Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, United States of America.
BMC Health Serv Res. 2023 Dec 12;23(1):1400. doi: 10.1186/s12913-023-10446-2.
Unmet social needs may impair health and access to health care, and intervening on these holds particular promise in high-risk patient populations, such as those with multiple chronic conditions. Our objective was to identify social needs in a patient population at significant risk-Medicare enrollees with multiple chronic illnesses enrolled in care management services-and measure their prevalence prior to any systematic screening.
We partnered with Renova Health, an independent Medicare Chronic Care Management (CCM) provider with patients in 10 states during our study period (January 2017 through August 2020). Our data included over 3,000 Medicare CCM patients, representing nearly 20,000 encounters. We used a dictionary-based natural language processing approach to ascertain the prevalence of six domains of barriers to care (food insecurity, housing instability, utility hardship) and unmet social needs (health care affordability, need for supportive services, transportation) in notes taken during telephonic Medicare CCM patient encounters.
Barriers to care, specifically need for supportive services (2.4%) and health care affordability (0.8%), were the most prevalent domains identified. Transportation as a barrier to care came up relatively less frequently in CCM encounters (0.1%). Unmet social needs were identified at a comparatively lower rate, with potential housing instability (0.3%) flagged most followed by potential utility hardship (0.2%) and food insecurity (0.1%).
There is substantial untapped opportunity to systematically screen for social determinants of health and unmet social needs in care management.
未满足的社会需求可能会影响健康和获得医疗保健的机会，而干预这些需求在高危患者群体中具有特殊的意义，例如患有多种慢性疾病的患者。我们的目的是在一个处于高风险的患者群体中确定社会需求 - 参加医疗管理服务的患有多种慢性疾病的 Medicare 参保者 - 在进行任何系统筛查之前，衡量这些需求的普遍性。
我们与 Renova Health 合作，该公司是一家独立的 Medicare 慢性护理管理（CCM）提供商，在我们的研究期间（2017 年 1 月至 2020 年 8 月）在 10 个州拥有患者。我们的数据包括 3000 多名 Medicare CCM 患者，代表近 20000 次就诊。我们使用基于词典的自然语言处理方法来确定在电话中记录的 Medicare CCM 患者就诊中六种护理障碍（食品不安全、住房不稳定、公用事业困难）和未满足的社会需求（医疗保健负担能力、需要支持性服务、交通）的普遍性。
护理障碍，特别是需要支持性服务（2.4%）和医疗保健负担能力（0.8%），是确定的最普遍的领域。在 CCM 就诊中，作为护理障碍的交通相对较少（0.1%）。未满足的社会需求的识别率相对较低，潜在的住房不稳定（0.3%）最为突出，其次是潜在的公用事业困难（0.2%）和食品不安全（0.1%）。
在护理管理中，有大量未被挖掘的机会来系统地筛查健康的社会决定因素和未满足的社会需求。
