Screening for Social Risk at Federally Qualified Health Centers: A National Study.
Screening for Social Risk at Federally Qualified Health Centers: A National Study.
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DOI：
10.1016/j.amepre.2021.11.008
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发表时间：
2022-05
影响因子：
5.5
通讯作者：
Murray, Genevra F.
中科院分区：
文献类型：
--
作者：
Cole, Megan B.;Nguyen, Kevin H.;Byhoff, Elena;Murray, Genevra F.
联邦合格的健康中心（FATHCs）为全美2980万低收入患者提供服务，他们中的许多人都有未解决的社会风险。2019年，首次收集了美国每家医疗机构的社会风险筛查能力数据。本研究的目的是描述国家的社会风险筛查能力的比率在整个CNOHC，确定组织的预测筛选，并评估国家之间的异质性。使用来自2019年统一数据系统的100%美国CIMCs样本（N= 1，384，代表2980万患者），主要结果是CIMCs是否收集了患者社会风险因素的数据（是/否）。社会风险筛查能力比率的汇总统计数据是按总体和州分列的。然后使用线性概率模型来估计社会风险筛查的概率与7个关键的CNOHC特征（例如，医疗补助计划的规模、医疗补助计划的MCO合同、医疗补助计划负责的医疗机构的存在）。2020-2021年的数据进行了分析。大多数（71%）CNOHC收集社会风险数据，州与州之间的变化。最常见的筛查工具是应对和评估患者资产风险和经验的方案（43%的筛查过的患者），而22%的患者使用非标准化筛查工具收集社会风险数据。在对其他特征进行调整后，具有社会风险筛查能力的CNOHC为更多的患者提供服务，更有可能位于一个拥有医疗补助责任护理组织的州，并且不太可能拥有MCO合同。在美国，社会风险筛查工具已被广泛采用，但各州之间存在差异。将社会风险筛查资源针对较小的社区卫生组织，可能会增加筛查工具的采用。
Federally Qualified Health Centers (FQHCs) serve 29.8 million low-income patients across the U.S., many of whom have unaddressed social risks. In 2019, for the first time, data on social risk screening capabilities were collected from every U.S. FQHC. The objectives of this study were to describe national rates of social risk screening capabilities across FQHCs, identify organizational predictors of screening, and assess between-state heterogeneity. Using a 100% sample of U.S. FQHCs (N=1,384, representing 29.8 million patients) from the 2019 Uniform Data System, the primary outcome was whether an FQHC collected data on patients’ social risk factors (yes/no). Summary statistics on rates of social risk screening capabilities were generated in aggregate and by state. Linear probability models were then used to estimate the relationship between probability of social risk screening and 7 key FQHC characteristics (e.g., FQHC size, Medicaid MCO contract, Medicaid accountable care organization presence). Data were analyzed in 2020–2021. Most (71%) FQHCs collected social risk data, with between-state variation. The most common screener was the Protocol for Responding to and Assessing Patients’ Assets Risks and Experiences (43% of FQHCs that screened), whereas 22% collected social risk data using a non-standardized screener. After adjusting for other characteristics, FQHCs with social risk screening capabilities served more total patients, were more likely to be located in a state with a Medicaid accountable care organization, and were less likely to have an MCO contract. There has been widespread adoption of social risk screening tools across U.S. FQHCs, but between-state disparities exist. Targeting social risk screening resources to smaller FQHCs may increase adoption of screening tools.
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