Age at diagnosis and social risks among Black cancer survivors: Results from the Detroit Research on Cancer Survivors cohort.

BACKGROUND: Social risks are common among cancer survivors who have the fewest financial resources; however, little is known about how prevalence differs by age at diagnosis, despite younger survivors' relatively low incomes and wealth. METHODS: The authors used data from 3703 participants in the Detroit Research on Cancer Survivors (ROCS) cohort of Black cancer survivors. Participants self-reported several forms of social risks, including food insecurity, housing instability, utility shut-offs, not getting care because of cost or lack of transportation, and feeling unsafe in their home neighborhood. Modified Poisson models were used to estimate prevalence ratios and 95% confidence intervals (CIs) of social risks by age at diagnosis, controlling for demographic, socioeconomic, and cancer-related factors. RESULTS: Overall, 35% of participants reported at least one social risk, and 17% reported two or more risks. Social risk prevalence was highest among young adults aged 20-39 years (47%) followed by those aged 40-54 years (43%), 55-64 years (38%), and 65 years and older (24%; p for trend < .001). Compared with survivors who were aged 65 years and older at diagnosis, adjusted prevalence ratios for any social risk were 1.75 (95% CI, 1.42-2.16) for survivors aged 20-39 years, 1.76 (95% CI, 1.52-2.03) for survivors aged 40-54 years, and 1.41 (95% CI, 1.23-1.60) for survivors aged 55-64 years at diagnosis. Similar associations were observed for individual social risks and experiencing two or more risks. CONCLUSIONS: In this population of Black cancer survivors, social risks were inversely associated with age at diagnosis. Diagnosis in young adulthood and middle age should be considered a risk factor for social risks and should be prioritized in work to reduce the financial effects of cancer on financially vulnerable cancer survivors.

Racial and ethnic disparities in self-reported general and mental health status among colorectal cancer survivors: impact of sociodemographic factors and implications for mortality-a SEER-CAHPS study.

PURPOSE: Patient-reported outcomes are recognized as strong predictors of cancer prognosis. This study examines racial and ethnic differences in self-reported general health status (GHS) and mental health status (MHS) among patients with colorectal cancer (CRC). METHODS: A retrospective analysis of Medicare beneficiaries between 1998 and 2011 with non-distant CRC who underwent curative resection and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey within 6-36 months of CRC diagnosis. Analysis included a stepwise logistic regression to examine the relationship between race and ethnicity and fair or poor health status, and a proportional hazards model to determine the mortality risk associated with fair or poor health status. RESULTS: Of 1867 patients, Non-Hispanic Black (OR 1.56, 95% CI 1.06-2.28) and Hispanic (OR 1.48, 95% CI 1.04-2.11) patients had higher unadjusted odds for fair or poor GHS compared to Non-Hispanic White patients, also Hispanic patients had higher unadjusted odds for fair or poor MHS (OR 1.92, 95% CI 1.23-3.01). These relationships persisted after adjusting for clinical factors but were attenuated after subsequently adjusting for sociodemographic factors. Compared to those reporting good to excellent health status, patients reporting fair or poor GHS or MHS had an increased mortality risk (OR 1.52, 95% CI 1.31-1.76 and OR 1.63, 95% CI 1.34-1.99, respectively). CONCLUSION: Racial and ethnic differences in GHS and MHS reported after CRC diagnosis are mainly driven by sociodemographic factors and reflect a higher risk of mortality. Identifying unmet biopsychosocial needs is necessary to promote equitable care.

In-person versus electronic screening for social risks among carers of pediatric inpatients: A mixed methods randomized trial.

We aimed to compare disclosure of social risks according to self-report on an iPad versus face-to-face questions from a health professional and to explore carers' experiences of screening. This two-arm, parallel group, randomized trial was conducted from January 19, 2021, to December 17, 2021, in a public hospital pediatric ward serving a disadvantaged area of an Australian capital city. Carers of children aged ≤ 5 years admitted to the Children's Ward were eligible. The primary outcome was disclosure of social risks. The screener included nine items on food security, household utilities, transport, employment, personal and neighborhood safety, social support, housing and homelessness. Disclosure of social risks was similar between the self-completion (n = 193) and assisted-completion (n = 193) groups for all 9 items, ranging 4.1% higher for worrying about money for food (95% CI - 11.4, 3.1%) among the assisted-completion group, to 5.7% (-1.6, 13.0%) higher for unemployment among the self-completion group. In qualitative interviews, participants were positive about screening for social risks in the hospital ward setting and the majority indicated a preference for self-completion.  Conclusion: Differences in the disclosure of social risks according to self- versus assisted-completion were small, suggesting that either method could be used. Most carers expressed a preference for self- completion, which is therefore recommended as the ideal mode for such data collection for Australian pediatric inpatient settings.  Trial registration: Australia New Zealand Clinical Trial Registry ( www.anzctry.org.au ; #ACTRN12620001326987; date of registration 8 December 2020). What is Known: • Most evidence on screening of social risks in pediatric inpatient settings is from the USA. • Little is known about disclosure of social risks in countries with universal health care and social welfare. What is New: • Disclosure of social risks was similar for electronic compared with face-to-face screening. • Carers preferred electronic completion over face-to-face completion.

Screening tools for employment in clinical healthcare delivery systems: a content analysis.

BACKGROUND: The relationship between work and health is complex and bidirectional, where work can have both health-harming and health-enhancing effects. Though employment is recognized as a social determinant of health, and clinical healthcare delivery systems are increasingly using screening tools to ask patients about social needs, little research has explored the extent to which employment-related social risk is captured in these screening tools. This study aimed to identify and characterize employment- and work-related questions in social risk screening tools that have been implemented in clinical healthcare delivery systems. METHODS: We conducted a qualitative content analysis of employment-related items in screening tools that have been implemented in clinical healthcare service delivery systems. Three content areas guided data extraction and analysis: Setting, Domain, and Level of Contextualization. RESULTS: Screening tools that asked employment-related questions were implemented in settings that were diverse in the populations served and the scope of care provided. The intent of employment-related items focused on four domains: Social Risk Factor, Social Need, Employment Exposure, and Legal Need. Most questions were found to have a low Level of Contextualization and were largely focused on identifying an individual's employment status. CONCLUSIONS: Several existing screening tools include measures of employment-related social risk, but these items do not have a clear purpose and range widely depending on the setting in which they are implemented. In order to maximize the utility of these tools, clinical healthcare delivery systems should carefully consider what domain(s) they aim to capture and how they anticipate using the screening tools to address social determinants of health.

Unwanted sexual activity among United States women early in the COVID-19 pandemic.

BACKGROUND: Female sexual activity and, accordingly, birth rates tend to decline in times of stress, such as a pandemic. In addition, when resources are scarce or exogenous conditions are threatening, some women may engage in sexual activity primarily to maintain socioeconomic security. Having unwanted sex may indicate sexual activity in exchange for economic security. OBJECTIVE: This study aimed to describe patterns and correlates of unwanted sex, defined as having sex more frequently than desired, among US women early in the COVID-19 pandemic. STUDY DESIGN: The National US Women's Health COVID-19 Study was conducted in April 2020, using a nested quota sample design to enroll 3200 English-speaking women (88% cooperation rate) aged 18 to 90 years recruited from a research panel. The quota strata ensured sufficient sample sizes in sociodemographic groups of interest, namely, racial and ethnic subgroups. Patterns of sexual activity, including unwanted sex early in the pandemic, were described. To further elucidate the experiences of women reporting unwanted sex, open-ended responses to an item querying "how the coronavirus pandemic is affecting your sex life" were assessed using conventional content analysis. Logistic regression analyses-adjusting for sociodemographic characteristics, self-reported health, and prepandemic health-related socioeconomic risk factors, including food insecurity, housing instability, utilities and transportation difficulties, and interpersonal violence-were used to model the odds of unwanted sex by a pandemic-related change in health-related socioeconomic risk factors. RESULTS: The proportion of women who were sexually active early in the pandemic (51%) was about the same as in the 12 months before the pandemic (52%), although 7% of women became active, and 7% of women became inactive. Overall, 11% of sexually active women were having unwanted sex in the early pandemic. The rates of anxiety, depression, traumatic stress symptoms, and each of the 5 health-related socioeconomic risk factors assessed were about 2 times higher among women having unwanted sex than other women (P<.001). Women having unwanted sex were also 5 times more likely than other women to report an increased frequency of sex since the pandemic (65% vs 13%; P<.001) and 6 times more likely to be using emergency contraception (18% vs 3%; P<.001). Women reporting unwanted sex commonly described decreased libido or interest in sex related to mood changes since the pandemic, having "more sex," fear or worry about the transmission of the virus because of sex, and having sex to meet the partner's needs. Among sexually active women, the odds of unwanted sex (adjusting for demographic, reproductive, and health factors) were higher among women with 1 prepandemic health-related socioeconomic risk factor (adjusted odds ratio, 2.0; 95% confidence interval, 1.1-3.8) and 2 or more prepandemic health-related socioeconomic risk factors (adjusted odds ratio, 6.0; 95% confidence interval, 3.4-10.6). Among sexually active women with any prepandemic health-related socioeconomic risk factor, those with new or worsening transportation difficulties early in the pandemic were particularly vulnerable to unwanted sex (adjusted odds ratio, 2.7; 95% confidence interval, 1.7-4.3). CONCLUSION: More than 1 in 10 sexually active US women was having unwanted sex early in the COVID-19 pandemic. Socioeconomically vulnerable women, especially those with new or worsening transportation problems because of the pandemic, were more likely than others to engage in unwanted sex. Pandemic response and recovery efforts should seek to mitigate unwanted sexual activity and related health and social risks among women.

A cross-sectional study of relationships between social risks and prevalence and severity of pediatric chronic conditions.

BACKGROUND: To examine the differential relationships between seven social risk factors (individually and cumulatively) with the prevalence and severity of asthma, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and overweight/obesity in children. METHODS: Using the 2017-2018 National Survey of Children's Health, we examined associations between social risk factors (caregiver education, caregiver underemployment, discrimination, food insecurity, insurance coverage, neighborhood support, and neighborhood safety) and the prevalence and severity of asthma, ADHD, ASD, and overweight/obesity. We used multivariable logistic regression to assess the relationship between individual and cumulative risk factors with each pediatric chronic condition, controlling for child sex and age. RESULTS: Although each social risk factor was significantly associated with increased prevalence and/or severity of at least one of the pediatric chronic conditions we investigated, food insecurity was significantly associated with higher disease prevalence and severity for all four conditions. Caregiver underemployment, low social support, and discrimination were significantly associated with higher disease prevalence across all conditions. For each additional social risk factor a child was exposed to, their odds of having each condition increased: overweight/obesity (aOR: 1.2, 95% CI: [1.2, 1.3]), asthma (aOR: 1.3, 95% CI: [1.2, 1.3], ADHD (aOR: 1.2, 95% CI: [1.2, 1.3]), and ASD (aOR: 1.4, 95% CI: [1.3, 1.5]). CONCLUSIONS: This study elucidates differential relationships between several social risk factors and the prevalence and severity of common pediatric chronic conditions. While more research is needed, our results suggest that social risks, particularly food insecurity, are potential factors in the development of pediatric chronic conditions.

"More than just giving them a piece of paper": Interviews with Primary Care on Social Needs Referrals to Community-Based Organizations.

BACKGROUND: Primary care practices are responding to calls to incorporate patients' social risk factors, such as housing, food, and economic insecurity, into clinical care. Healthcare likely relies on the expertise and resources of community-based organizations to improve patients' social conditions, yet little is known about the referral process. OBJECTIVE: To characterize referrals to community-based organizations by primary care practices. DESIGN: Qualitative study using semi-structured interviews with healthcare administrators responsible for social care efforts in their organization. PARTICIPANTS: Administrators at 50 diverse US healthcare organizations with efforts to address patients' social risks. MAIN MEASURES: Approaches used in primary care to implement social needs referral to community-based organizations. RESULTS: Interviewed administrators reported that social needs referrals were an essential element in their social care activities. Administrators described the ideal referral programs as placing limited burden on care teams, providing patients with customized referrals, and facilitating closed-loop referrals. We identified three key challenges organizations experience when trying to implement the ideal referrals program: (1) developing and maintaining resources lists; (2) aligning referrals with patient needs; and (3) measuring the efficacy of referrals. Collectively, these challenges led to organizations relying on staff to manually develop and update resource lists and, in most cases, provide patients with generic referrals. Administrators not only hoped that referral platforms may help overcome some of these barriers, but also reported implementation challenges with platforms including inconsistent buy-in and use across staff; integration with electronic health records; management and prioritization of resources; and alignment with other organizations in their market. CONCLUSION AND RELEVANCE: Referrals to community-based organizations were used in primary care to improve patients' social conditions, but despite strong motivations, interviewees reported challenges providing tailored and up-to-date information to patients.

Social needs screening and referral in pediatric primary care clinics: a multiple case study.

BACKGROUND: Unmet social risks such as housing, food insecurity and safety concerns are associated with adverse health outcomes in adults and children. Experimentation with social needs screening in primary care is currently underway throughout the United States. Pediatric primary care practices are well-positioned to amplify the effects of social needs screening and referral programs because all members of the household have the potential to benefit from connection to needed social services; however, more research is needed to determine effective implementation strategies. METHODS: To describe common implementation barriers and facilitators, we conducted 48 in-depth qualitative interviews with leadership, providers and staff between November 2018 and June 2019 as part of a multiple case study of social needs screening and referral programs based out of four pediatric ambulatory care clinics in New York City. Interviews were recorded, transcribed and coded using a protocol-driven, template-based rapid analysis approach designed for pragmatic health services research. In addition to analyzing content for our study, we delivered timely findings to each site individually in order to facilitate quality improvement changes in close-to-real time. RESULTS: Effective implementation strategies included tailoring screening tools to meet the needs of families seen at the clinic and reflect the resources available in the community, hiring dedicated staff to manage the program, building strong and lasting partnerships with community-based organizations, establishing shared communication methods between partners, and utilizing technology for efficient tracking of screening data. Respondents were enthusiastic about the value of their programs and the impact on families, but remained concerned about long-term sustainability after the grant period. CONCLUSION: Implementation of social needs screening and referral interventions is dependent on contextual factors including the nature of family needs and the availability of intraorganizational and community resources to address those needs. Additional research is needed to prospectively test promising implementation strategies that were found to be effective across sites in this study. Sustainability of programs is challenging, and future research should also explore measurable outcomes and payment structures to support such interventions in pediatric settings, as well as aim to better understand caregiver perspectives to improve engagement.

Is China facing the social risks associated with reliance on hospitalization for the care of the elderly with chronic diseases?

This study aims to investigate if China is facing the social risks associated with reliance on hospitalization for the care of the elderly with chronic diseases. Textual studies and big data analysis indicate the following outcomes: (1) The elderly population suffering from chronic diseases is expanding rapidly, while the prevalence rate also shows a growing trend; (2) the reliance on hospitalization for the care of the elderly patients exists and has caused three new social risks; and (3) these social risks are wasted health resources, poverty between individuals and families, and relative increase in the disability rate of the elderly after hospital admission. We conclude that effectively defusing the risks entails strengthening the management of chronic diseases related to communal public health, initiating the concept of "continuity of care" to pursue an active combination of medical and health care, hastening the implementation of long-term care insurance (LTCI) and other policy measures.

[Work ability in workers with heart disease: assessing physical and psycho-social risks]. / Idoneità lavorativa nel cardiopatico: valutare i rischi fisici e psico-sociali.

SUMMARY: Cardiovascular diseases are the main cause of death and disability in all industrialized countries, including Italy. Advances in acute phase treatment and increasingly effective rehabilitation programs have determined higher survival rates and a subsequent rise in disease prevalence in working age population. Hence the need for implementing social reintegration programs, including interventions aimed specifically at aiding the process of returning to work, in which the occupational physician plays a crucial role by means of assessing the compatibility between the workers residual clinical and functional capabilities and the characteristics of their job profile. On the basis of recent literature data, particular attention must be paid to occupational risks towards which cardiopathic patients are particularly susceptible, i.e. environmental risks (physical effort), organizational and psycho-social risks (workload and time pressure, shifts, job demand and control). A close collaboration between the occupation physician and the cardiologist to ensure an effective return to work process is highly recommended, as well as periodic re-evaluations of job placement adequacy that can also include clinical examinations, performed during working hours, of the degree of cardiovascular adaptation to working conditions.

[Family care as a tool of mitigation the social risks of the elderly people in remote areas.]

The purpose of the study was to analyze the foster family as tool of the social security system for elderly in remote northern territories. The significance of long-term previous relationships for building and microclimate of a foster family, relationship with the living environment as a socio-psychological support for reducing (eliminating) the risks of loneliness, social inclusion in society through a foster family has been revealed. It was noted that legally consolidated efforts of the state and family at the regional level faster respond to changing needs for various types of services, taking into account local socio-economic opportunities and cultural traditions, which helps to diversify the number of forms of services that directly affect risk reduction and meeting the needs of an elderly person. It is shown that the uncertainty associated with the organization (accessibility) of care services (palliative care) of chronically sick people in old age, worthy death, is a risk in the remote northern territories.

An Integrative Review of Social Determinants of Health Assessment and Screening Tools Used in Pediatrics.

PROBLEM: Social and physical contexts which make up social determinants of health (SDOH) have tremendous impacts on youth development, health and well-being. Despite knowledge and evidence of these impacts, few pediatric SDOH screening tools are known. The purpose of this review was to identify and evaluate available pediatric SDOH screening tools. ELIGIBILITY CRITERIA: Articles were limited to studies in the English language, with pediatric populations, conducted in the United States, and were peer-reviewed, primary studies. SAMPLE: Search of 3 databases (PsychInfo, CINAHL and PubMed) yielded 499 articles, 486 were excluded. Total of 13 articles were appraised and synthesized using the SDOH framework outlined by Healthy People 2020. RESULTS: Thirteen articles relevant to the assessment of SDOH domains were evaluated. Majority of studies were limited in both the number of SDOH domains screened and the depth of screening. Tools were heterogeneous in methods used to assess SDOH risks and few were validated. Limited number of studies included youth or families in the initial development of tools. CONCLUSIONS: Despite growing recognition across healthcare that SDOH greatly influence pediatric health risks, management and outcomes, there is a dearth of available high quality, multidimensional, comprehensive screening tools for pediatric care professionals. IMPLICATIONS: This review emphasizes the need for the continued development of effective, comprehensive and practical tools for assessing pediatric SDOH risk factors. Pediatric nursing care includes the assessment of the youth and family context to effectively evaluate resource needs. Pediatric nurses are well poised to address this knowledge and resource gap.

Environmental and social risk evaluation of overseas investment under the China-Pakistan Economic Corridor.

Along with the further implementation of the "One Belt, One Road" initiative and the promotion of the China-Pakistan Economic Corridor (CPEC), the construction of the CPEC will likely face challenges owing to differences between China and Pakistan in politics, economics, culture, religion, language, customs, environmental management systems, environmental protection laws, social management systems, and social management regulations. To address potential environmental and social risks associated with Chinese enterprises as they invest in the CPEC region, this paper examines previous studies addressing topics such as the environmental and social safeguards of international institutions and Pakistan's domestic environmental and social management requirements. We then systematically identify the environmental and social risk factors involved in CPEC construction, which cover risks regarding water, air, soil, noise, biodiversity, politics, economics, culture, technology, and individuals. By establishing and calculating these risks and using a multi-fuzzy comprehensive evaluation model, we found that noise and individual risks belong to a medium risk category, while others belong to a higher risk category. In view of these risks, the Chinese government must create a friendly and peaceful environment for Chinese enterprises to invest in the CPEC region, and Chinese enterprises must adopt a development strategy of strength and capacity building and establish enterprises capable of addressing environmental and social issues during the investment process. All stakeholders must understand that if no determined and diligent steps are taken, CPEC construction might be doomed for failure from the start.

HIV/AIDS clients, privacy and confidentiality; the case of two health centres in the Ashanti Region of Ghana.

BACKGROUND: While most studies on HIV/AIDS often identify stigmatization and patients' unwillingness to access health care as critical problems in the control of the pandemic, very few studies have focused on the possible consequences of accessing health care by sero-positives. This paper examines the socio-psychological trauma patients experience in their desire to access health care in two health facilities in the Ashanti Region of Ghana. METHODS: Through participant observation, informal conversation and in-depth interviews, data were collected from health workers and clients of the voluntary counselling (VCT) and antiretroviral therapy units in the two hospitals. The data gathered were analysed and categorized into themes and supported with illustrative quotes obtained from health workers and clients. RESULTS: The study found that the mere presence of a person at the HIV counselling centre or clinic is enough for the person to be labelled as or suspected to be HIV patient. It demonstrates that stigmatization may occur not only in the community but also overtly or covertly, in the health facility itself. Consequently, for many HIV/AIDS patients, access to antiretroviral therapy and treatment of related nosocomial infections are problematic. Besides, the study found that many clients and potential users of services were uncomfortable with the quality of care given by some health workers, especially as they overtly and covertly breached confidentiality about their clients' health status. This has compelled many patients and potential users of the services to adopt a modus vivendi that provides them access to some care services while protecting their identity. CONCLUSION: The paper argues that by examining issues relating to privacy and confidentiality in the provision of care for and use of services by seropositives, more light will be shed on the whys of the limited uptake of HIV-related health care services in Ghana.

Prevalence of financial hardship and health-related social needs among patients with missed radiology appointments.

PURPOSE: We aimed to evaluate the prevalence of financial hardship and Health-Related Social Needs (HRSN) among patients who missed their radiology appointment. METHODS: English-speaking adult patients, with a missed outpatient imaging appointment at any of a tertiary care imaging centers between 11/2022 and 05/2023 were eligible. We measured self-reported general financial worry using Comprehensive Score for Financial Toxicity (COST), imaging hardship (worry that the current imaging is a financial hardship to patient and their family), material hardship (e.g., medical debt), cost-related care nonadherence, and HRSNs including housing instability, food insecurity, transportation problems, and utility help needs. RESULTS: 282 patients were included (mean age 54.7 ± 15.0 years; 70.7 % female). Majority were non-Hispanic White (52.4 %), followed by Asian (23.0 %) and Hispanic (16.0 %) racial/ethnic background. Most missed appointments were patient-initiated (74.8 %); 13.5 % due to cost or insurance coverage and 6.4 % due to transportation and parking. Mean COST score was 26.8 with 44.4 % and 28.8 % reporting their illness and imaging as a source of financial hardship. 18.3 % and 35.2 % endorsed cost-related care nonadherence and material hardship. 32.7 % had at least one HRSNs with food insecurity the most common (25.4 %). Only 12.5 % were previously screened for financial hardship or HRSNs. Having comorbidity and living in more disadvantaged neighborhoods was associated with higher report of financial hardship and HRSNs. CONCLUSION: Financial hardship and HRSNs are common among those who miss radiology appointments. There needs to be more rigorous screening for financial hardship and HRSNs at every health encounter and interventions should be implemented to address these.

Addressing adverse social determinants of health in pediatric primary care: Study protocol for a hybrid type 2 effectiveness-implementation randomized controlled trial in two national pediatric practice-based research networks.

BACKGROUND: Growing evidence linking social determinants of health (SDOH) to child health outcomes has prompted widespread recommendations for pediatricians to screen and refer for adverse SDOH at primary care visits. Yet there is little evidence to date demonstrating the effectiveness of practice-based SDOH screening and referral interventions on increasing family engagement with resources. This hybrid type 2 effectiveness-implementation trial aims to demonstrate the non-inferiority of a low-touch implementation strategy in order to facilitate dissemination of an existing SDOH screening and referral system (WE CARE) and demonstrate its effectiveness and sustainability in various pediatric practices. METHODS: We recruited eighteen pediatric practices in fourteen US states through two pediatric practice-based research networks. For this stepped wedge cluster RCT, practices serve as their own controls during the Usual Care phase and implement WE CARE during the intervention phase via one of two randomized implementation strategies: self-directed, pre-recorded webinar vs. study team-facilitated, live webinar. We collect data at practice, clinician/staff, and parent levels to assess outcomes grounded in the Proctor Conceptual Model of Implementation Research. We use generalized mixed effects models and differences in proportions to compare rates of resource referrals by implementation strategy, and intention-to-treat analysis to compare odds of engagement with new resources among families enrolled in the Usual Care vs. WE CARE phases. DISCUSSION: Findings from this trial may inform decisions about broader dissemination of SDOH screening systems into a diverse spectrum of pediatric practices across the US and potentially minimize the impact of adverse SDOH on children and families.

Establishing a Regional Health System and Community-Based Organization Social Care Coordination Network: An Application of Geospatial Analysis.

INTRODUCTION: Adverse social determinants of health have been shown to be associated with a greater chance of developing chronic conditions. Although there has been increased focus on screening for health-related social needs (HRSNs) in health care delivery systems, it is seldom examined if the provision of needed services to address HRSNs is sufficiently available in communities where patients reside. METHODS: The authors used geospatial analysis to determine how well a newly formed health system and community-based organizations (CBOs) social care coordination network covered the areas in which a high number of patients experiencing HRSNs live. Geospatial clusters (hotspots) were constructed for Kaiser Permanente Northwest members experiencing any of the following 4 HRSNs: transportation needs, housing instability, food insecurity, or financial strain. Next, a geospatial polygon was calculated indicating whether a member could reach a social care provider within 30 minutes of travel time. RESULTS: A total of 185,535 Kaiser Permanente Northwest members completed a HRSN screener between April 2022 and April 2023. Overall, the authors found that among Kaiser Permanente Northwest members experiencing any of the 4 HRSNs, 97% to 98% of them were within 30 minutes of a social care provider. A small percentage of members who lived greater than 30 minutes to a social care provider were primarily located in rural areas. DISCUSSION AND CONCLUSION: This study demonstrates the importance of health system and community-based organization partnerships and investment in community resources to develop social care coordination networks, as well as how patient-level HRSN can be used to assess the coverage and representativeness of the network.

The association between social risks and days at home for older veterans.

BACKGROUND: Many health systems are trying to support the ability of older adults to remain in their homes for as long as possible. Little is known about the relationship between patient-reported social risks and length of time spent at home. We assessed how social risks were associated with days at home for a cohort of older Veterans at high risk for hospitalization and mortality. METHODS: A prospective cross-sectional study using a 2018 survey of 3479 high-risk Veterans aged ≥65 linked to Veterans Health Administration data. Social risks included measures of social resources (i.e., no partner present, low social support), material resources (i.e., not employed, financial strain, medication insecurity, food insecurity, and transportation barriers), and personal resources (i.e., low medical literacy and less than high school education). We estimated how social risks were associated with days at home, defined as the number of days spent outside inpatient, long-term care, observation, or emergency department settings over a 12-month period, using a negative binomial regression model. RESULTS: Not having a partner, not being employed, experiencing transportation barriers, and low medical literacy were respectively associated with 2.57, 3.18, 3.39, and 6.14 fewer days at home (i.e., 27% more facility days, 95% confidence interval [CI] 8%-50%; 42% more facility days, 95% CI 7%-89%; 34% more facility days, 95% CI 7%-68%; and 63% more facility days, 95% CI 27%-109%). Experiencing food insecurity was associated with 2.62 more days at home (i.e., 24% fewer facility days, 95% CI 3%-59%). CONCLUSIONS: Findings suggest that screening older Veterans at high risk of community exit for social risks (i.e., social support, material resources, and medical literacy) may help identify patients likely to benefit from home- and community-based health and social services that facilitate remaining in home settings. Future research should focus on understanding the mechanisms by which these associations occur.

Understanding Health-Related Social Risks.

Because of the established contribution of social factors to health outcomes, approaches that address upstream determinants of health have increasingly been recognized as cost-effective means to improve population health. Understanding and usage of precise terminology is important to facilitate collaboration across disciplines. Social determinants of health affect everyone, not just the socially and economically disadvantaged, whereas health-related social risks (HRSR) are specific adverse conditions at the individual or family level that are associated with poor health and related to the immediate challenges individuals face. Health-related social needs account for patient preference in addressing identified social risks. The use of validated screening tools is important to capture risk factors in a standardized fashion to support research and quality improvement. There is a paucity of studies that address HRSR in the context of radiology. This review provides an understanding of HRSR and outlines various ways in which radiologists can work to mitigate them.

Codesigning Online Continuing Medical Education on Social Health Integration and Social Risk-Informed Care for Primary Care Providers.

INTRODUCTION: Adapting clinical care decisions for patient-reported social risks is essential to social health integration and patient-centered care. Most research in this area focuses on awareness and assistance (social-needs-targeted care), such as screening and referral to food, financial, and other resources. Limited evidence for adjustment strategies (social risk-informed care) or adapting care for social risks made it difficult for Kaiser Permanente to implement new initiatives. This article describes a codesign process to build a novel, adjustment-focused continuing medical education course. METHODS: The authors codeveloped the online continuing medical education course with patients and clinicians using user-centered design. Transcripts from codesign activities were coded and analyzed by thematic analysis to identify major themes, including perceptions of social risk-informed care and barriers to care adjustment. RESULTS: Practical hurdles for implementing social risk-informed care emerged, including clinicians' concerns about the ethics of adjustment as substandard care, particularly without robust assistance activities. However, patients expressed a desire for their care to be adapted to their social circumstances, to allow for more realistic care plans. DISCUSSION: Implementation barriers identified from the codesign were addressed through an interactive, case-study approach. Existing evidence on contextualized care and shared decision making informed a general framework for primary care providers to engage in awareness and adjustment activities, paired with 3 interactive case studies based on real-world, clinician-supplied scenarios. CONCLUSION: The authors recommend that multiple stakeholder perspectives be incorporated during the development of social health integration initiatives, particularly adjustment. Education complemented by active, nuanced, flexible implementation strategies may be necessary for the successful uptake of care-delivery-based social health integration activities.