How High-Performing Community Health Clinics Accomplish Social Risk Screening | JoVE Visualize

Area of Science:

Health Services Research
Primary Care Medicine
Health Equity

Background:

National policies now mandate documenting patients' social risks (SR), such as food, housing, and transportation insecurity, and connecting them to community resources.
Under-resourced community health centers (CHCs) encounter significant hurdles in integrating SR screening into their daily operations.
This study identifies key factors enabling CHCs to achieve and maintain high rates of SR screening.

Purpose of the Study:

To investigate the drivers of sustained social risk (SR) screening integration in under-resourced community health centers (CHCs).
To understand the internal and external factors that facilitate successful implementation and long-term maintenance of SR screening processes.
To identify best practices for CHCs aiming to improve their capacity for addressing patients' social determinants of health.

Main Methods:

A qualitative study employing semistructured interviews with 27 clinic staff across 5 CHCs in 3 states.
CHCs were selected based on having SR screening rates in the top 20% of a national network.
Thematic analysis was used to interpret interview transcripts, focusing on implementation strategies, staff/patient experiences, and external influences.

Main Results:

Internal drivers included organization-wide commitment to team-based care, continuous quality improvement initiatives, and robust social service coordination capacity.
External influences comprised incentives from Accountable Care Organizations, Primary Care Medical Home certification requirements, and support from CHC consortia and grants.
SR screening was consistently viewed by staff as a collective effort integral to the CHC mission of holistic patient care.

Conclusions:

CHCs demonstrating a strong culture of team-based care, quality improvement, and care coordination are better positioned for successful SR screening integration.
Sustained SR screening in primary care settings is likely to be enhanced by investments in these foundational elements of primary care.
Strengthening these core components, alongside targeted external support, is crucial for embedding social risk screening into routine clinical practice.