Background: Our objective was to examine the variation in telemedicine adoption by specialty line and patient demographic characteristics after the initial peak period of the coronavirus disease 2019 pandemic when in-person visits had resumed and visit volume returned to prepandemic levels. Materials and Methods: Aggregated encounter data were extracted for six service lines (dermatology, psychiatry, endocrinology, cardiology, orthopedics, and nonurgent primary care) in an integrated health system across three time periods:

Background Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients’ health outcomes. To our knowledge, this is the first study to apply an implementation science framework to identify implementation factors and best practices for social needs screening and response. Methods Guided by the Health Equity Implementation Framework (HEIF), we collected qualitative data from clinicians and patients to evaluate barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE), a standardized social needs screening and response protocol, in a federally qualified health center. Eligible patients who received the PRAPARE as a standard of care were invited to participate in semi-structured interviews. We also obtained front-line clinician perspectives in a semi-structured focus group. HEIF domains informed a directed content analysis. Results Patients and clinicians (i.e., case managers) reported implementation barriers and facilitators across multiple domains (e.g., clinical encounters, patient and provider factors, inner context, outer context, and societal influence). Implementation barriers included structural and policy level determinants related to resource availability, discrimination, and administrative burden. Facilitators included evidence-based clinical techniques for shared decision making (e.g., motivational interviewing), team-based staffing models, and beliefs related to alignment of the PRAPARE with patient-centered care. We found high levels of patient acceptability and opportunities for adaptation to increase equitable adoption and reach. Conclusion Our results provide practical insight into the implementation of the PRAPARE or similar social needs screening and response protocols in primary care at the individual encounter, organizational, community, and societal levels. Future research should focus on developing discrete implementation strategies to promote social needs screening and response, and associated multisector care coordination to improve health outcomes and equity for vulnerable and marginalized patient populations.

resident Obama's Precision Medicine Initiative has refocused national attention on the ability of genomics and other emerging technologies to provide a better understanding of the relationship between genetics, environment, lifestyles, and the development of disease 1. This initiative was heralded as a "bold new research effort to revolutionize how to improve health and treat disease" 2. Yet, in 2000 the sequencing of the human genome was also anticipated to lead to new ways to personalize medicine and to prevent, diagnose, and cure disease. While there have been major advances in diagnosing and treating disease, the goals for personalized medicine to improve health and prevent disease have not yet been achieved 3-5. Despite the benefits of more targeted disease treatments, the real promise of personalized/precision medicine lies in its ability to prevent disease and improve health as, in addition to the human cost, our nation spends almost 80% of its unaffordable health care expenses on treating complex, chronic diseases which are preventable. Research in precision medicine will certainly provide new capabilities to improve health and minimize disease, but to actually do so, the approach to the practice of medicine must change so it is prepared to use them. The Limitations of Reductionism in Medicine Medical care today is derivative of concepts developed over a century ago when science began to be applied to the practice of medicine and identified the causes of many, particularly infectious, diseases. The logical assumption arose that diseases have a root cause and the role of the physician became to "find it and fix it." This concept led to a paradigm of care based on the capability of the physician to identify the disease underlying the patient's chief clinical complaint and, when possible, eliminate the cause. With improving technologies and clinical experience, this reductionist approach to care has improved and resulted in wondrous cures and treatments for many diseases. However, the concept of treating disease by removing its root cause is overly simplistic in dealing with the increasingly common chronic multifactorial diseases that develop over long periods of time. Complex chronic diseases such as obesity, type II diabetes, and cardiovascular disease are but a few examples of many conditions which account for a vast proportion of our nation's health and medical expenses. As medical practice continues to be reactive to the patient's chief complaint rather than also being proactive, care is not designed to effectively adopt new technologies to improve health or predict and prevent disease. To do this, a new approach to care is needed; one that utilizes the best of what works in the current system but is based on what we know about the evolution of disease.

Introduction: While unmet social needs are major drivers of health outcomes, most health systems are not fully integrated with the social care sector to address them. In this case study, we describe the development and implementation of a model utilizing student volunteer community resource navigators to help patients connect with community-based organizations (CBOs). We then detail initial implementation outcomes and practical considerations for future work. Methods: We used the Ten Essential Public Health Services Framework to guide program planning of a student “Help Desk” model for a community health center. Planning included a literature review, observation of exemplar programs, development of a CBO directory, and evaluation of the center’s patient population, clinical workflows, and data infrastructure. We piloted the model for two months. After pilot completion, we reviewed patient data to understand the feasibility of the student “Help Desk” model. We utilized planning and pilot execution materials, as well as pilot data, to develop and discuss practical considerations. Results: Design and implementation complemented ongoing social needs screening and referral to CBOs by center case managers. Patients were asked if they would accept telephone follow-up by volunteers two and four weeks after the clinic visit. Of 61 patients screened, 29 patients were referred for follow-up. Ninety percent were reached at least once during the follow-up period, and 48% of patients referred reported connecting to at least one CBO. Only 27% of patients required escalation back to case managers, and no emergency escalation was needed for any patients. Students, faculty advisors, and community health center frontline staff and leadership supported the scale up and continuation of the “Help Desk” model at the community health center. Discussion: Successful implementation required multi-sectoral collaboration, well-defined scope of practice, and data interoperability. Student volunteers are untapped resources to support integrated health and social care.

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