Evaluation of an Integrated Intervention to Address Clinical Care and Social Needs Among Patients with Type 2 Diabetes

Abstract

BACKGROUND:The Providence Diabetes Collective Impact Initiative (DCII) was designed to address the clinical challenges of type 2 diabetes and the social determinants of health (SDoH) challenges that exacerbate disease impact. OBJECTIVE: We assessed the impact of the DCII, a multifaceted intervention approach to diabetes treatment that employed both clinical and SDoH strategies, on access to medical and social services. DESIGN: The evaluation employed a cohort design and used an adjusted difference-in-difference model to compare treatment and control groups. PARTICIPANTS: Our study population consisted of 1220 people (740 treatment, 480 control), aged 18-65 years old with a pre-existing type 2 diabetes diagnosis who visited one of the seven Providence clinics (three treatment and four control) in the tri-county area of Portland, Oregon, between August 2019 and November 2020. INTERVENTIONS:The DCII threaded together clinical approaches such as outreach, standardized protocols, and diabetes self-management education and SDoH strategies including social needs screening, referral to a community resource desk, and social needs support (e.g., transportation) to create a comprehensive, multi-sector intervention. MAIN MEASURES: Outcome measures included SDoH screens, diabetes education participation, HbA1c, blood pressure, and virtual and in-person primary care utilization, as well as inpatient and emergency department hospitalization. KEY RESULTS: Compared to patients at the control clinics, patients at DCII clinics saw an increase in diabetes education (15.5%, p<0.001), were modestly more likely to receive SDoH screening (4.4%, p<0.087), and had an increase in the average number of virtual primary care visits of 0.35 per member, per year (p<0.001). No differences in HbA1c, blood pressure, or hospitalization were observed. CONCLUSIONS: DCII participation was associated with improvements in diabetes education use, SDoH screening, and some measures of care utilization.

Screening for social determinants of health among populations at risk for MASLD: a scoping review

“…Similarly, Roth et al referred individuals to their community resource desk staffed by multilingual and multicultural resource specialists employed by community partners to assist with the navigation of community services including nutrition assistance, housing and employment support, and dental care. When appropriate, patients were also enrolled in their Diabetic Transportation Program ( 56 ). Berkowitz and colleagues also connected participants with social needs to community resources.…”

“…Of the 6,729 unique studies identified using our search criteria, after reviewing 460 abstracts and 25 full texts, 10 studies met our inclusion criteria -8 manuscripts and 2 conference abstracts (47)(48)(49)(50)(51)(52)(53)(54)(55)(56). Figure 2 shows the flow diagram summarizing our study identification and selection.…”

“…Four studies used a version of the SDoH screener used in the Health Leads program (48)(49)(50)53). Two studies used the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) screening tool (51,56,57). One study supplemented this with the validated 2-question screener for food insecurity (58).…”

“…SDoH screening was available in either setting as it was embedded into existing clinical workflows, however remained less than 30% overall. Screening rates were higher among clinics within the Diabetes Collective Impact Initiative, where 26.1% of patients were screened, compared to standard of care primary care clinics with 1.5% screened (56). The Simplified directed acyclic graph (DAG) depicting the relationship between social determinants of health (SDoH) and metabolic dysfunction-associated steatotic liver disease (MASLD).…”

Enhancing Chronic-Disease Education through Integrated Medical and Social Care: Exploring the Beneficial Role of a Community Teaching Kitchen in Oregon

“…Providence St. Joseph Health in Oregon developed a comprehensive intervention designed to simultaneously address the clinical challenges of chronic conditions and the social-need challenges that exacerbate medical care for underserved populations [26]. In addition to this multi-year effort, Providence St. Joseph Health also integrated socialneeds screening and referral activities into clinical settings with dedicated support from a program, co-developed with a local social-service agency, called the Community Resource Desk [26,27]. The Providence Community TK and it's staff were integrated into these interventions.…”