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We conducted interviews with frontline community resource staff (community resource specialists, community health workers, social workers hereafter referred to as “resource staff”), managers of community health center programs responsible for addressing SDOH, and program managers responsible for the implementation of the Medicaid ACO screening program to explore the: (1) SDOH referral workflow, (2) common ways of addressing food and housing needs, and (3) facilitators and barriers of SDOH referrals. To address these gaps, the present study explored facilitators and barriers to addressing SDOH identified by systematic screening in a healthcare system participating in a Medicaid ACO. Identification of these important factors can inform workflow implementation efforts as well as staff training and support across the many types of healthcare organizations screening for SDOH. Further, little is known about the experiences of staff members who are largely responsible for this work as well as the challenges they face in addressing patients’ SDOH. 12ĭespite the importance of effective systems for SDOH resource linkage, there is limited research examining the facilitators and barriers of these processes.
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10 Some systems harness technology (eg, electronic health record automation) to connect patients with SDOH referrals and/or resource guides 6, 11 while others provide one-on-one or on-site assistance (eg, food pantries, enrollment of patients into Supplemental Nutrition Assistance Program ). Common procedures involve linking patients with clinic and community resources. Therefore, healthcare systems that screen for SDOH must establish efficient and feasible workflows and programs for addressing needs. Garg et al 9 have cautioned against screening patients for sensitive issues such as food and housing insecurity when addressing such needs is not plausible, because it could lead to frustration for both patients and providers. Screening for SDOH, however, is more likely to be beneficial if followed by adequate provision of resources to meet identified needs. Therefore, systematic screening for SDOH across healthcare systems has the potential to substantively improve important health-related outcomes.
SNAP OPTION IN PCAD 2006 PROFESSIONAL
2, 3 Providers and professional organizations support systematic SDOH screening 4, 5 and healthcare settings, including large systems 6, 7 and community health centers, 8 have generally found it feasible. 1 In the United States, Accountable Care Organizations (ACOs), healthcare networks that share medical and financial responsibility for a particular patient group (eg, Medicaid beneficiaries), have contributed to increased recognition that social needs have a substantial impact on health outcomes and healthcare delivery. Screening for social determinants of health (SDOH), such as food insecurity and housing instability, is increasingly being implemented in health care settings.