Associations among social needs, health and healthcare utilization, and desire for navigation services among US Medicaid beneficiaries with type 2 diabetes

McQueen, Amy; Kreuter, Matthew W.; Herrick, Cynthia; Li, Linda; Brown, Derek S.; Haire‐Joshu, Debra

doi:10.1111/hsc.13296

Cited by 10 publications

(10 citation statements)

References 31 publications

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“…Unmet social risk factors like lack of access to health insurance, food insecurity, and housing instability create barriers to managing diabetes and are major drivers of poor glycemic control [ 7 ]. Prior to the pandemic, these risk factors drove much of the inequities observed in diabetes morbidity and mortality across sociodemographic groups in the US [ [7] , [8] , [9] ]. Unmet basic needs are highly prevalent, even among patients who are insured, and are associated with poor diabetes-related clinical outcomes [ 8 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Prior to the pandemic, these risk factors drove much of the inequities observed in diabetes morbidity and mortality across sociodemographic groups in the US [ [7] , [8] , [9] ]. Unmet basic needs are highly prevalent, even among patients who are insured, and are associated with poor diabetes-related clinical outcomes [ 8 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

Patel

Zhang

Leung

et al. 2022

Primary Care Diabetes

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

Patel

Zhang

Leung

et al. 2022

Primary Care Diabetes

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“…These unmet social needs contribute to uncontrolled diabetes, which leads to major health complications and contributes to diabetes-related morbidity, mortality, and health care costs. 36,37 Quantitatively, there was low use of Z-codes within the EHR; this was not in alignment with the qualitative reports of patient social needs by providers. Providers informally discussed social needs with patients, but they were not systematically using standardized SDOH screeners and were generally unaware of Z-codes as a means to document social needs in the EHR.…”

Section: Discussionmentioning

confidence: 89%

“…While not systematically documented using Z‐codes, qualitative findings suggest that housing and economic circumstances, education, and literacy are critical factors that impact patients. These unmet social needs contribute to uncontrolled diabetes, which leads to major health complications and contributes to diabetes‐related morbidity, mortality, and health care costs 36,37 …”

Section: Discussionmentioning

confidence: 99%

The adoption of social determinants of health documentation in clinical settings

Kepper

Walsh‐Bailey

Prusaczyk

et al. 2022

Health Services Research

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Objective To understand the frequency of social determinants of health (SDOH) diagnosis codes (Z‐codes) within the electronic health record (EHR) for patients with prediabetes and diabetes and examine factors influencing the adoption of SDOH documentation in clinical care. Data Sources EHR data and qualitative interviews with health care providers and stakeholders. Study Design An explanatory sequential mixed methods design first examined the use of Z‐codes within the EHR and qualitatively examined barriers to documenting SDOH. Data were integrated and interpreted using a joint display. This research was informed by the Framework for Dissemination and Utilization of Research for Health Care Policy and Practice. Data Collection/Extraction Methods We queried EHR data for patients with a hemoglobin A1c > 5.7 between October 1, 2015 and September 1, 2020 (n = 118,215) to examine the use of Z‐codes and demographics and outcomes for patients with and without social needs. Semi‐structured interviews were conducted with 23 participants (n = 15 health care providers; n = 7 billing and compliance stakeholders). The interview questions sought to understand how factors at the innovation‐, individual‐, organizational‐, and environmental‐level influence SDOH documentation. We used thematic analysis to analyze interview data. Principal Findings Patients with social needs were disproportionately older, female, Black, uninsured, living in low‐income and high unemployment neighborhoods, and had a higher number of hospitalizations, obesity, prediabetes, and type 2 diabetes than those without a Z‐code. Z‐codes were not frequently used in the EHR (<1% of patients), and there was an overall lack of congruence between quantitative and qualitative results related to the prevalence of social needs. Providers faced barriers at multiple levels (e.g., individual‐level: discomfort discussing social needs; organizational‐level: limited time, competing priorities) for documenting SDOH and identified strategies to improve documentation. Conclusions Providers recognized the impact of SDOH on patient health and had positive perceptions of screening for and documenting social needs. Implementation strategies are needed to improve systematic documentation.

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“…Social Determinants of Health (SDOH) assessment: LHCC adopted and administered social needs questions developed for and used in several previous studies, including a pilot survey the 2 organizations conducted. 5,6 Ten items assessed the likelihood that each participant's personal safety, housing, food, transportation, childcare (if applicable), and various financial needs would be met in the next month. Response options ranged from 1 = very unlikely to 4 = very likely.…”

Section: Methodsmentioning

confidence: 99%

Social Needs Are Associated With Greater Anticipated Needs During an Emergency and Desire for Help in Emergency Preparedness Planning

McQueen

Charles

Staten

et al. 2022

Disaster med. public health prep.

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Objective: Most emergency preparedness planning seeks to identify vulnerable population subgroups; however, focusing on chronic conditions alone may ignore other important characteristics such as location and poverty. Social needs were examined as correlates of anticipated needs and desire for assistance during an emergency. Methods: A retrospective, secondary analysis was conducted using assessments of 8280 adult Medicaid beneficiaries in Louisiana, linked with medical (n = 7936) and pharmacy claims (n = 7473). Results: The sample was 73% female; 47% Black; 34% White; mean age 41 y. Many had at least 1 chronic condition (75.9%), prescription (90.3%), and social need (45.2%). Across assessments, many reported food (40%), housing (34%), and transportation (33%) needs. However, far more people anticipated social needs during an emergency than in the next month. Having social needs increased the odds of anticipating any need (odds ratio [OR] = 1.5, 1.44-1.56) and desire for assistance during an emergency, even after controlling for significant covariates including older age, race, geographic region, Medicaid plan type, and prescriptions. Chronic conditions were significantly correlated with all anticipated needs in bivariate analyses, but only modestly associated (OR = 1.03, 1.01-1.06) with anticipated medication needs in multivariable analyses. Conclusions: Identifying individuals with social needs, independent of their chronic disease status, will benefit emergency preparedness outreach efforts.

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Associations among social needs, health and healthcare utilization, and desire for navigation services among US Medicaid beneficiaries with type 2 diabetes

Cited by 10 publications

References 31 publications

Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

The adoption of social determinants of health documentation in clinical settings

Social Needs Are Associated With Greater Anticipated Needs During an Emergency and Desire for Help in Emergency Preparedness Planning

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