS). CHFS joint coordination payer organization partners provides HUD vouchers, premiums cover housing-related costs, personalized plan, residential partners. retrospectively analyzed 6 months 80 recipients urban Pennsylvania county 2018 determine rates, comparing 12 before enrollment after CHFS. post-enrollment, lower emergency department services, primary specialist use, ED total compared pre-housing period. highlights vital contributions which, case, engaged efforts become increasingly within settings, scientists attempted novel screening risk, varying degrees success. Kim utilized cTAKES, form NLP, extract needs information EHRs be inefficient. While cTAKES somewhat successful extracting insecurity, unsuccessful [12]. Dankovchik centers opportunity EHR referrals national network clinics [13]. This paper discusses providers called upon report referrals. If provider goes referral, they incentivized rates. difficulty providing if there no standardized methods document EHR, may pose barriers reporting. investigate topic further, researchers developed included smart phrases procedure codes potential indicators referral. Furthermore, mentions structured fields currently place labor-intensive impractical clinic use. case reporting analyzing financial stress, patterns. A barrier codes, mentioned above, monitor occurrences effectively. More documenting recommended. Past capacity vary locality type needed [14, 15]. supported Brewster specific goals (e.g., housing) less resolved others, like [16]. Multiple explore identifying benefit interventions. implementation supports CHCs, Hessler-Jones difference-in-difference evaluate two risk-screening (financial incentives versus practice facilitation) combined 32 clinics. Their results show average monthly screenings increased modestly post-intervention facilitation interventions, consider additional investments gains [17]. Some answers conundrum come Olson mixed-methods, participatory experiences "Resourceful," resource referral system. "Resourceful" relates systems' EHRs, workers CBOs track drawn online surveys 62 14 semi-structured 5 workers. elicited significance facilitating trust, positively impacting patients' finding connecting help, improving communication workers, accessing resources addressed Interviews high-quality, reliable relationships patients, accessible platform resources, set essential reducing barriers. substantial difference workers' perceptions patient's expressed themselves—health consistently overestimated beneficial experiential dimensions [18]. offer unique into rapidly evolving learn. None randomized controlled trials, quasi-experimental assess effects Of included, six mixed methods, only, quantitative data. survey results, claims, notes, interviews. heterogeneity methodological measure findings previous review determinants, most tested via cross-sectional designs, often incomparable [19]. stems partly fact many limited number [20] although individuals wide range [21]. accounted when testing even trials Housing First [22, 23]) relatively few again reflects trends broader literature, where predominantly focus process measures rather inequality [24, 25]. strengthen inform new care, future rigorously equity, cost HRSN-related require monetary investment—11 occur large Administration Kaiser Permanente, initiatives collaboratives focused drivers HRSNs, WPC. Smaller independent practices, involved federal personnel developing, testing, implementing well-designed ensure kinds meaningfully their populations. Additionally, evidence disproportionately western United States—nearly half (7) take exclusively, least others primarily Pacific Northwest. Only representative claims understand Thus, generated generalize parts States, inequities race, ethnicity, sexual orientation, gender identity, rurality potentially differences [26, 27]. field made strides breadth room quality studies. Although progress slow due possible disinvestments HRSN, clear producing rigorous ultimately enable better, informed down line. There report. declare conflicts interest. sharing applicable datasets analysed during current study.

Language: Английский

Equitable Access to Lifestyle Medicine: FQHCs, YMCAs, Trauma-Informed Health Coaching, and “Community as Medicine” DOI
Sally C. Duplantier,

Rachel Barach,

Sheila John

et al.

American Journal of Lifestyle Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: March 18, 2025

Without intentional and collaborative input from stakeholders members of the communities we serve, Lifestyle Medicine (LM) is at risk evolving in ways that are inapplicable even alienating to diverse underserved populations. To mitigate this risk, paper advocates for implementing transdiagnostic, culturally affirmative, trauma-informed, integrative treatment frameworks address mental, social, physical health tandem. It demonstrates how Community as model can bridge divide between clinical settings such Federally Qualified Health Centers (FQHCs) community settings, YMCAs, improving accessibility groups. also shows emerging professional identities—exemplified by coaches—can be cultivated expand reach care while simultaneously opening pathways employment. By centering inclusivity, cultural affirmation, interprofessional collaboration, LM more effectively meet needs vulnerable enhance overall public outcomes.

Language: Английский

Citations

0
‘Food is Medicine’ to advance mental health and build resilient food systems globally DOI
Ronit Ridberg, Caroline Owens, Meng Wang

et al.

Nature Food, Journal Year: 2025, Volume and Issue: 6(3), P. 223 - 227

Published: March 24, 2025

Language: Английский

Citations

0
Highlights and Areas of Inquiry in the HSR Special Issue: Social Care and the US Health Care Sector DOI Creative Commons
Margarita Alegrı́a, Carrie Fry, Momiao Xiong

et al.

Health Services Research, Journal Year: 2025, Volume and Issue: unknown

Published: March 25, 2025

Recognizing that social context influences health, over much of the last decade, federal, and state policies have encouraged healthcare institutions to identify patients without adequate access basic material goods such as food, housing, transportation develop partnerships with community-based organizations (CBOs) service support any identified gaps [1]. As an example, 27 states District Columbia active or pending Medicaid Section 1115(a) waivers include provisions related health-related need (HRSN), which Centers for Medicare & Services has described "an individual's unmet, adverse conditions contribute poor health." [2] These are based on research suggesting interventions determinants will likely improve health [3]. However, recent policy changes threaten sustainability these other "social care" activities undertaken in sector. The February 2025 Executive Order "Establishing President's Make America Healthy Again Commission" does not mention health. Instead, order emphasizes individual accountability behaviors [4]. this special issue was going press March 2025, rescinded prior guidance about using dollars address members' HRSN [5]. shifts play out, it is pertinent remember long-term outcomes shaped more by factors than [6]. country aligned how should incorporate fact. We believe disseminating what we learned care—whether at patient, community, levels—is key strengthening alignment. At very least, relevant can awareness provide insights face great uncertainty. In Special Issue, "Social Care US Health Sector," partner Social Interventions Research Evaluation Network (SIREN) elevate studies exploring care systems, CBOs, agencies aiming assessing patient- population-level attending needs. Below, highlight ways Issue build existing field, persistent knowledge. Several SIREN articles describe community policy-level medical integration. California's Medi-Cal Whole Person (WPC) program assessed through qualitative mixed-method approaches Chuang et al., Safaeinili al. [7, 8] WPC initiative a $3 billion intervention, offered California waiver demonstration. pilots programs deliver integrated across multiple sectors HRSN. Utilizing data from program, 11 improved cross-sector collaboration 15 did not. Cross-sector facilitated collaborative governance braided funding meaningful use data-sharing systems [7]. study 26 services enrollees. Twenty-two sustained model. Four sustainability: adaptability flexibility, consistent reimbursement infrastructure, leadership managed plans, contracts [8]. understanding organizational promote well-being. Other examine impacts patient level. Thompson-Lastad studied effectiveness Recipe4Health (R4H) Alameda County, CA, community-level intervention addressing food insecurity mental outcomes. part R4H, eligible participants received optional group visits trained center (CHC) staff who provided nutrition cooking education, movement relaxation techniques, coaching, weekly home delivery fresh fruits vegetables. Eligible R4H were racially ethnically diverse children adults demonstrated either nutrition-sensitive condition. Data collected between 2020 2023 four five participating CHCs suggested only deliveries, security baseline depression anxiety. For both deliveries visits, depression, anxiety, significantly improved. Qualitative interviews also showed helped reduce pervasive loneliness among participants. subgroup analyses especially interesting since those One takeaway critical better appreciating whom work under [9]. Chapman evaluated Supportive Veteran Families (SSVF) targeting short- housing veterans struggling instability. To discern SSVF's effectiveness, team examined clinical Veterans Affairs electronic records (EHRs). They used natural language processing (NLP) "assign" SSVF standard 36 simulated trials. total, 238,059 "enrolled" one "trials." authors found risk being unhoused reduced control arms but pronounced groups first 120 days. note significant limitations prone error NLP selection bias assignment [10]. article examines impact costs utilization [11]. Lovelace colleagues pre-post design dually supportive enrolled Cultivating Success (CHFS). CHFS joint coordination payer organization partners provides HUD vouchers, premiums cover housing-related costs, personalized plan, residential partners. retrospectively analyzed 6 months 80 recipients urban Pennsylvania county 2018 determine rates, comparing 12 before enrollment after CHFS. post-enrollment, lower emergency department services, primary specialist use, ED total compared pre-housing period. highlights vital contributions which, case, engaged efforts become increasingly within settings, scientists attempted novel screening risk, varying degrees success. Kim utilized cTAKES, form NLP, extract needs information EHRs be inefficient. While cTAKES somewhat successful extracting insecurity, unsuccessful [12]. Dankovchik centers opportunity EHR referrals national network clinics [13]. This paper discusses providers called upon report referrals. If provider goes referral, they incentivized rates. difficulty providing if there no standardized methods document EHR, may pose barriers reporting. investigate topic further, researchers developed included smart phrases procedure codes potential indicators referral. Furthermore, mentions structured fields currently place labor-intensive impractical clinic use. case reporting analyzing financial stress, patterns. A barrier codes, mentioned above, monitor occurrences effectively. More documenting recommended. Past capacity vary locality type needed [14, 15]. supported Brewster specific goals (e.g., housing) less resolved others, like [16]. Multiple explore identifying benefit interventions. implementation supports CHCs, Hessler-Jones difference-in-difference evaluate two risk-screening (financial incentives versus practice facilitation) combined 32 clinics. Their results show average monthly screenings increased modestly post-intervention facilitation interventions, consider additional investments gains [17]. Some answers conundrum come Olson mixed-methods, participatory experiences "Resourceful," resource referral system. "Resourceful" relates systems' EHRs, workers CBOs track drawn online surveys 62 14 semi-structured 5 workers. elicited significance facilitating trust, positively impacting patients' finding connecting help, improving communication workers, accessing resources addressed Interviews high-quality, reliable relationships patients, accessible platform resources, set essential reducing barriers. substantial difference workers' perceptions patient's expressed themselves—health consistently overestimated beneficial experiential dimensions [18]. offer unique into rapidly evolving learn. None randomized controlled trials, quasi-experimental assess effects Of included, six mixed methods, only, quantitative data. survey results, claims, notes, interviews. heterogeneity methodological measure findings previous review determinants, most tested via cross-sectional designs, often incomparable [19]. stems partly fact many limited number [20] although individuals wide range [21]. accounted when testing even trials Housing First [22, 23]) relatively few again reflects trends broader literature, where predominantly focus process measures rather inequality [24, 25]. strengthen inform new care, future rigorously equity, cost HRSN-related require monetary investment—11 occur large Administration Kaiser Permanente, initiatives collaboratives focused drivers HRSNs, WPC. Smaller independent practices, involved federal personnel developing, testing, implementing well-designed ensure kinds meaningfully their populations. Additionally, evidence disproportionately western United States—nearly half (7) take exclusively, least others primarily Pacific Northwest. Only representative claims understand Thus, generated generalize parts States, inequities race, ethnicity, sexual orientation, gender identity, rurality potentially differences [26, 27]. field made strides breadth room quality studies. Although progress slow due possible disinvestments HRSN, clear producing rigorous ultimately enable better, informed down line. There report. declare conflicts interest. sharing applicable datasets analysed during current study.

Language: Английский

Citations

0