De Marchis Emilia H, Aceves Benjamin, Razon Na'amah, Chang Weir Rosy, Jester Michelle, Gottlieb Laura M
From the Department of Family & Community Medicine, University of California, San Francisco (EHDM, RMG); School of Public Health, San Diego State University (BA); Department of Family & Community Medicine, University of California, Davis (NR); Association of Asian Pacific Community Health Organizations, San Francisco, CA (RCW); National Association of Community Health Centers (now with America's Health Insurance Plans, Washington, DC) (MJ).
J Am Board Fam Med. 2023 Oct 11;36(5):817-831. doi: 10.3122/jabfm.2023.230099R1. Epub 2023 Sep 29.
Many community health centers (CHC) are scaling social risk screening in response to growing awareness of the influence of social adversity on health outcomes and concurrent incentives for social risk data collection. We studied the implementation of social risk screening in Texas CHCs to inform best practices and understand equity implications.
Convergent mixed methods of 3 data sources. Using interviews and surveys with CHC providers and staff, we explored social risk screening practices to identify barriers and facilitators; we used electronic health record (EHR) data to assess screening reach and disparities in screening.
Across 4 urban/suburban Texas CHCs, we conducted 27 interviews (15 providers/12 staff) and collected 97 provider surveys; 2 CHCs provided EHR data on 18,672 patients screened during the study period. Data revealed 2 cross-cutting themes: 1) there was broad support for social risk screening/care integration that was rooted in CHCs' mission and positionalities, and 2) barriers to social risk screening efforts were largely a result of limited time and staffing. Though EHR data showed screens per month and screens/encounters increased peri-pandemic (4.1% of encounters in 8/2019 to 46.1% in 2/2021), there were significant differences in screening rates by patient race/ethnicity and preferred language (). In surveys, 90.0% of surveyed providers reported incorporating social risk screening into patient conversations; 28.6% were unaware their clinic had an embedded screening tool.
Study CHCs were in the early stages of standardizing social risk screening. Differences in screening reach by patient demographics raise concerns that social screening initiatives, which often serve as a path to resource/service connection, might exacerbate disparities. Overcoming barriers to reach, sustainability, and equity requires supports targeted to program design/development, workforce capacity, and quality improvement.
随着人们越来越意识到社会逆境对健康结果的影响以及社会风险数据收集的同步激励措施，许多社区卫生中心（CHC）正在扩大社会风险筛查的规模。我们研究了德克萨斯州社区卫生中心社会风险筛查的实施情况，以提供最佳实践信息并了解公平性影响。
采用三种数据源的收敛性混合方法。通过对社区卫生中心提供者和工作人员进行访谈和调查，我们探索了社会风险筛查实践，以确定障碍和促进因素；我们使用电子健康记录（EHR）数据来评估筛查覆盖范围和筛查差异。
在德克萨斯州的4个城市/郊区社区卫生中心，我们进行了27次访谈（15名提供者/12名工作人员），并收集了97份提供者调查问卷；2个社区卫生中心提供了研究期间筛查的18672名患者的电子健康记录数据。数据揭示了两个贯穿各领域的主题：1）基于社区卫生中心的使命和定位，对社会风险筛查/护理整合有广泛支持；2）社会风险筛查工作的障碍主要是时间和人员配备有限。尽管电子健康记录数据显示，大流行期间每月的筛查次数和每次就诊的筛查次数有所增加（从2019年8月的4.1%的就诊次数增加到2021年2月的46.1%），但按患者种族/民族和首选语言划分的筛查率存在显著差异（）。在调查中，90.0%的受访提供者报告将社会风险筛查纳入患者对话；28.6%的人不知道他们的诊所拥有嵌入式筛查工具。
研究中的社区卫生中心正处于社会风险筛查标准化的早期阶段。患者人口统计学特征在筛查覆盖范围上的差异引发了人们的担忧，即社会筛查举措（通常是获取资源/服务的途径）可能会加剧差异。克服覆盖范围、可持续性和公平性方面的障碍需要针对项目设计/开发、劳动力能力和质量改进提供支持。
