Advancing Social Prescribing with Implementation Science

Gottlieb, Laura M.; Cottrell, Erika; Park, Brian; Clark, Khaya D.; Gold, Rachel; Fichtenberg, Caroline

doi:10.3122/jabfm.2018.03.170249

Cited by 44 publications

(38 citation statements)

References 29 publications

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“…The growing field of implementation science provides general guidance on this topic 45,46 ; however, there are a number of questions specific to social needs interventions that will need to be answered as the field evolves. 47 What Technology and Capacity-Building Supports Help Health Systems and Care Teams Implement Effective Interventions? Despite widespread interest in social needs interventions, barriers to implementation abound, including busy clinical workflows, lack of staff training, lack of technology to facilitate interventions, and provider concerns about unintended consequences.…”

Section: How To Encourage Adoption and Uptake Of Effective Interventionsmentioning

confidence: 99%

Improving Social Needs Intervention Research: Key Questions for Advancing the Field

Fichtenberg

Alley

Mistry

2019

American Journal of Preventive Medicine

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Spurred by accumulated evidence documenting how social determinants of health shape health outcomes as well as the push for better value, the healthcare sector is embracing interventions that address patients' health-related social needs. An increasing number of healthcare organizations and payers are experimenting with strategies to identify needs and connect patients to resources that address identified needs with the goal of improving health outcomes, reducing avoidable utilization of costly health services, and improving health equity. Although many studies link social factors to health, relatively little published research exists about how the healthcare sector can effectively intervene to help identify and address social needs. This paper summarizes emerging evidence and identifies key areas where more research is needed to advance implementation and policy development. Although some healthcare-based social needs interventions have been shown to improve health and reduce avoidable utilization, important gaps remain in terms of comparative effectiveness and cost effectiveness of social needs intervention approaches. Additionally, the field would benefit from an increased understanding of mechanisms of action to maximize practitioners' ability to tailor interventions. More research is also needed to guard against unintended consequences and ensure these interventions reduce health inequities. Finally, implementation science research should identify supports and incentives for adoption of effective interventions. Focusing both public and private research efforts on these evidence gaps can help advance identification of interventions that maximize both health equity and healthcare value.

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Section: How To Encourage Adoption and Uptake Of Effective Interventionsmentioning

confidence: 99%

Improving Social Needs Intervention Research: Key Questions for Advancing the Field

Fichtenberg

Alley

Mistry

2019

American Journal of Preventive Medicine

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“…Even the Centers for Medicare and Medicaid Services’ innovative Accountable Healthcare Communities initiative [146], designed to test “… whether systematically identifying and addressing the health-related social needs … will impact health care costs and reduce health care utilization,” does not focus on the support needs associated with implementing these activities. The study described here will identify strategies for helping community health centers adopt electronic health record-based documentation of patient-reported social determinants of health needs and actions to address those needs [28, 47, 63, 64]. We will document how this support can be tailored to meet local needs and the resources and competencies needed to do so.…”

Section: Discussionmentioning

confidence: 99%

“…These benefits cannot accrue without effective strategies for implementing social determinants of health data documentation/action, but little evidence yet exists to guide integrating social determinants of health documentation into standard practice [28, 42, 61–64]. The need for such guidance is especially urgent in primary care community health centers, which serve patients whose health risks are high, and whose exposure to social determinants of health are profound [17, 20, 21, 65–67].…”

Section: Introductionmentioning

confidence: 99%

Study protocol: a pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation

et al. 2019

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BackgroundNational leaders recommend documenting social determinants of health and actions taken to address social determinants of health in electronic health records, and a growing body of evidence suggests the health benefits of doing so. However, little evidence exists to guide implementation of social determinants of health documentation/action.MethodsThis paper describes a 5-year, mixed-methods, stepped-wedge trial with realist evaluation, designed to test the impact of providing 30 community health centers with step-by-step guidance on implementing electronic health record-based social determinants of health documentation. This guidance will entail 6 months of tailored support from an interdisciplinary team, including training and technical assistance. We will report on tailored support provided at each of five implementation steps; impact of tailored implementation support; a method for tracking such tailoring; and context-specific pathways through which these tailored strategies effect change. We will track the competencies and resources needed to support the study clinics’ implementation efforts.DiscussionResults will inform how to tailor implementation strategies to meet local needs in real-world practice settings. Secondary analyses will assess impacts of social determinants of health documentation and referral-making on diabetes outcomes. By learning whether and how scalable, tailored implementation strategies help community health centers adopt social determinants of health documentation and action, this study will yield timely guidance to primary care providers. We are not aware of previous studies exploring implementation strategies that support adoption of social determinants of action using electronic health and interventions, despite the pressing need for such guidance.Trial registrationclinicaltrials.gov, NCT03607617, registration date: 7/31/2018—retrospectively registeredElectronic supplementary materialThe online version of this article (10.1186/s13012-019-0855-9) contains supplementary material, which is available to authorized users.

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“…However, it became evident that a dedicated tactic team could be more effective. 13 Family medicine organizations will intentionally highlight aspects of health equity throughout 2018-2019 and beyond. In 2017, AAFP started a Center for Diversity and Health Equity to address social determinants of health with the "EveryONE Project" 7 to equip family physicians to address health disparities.…”

Section: Health Equitymentioning

confidence: 99%

Family Medicine for America’s Health—4 Years Later, Heading Into the Future

Wilson

2018

Fam Med

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Advancing Social Prescribing with Implementation Science

Cited by 44 publications

References 29 publications

Improving Social Needs Intervention Research: Key Questions for Advancing the Field

Improving Social Needs Intervention Research: Key Questions for Advancing the Field

Study protocol: a pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation

Family Medicine for America’s Health—4 Years Later, Heading Into the Future

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