School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
Health Communication Research Lab, Brown School, Washington University in St. Louis, 1 Brookings Hall, St. Louis, MO 63130, USA.
Int J Environ Res Public Health. 2024 Jul 18;21(7):936. doi: 10.3390/ijerph21070936.
Health systems are increasingly assessing and addressing social needs with referrals to community resources. The objective of this randomized controlled trial was to randomize adult Medicaid members with type 2 diabetes to receive usual care ( = 239) or social needs navigation ( = 234) for 6 months and compare HbA1c (primary outcome), quality of life (secondary outcome), and other exploratory outcomes with -tests and mixed-effects regression. Eligible participants had an HbA1c test in claims in the past 120 days and reported 1+ social needs. Data were collected from November 2019 to July 2023. Surveys were completed at baseline and at 3-, 6-, and 12-month follow-up. Health plan data included care management records and medical and pharmacy claims. The sample was from Louisiana, USA, M = 51.6 (SD = 9.5) years old, 76.1% female, 66.5% Black, 29.4% White, and 3.0% Hispanic. By design, more navigation (91.5%) vs. usual care (6.7%) participants had a care plan. Social needs persisted for both groups. No group differences in HbA1c tests and values were observed, though the large amount of missing HbA1c lab values reduced statistical power. No group differences were observed for other outcomes. Proactively eliciting and attempting to provide referrals and resources for social needs did not demonstrate significant health benefits or decrease healthcare utilization in this sample.
卫生系统越来越多地评估和解决社会需求,并将患者转介到社区资源。本随机对照试验的目的是将患有 2 型糖尿病的成年医疗补助计划成员随机分为接受常规护理(n = 239)或社会需求导航(n = 234)组,为期 6 个月,并使用 t 检验和混合效应回归比较 HbA1c(主要结局)、生活质量(次要结局)和其他探索性结局。合格参与者在过去 120 天内的索赔中有 HbA1c 检测结果,并报告有 1+项社会需求。数据收集时间为 2019 年 11 月至 2023 年 7 月。基线和 3、6、12 个月随访时完成了调查。健康计划数据包括护理管理记录以及医疗和药房索赔。样本来自美国路易斯安那州,M = 51.6(SD = 9.5)岁,76.1%为女性,66.5%为黑人,29.4%为白人,3.0%为西班牙裔。按设计,与常规护理组(6.7%)相比,更多的导航组(91.5%)有护理计划。两组的社会需求都持续存在。尽管大量缺失的 HbA1c 实验室值降低了统计效力,但未观察到两组之间 HbA1c 检测和值存在差异。其他结局也未观察到组间差异。在该样本中,主动查明并尝试为社会需求提供转介和资源并没有显示出显著的健康益处或减少医疗保健利用。