Montefiore Medical Center, Bronx, NY, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
J Prim Care Community Health. 2023 Jan-Dec;14:21501319231166918. doi: 10.1177/21501319231166918.
Identifying social needs is a growing priority in primary care, but there is significant variation in how patients access services to meet such needs. This study identifies predictors of successful linkage with a community health worker (CHW) among patients with social needs seen in an outpatient setting.
This study uses a cross-sectional analysis of social needs assessments administered in an urban health system between April 2018 and December 2019. Social needs included: food insecurity, housing quality, housing instability, healthcare cost, healthcare related transportation, utilities, care for dependents, legal assistance, safety, and getting along with household members. Patients with at least 1 social need and accepting help were included in the analysis. On contact with a CHW, patients were entered into a separate database. The primary outcome was successful "linkage," defined by having a positive social needs assessment in the medical record and a corresponding record in the CHW database. Multivariate logistic regression was used to assess predictors of linkage.
Among patients with at least 1 social need accepting help, 25% (758/3064) were linked to a CHW. Positive predictors included female gender (OR 1.28 [95% CI 1.01-1.63]), Spanish language preference compared to English (1.51 [1.14-1.03]), and having a food related need (1.35 [1.03-1.79]). Negative predictors included age 18 to 65 (0.34 [0.17-0.71] for age 18-24) and 0 to 5 (0.45 [0.24-0.78]) compared to over 65, non-Hispanic White race compared to Hispanic race (0.39 [0.18-0.84]), and having needs of getting along with household members (0.52 [0.38-0.71]) and safety (0.64 [0.42-0.98]).
Twenty-five percent of patients who had at least 1 social need and were accepting help had a successful CHW linkage. Predictors of linkage suggest areas of further system-level improvements to screening and referral interventions to target at risk patients and communities.
在初级保健中，识别社会需求是一个日益重要的优先事项，但患者获得服务以满足这些需求的方式存在很大差异。本研究旨在确定在门诊环境中就诊的有社会需求的患者与社区卫生工作者（CHW）成功联系的预测因素。
本研究使用了 2018 年 4 月至 2019 年 12 月期间在城市卫生系统中进行的社会需求评估的横断面分析。社会需求包括：食物不安全、住房质量、住房不稳定、医疗保健费用、与医疗保健相关的交通、水电费、照顾家属、法律援助、安全以及与家庭成员相处。有至少 1 项社会需求且愿意接受帮助的患者被纳入分析。与 CHW 联系后，患者将被输入到一个单独的数据库中。主要结局是成功“联系”，定义为医疗记录中有积极的社会需求评估和 CHW 数据库中的相应记录。采用多变量逻辑回归评估联系的预测因素。
在有至少 1 项社会需求且愿意接受帮助的患者中，25%（758/3064）与 CHW 联系。阳性预测因素包括女性（比值比 1.28[95%置信区间 1.01-1.63]）、西班牙语偏好（1.51[1.14-1.03]）和食物相关需求（1.35[1.03-1.79]）。阴性预测因素包括 18-65 岁（18-24 岁为 0.34[0.17-0.71]）和 0-5 岁（0.45[0.24-0.78]），与 65 岁以上相比，非西班牙裔白人种族（0.39[0.18-0.84]）与西班牙裔种族相比，以及有与家庭成员相处的需求（0.52[0.38-0.71]）和安全需求（0.64[0.42-0.98]）。
有至少 1 项社会需求且愿意接受帮助的患者中，有 25%的患者与 CHW 成功联系。联系的预测因素表明，在系统层面上需要进一步改进筛查和转介干预措施，以针对有风险的患者和社区。
