Impact of Risk Stratification on Referrals and Uptake of Wraparound Services That Address Social Determinants

A Stepped Wedged Trial

Joshua Vest, Nir Menachemi, Shaun Grannis, Jennifer L. Ferrell, Suranga N. Kasthurirathne, Ying Zhang, Yan Tong, Paul Halverson

Research output: Contribution to journalArticle

Abstract

Introduction: Social determinants of health are critical drivers of health status and cost, but are infrequently screened or addressed in primary care settings. Systematic approaches to identifying individuals with unmet social determinants needs could better support practice workflows and linkages of patients to services. A pilot study examined the effect of a risk-stratification tool on referrals to services that address social determinants in an urban safety-net population. Methods: An intervention that risk stratified patients according to the need for wraparound was evaluated in a stepped wedge design (i.e., phased implementation at the clinic level during 2017). Staff at nine federally qualified health centers received a daily report predicting patients’ needs for social worker, dietitian, behavioral health, and other wraparound services (categorized as low, rising, or high risk). Outcomes included referrals and uptake of appointments to wraparound services. Results: Among 238,087 encounters, providing clinic staff with risk-stratification scores increased the odds that a patient would be referred to a social worker. For patients categorized as high risk, the odds of a social work referral was 65% higher than controls and similar patients, but lower effect sizes were observed for individuals categorized with rising and low risk. Among referred patients, the intervention was generally associated with increased odds of kept appointments. Conclusions: This study provided preliminary evidence that risk-stratification interventions to identify patients in need of wraparound services to address social determinants can increase referrals and uptake of services that may address social drivers of disease burden.

Original languageEnglish (US)
JournalAmerican Journal of Preventive Medicine
DOIs
StatePublished - Jan 1 2019

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Referral and Consultation
Social Work
Appointments and Schedules
Social Determinants of Health
Nutritionists
Workflow
Health
Health Care Costs
Health Status
Primary Health Care
Safety
Population

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

@article{91f61063104644e4aa4c637bce80da78,
title = "Impact of Risk Stratification on Referrals and Uptake of Wraparound Services That Address Social Determinants: A Stepped Wedged Trial",
abstract = "Introduction: Social determinants of health are critical drivers of health status and cost, but are infrequently screened or addressed in primary care settings. Systematic approaches to identifying individuals with unmet social determinants needs could better support practice workflows and linkages of patients to services. A pilot study examined the effect of a risk-stratification tool on referrals to services that address social determinants in an urban safety-net population. Methods: An intervention that risk stratified patients according to the need for wraparound was evaluated in a stepped wedge design (i.e., phased implementation at the clinic level during 2017). Staff at nine federally qualified health centers received a daily report predicting patients’ needs for social worker, dietitian, behavioral health, and other wraparound services (categorized as low, rising, or high risk). Outcomes included referrals and uptake of appointments to wraparound services. Results: Among 238,087 encounters, providing clinic staff with risk-stratification scores increased the odds that a patient would be referred to a social worker. For patients categorized as high risk, the odds of a social work referral was 65{\%} higher than controls and similar patients, but lower effect sizes were observed for individuals categorized with rising and low risk. Among referred patients, the intervention was generally associated with increased odds of kept appointments. Conclusions: This study provided preliminary evidence that risk-stratification interventions to identify patients in need of wraparound services to address social determinants can increase referrals and uptake of services that may address social drivers of disease burden.",
author = "Joshua Vest and Nir Menachemi and Shaun Grannis and Ferrell, {Jennifer L.} and Kasthurirathne, {Suranga N.} and Ying Zhang and Yan Tong and Paul Halverson",
year = "2019",
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language = "English (US)",
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AU - Grannis, Shaun

AU - Ferrell, Jennifer L.

AU - Kasthurirathne, Suranga N.

AU - Zhang, Ying

AU - Tong, Yan

AU - Halverson, Paul

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