Implementation of Health-Related Social Needs Screening at Michigan Health Centers: A Qualitative Study

• Published in: Annals of family medicine 2021-07, Vol.19 (4), p.310-317
• Main Authors: Greenwood-Ericksen, Margaret, MD, MSc, DeJonckheere, Melissa, PhD, Syed, Faiyaz, MD, Choudhury, Nashia, MPH, Cohen, Alicia J., MD, MSc, Tipirneni, Renuka, MD, MSc
• Format: Article
• Language: English
• Subjects: Aged; Clinics; Community Health Centers; Community health services; Community Health Workers; Family Medicine/General Medicine; Humans; Internal Medicine; Interviews as Topic; Mass Screening - methods; Medical screening; Methods; Michigan; Original Research; Primary Health Care; Qualitative Research; Services; Social aspects; Social Determinants of Health; Social medicine; United States
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.2690

AbstractPurposeFederally qualified health centers (FQHCs) are leaders in screening for and addressing patient’s health-related social needs but variation exists in screening practices. This variation is relatively unexplored, particularly the influences of organizational and state policies. We employed a qualitative descriptive approach to study social needs screening practices at Michigan FQHCs to characterize screening processes and identify drivers of variation in screening implementation. MethodsSite visits and semistructured interviews were conducted from October 2016 through March 2017, to explore implementation of social needs screening in clinical practice. Five FQHCs were selected through maximum variation sampling. Within each site, snowball sampling identified care team members highly knowledgeable about social needs screening. We conducted 4 to 5 interviews per site. Transcripts were analyzed using a thematic approach. ResultsWe interviewed 23 participants from 5 sites; these sites varied by geography, age distribution, and race/ethnicity. We identified 4 themes: (1) statewide initiatives and local leadership drove variation in screening practices; (2) as community health workers (CHWs) played an integral role in identifying patients’ needs, their roles often shifted from that of screener to implementer; (3) social needs screening data was variably integrated into electronic health records and infrequently used for population health management; and (4) sites experienced barriers to social needs screening that limited the perceived impact and sustainability. ConclusionsFQHCs placed value on the role of CHWs, on sustainable initiatives, and on funding to support continued social needs screening in primary care settings.