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Abstract Background In recent years, health systems have expanded the focus on health equity to include health-related social needs (HRSNs) screening. Community health workers (CHWs) are positioned to address HRSNs by serving as linkages between health systems, social services, and the community. This study describes a health system’s 12-month experience integrating CHWs to navigate HRSNs among primary care patients in Bronx County, NY. Methods We organized process and outcome measures using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation framework domains to evaluate a CHW intervention of the Community Health Worker Institute (CHWI). We used descriptive and inferential statistics to assess RE-AIM outcomes and socio-demographic characteristics of patients who self-reported at least 1 HRSN and were referred to and contacted by CHWs between October 2022 and September 2023. Results There were 4,420 patients who self-reported HRSNs in the standardized screening tool between October 2022 and September 2023. Of these patients, 1,245 were referred to a CHW who completed the first outreach attempt during the study period. An additional 1,559 patients self-reported HRSNs directly to a clinician or CHW without being screened and were referred to and contacted by a CHW. Of the 2,804 total patients referred, 1,939 (69.2%) were successfully contacted and consented to work with a CHW for HRSN navigation. Overall, 78.1% (n = 1,515) of patients reported receiving social services. Adoption of the CHW clinician champion varied by clinical team (median 22.2%; IQR 13.3–39.0%); however, there was no difference in referral rates between those with and without a clinician champion (p = 0.50). Implementation of CHW referrals via an electronic referral order appeared successful (73.2%) and timely (median 11 days; IQR 2–26 days) compared to standard CHWI practices. Median annual cost per household per CHW for the intervention was determined to be $184.02 (IQR $134.72 – $202.12). Conclusions We observed a significant proportion of patients reporting successful receipt of social services following engagement with an integrated CHW model. There are additional implementation factors that require further inquiry and research to understand barriers and enabling factors to integrate CHWs within clinical teams.

Abstract Introduction: Screening for health-related social needs (HRSNs) within health systems is a widely accepted recommendation, however challenging to implement. Aggregate area-level metrics of social determinants of health (SDoH) are easily accessible and have been used as proxies in the interim. However, gaps remain in our understanding of the relationships between these measurement methodologies. This study assesses the relationships between three area-level SDoH measures, Area Deprivation Index (ADI), Social Deprivation Index (SDI) and Social Vulnerability Index (SVI), and individual HRSNs among patients within one large urban health system. Methods: Patients screened for HRSNs between 2018 and 2019 (N = 45,312) were included in the analysis. Multivariable logistic regression models assessed the association between area-level SDoH scores and individual HRSNs. Bivariate choropleth maps displayed the intersection of area-level SDoH and individual HRSNs, and the sensitivity, specificity, and positive and negative predictive values of the three area-level metrics were assessed in relation to individual HRSNs. Results: The SDI and SVI were significantly associated with HRSNs in areas with high SDoH scores, with strong specificity and positive predictive values (∼83% and ∼78%) but poor sensitivity and negative predictive values (∼54% and 62%). The strength of these associations and predictive values was poor in areas with low SDoH scores. Conclusions: While limitations exist in utilizing area-level SDoH metrics as proxies for individual social risk, understanding where and how these data can be useful in combination is critical both for meeting the immediate needs of individuals and for strengthening the advocacy platform needed for resource allocation across communities.

We investigate the role of physician agency in determining health care sup-ply and patient outcomes. We show that an increase in health care supplydue to a change in private physician incentives has a theoretically ambiguous impact on patient welfare. The increase can reflect either induced demand for ineffective care or a reduction in prior rationing of effective care. Furthermore, physician market structure matters in determining the welfare effects of changes in private physician incentives. We then analyze a change to Medicare fees that caused physicians to increase their provision of chemotherapy. We find that this increase in treatment improved patient survival, extending median life expectancy for lung cancer patients by about 18%. Consistent with the model, we find that while the treatment response was larger in less concentrated markets, survival improvements were larger in more concentrated markets.

IntroductionThis study examines the associations of neighborhood environments with BMI, HbA1c, and diabetes across 6 years in Hispanic/Latino adults.MethodsParticipants from the Hispanic Community Health Study/Study of Latinos San Diego site (n=3,851, mean age=39.4 years, 53.3% women, 94.0% Mexican heritage) underwent assessment of metabolic risk factors and diabetes status (categorized as normoglycemia, prediabetes, and diabetes) at baseline (2008-2011) and approximately 6 years later (2014-2017). In the Study of Latinos Community and Surrounding Areas Study ancillary study (2015-2020), participant baseline addresses were geocoded, and neighborhoods were defined using 800-meter circular buffers. Neighborhood variables representing socioeconomic deprivation, residential stability, social disorder, walkability, and greenness were created using Census and other public databases. Analyses were conducted in 2020-2021.ResultsComplex survey regression analyses revealed that greater neighborhood socioeconomic deprivation was associated with higher BMI (β=0.14, p

Neighborhood-level socioeconomic deprivation can increase risk for higher blood pressure or hypertension, while greater neighborhood safety and walkability may protect against hypertension. Large-scale prospective research, particularly among Hispanics/Latinos, is lacking. We examined cross-sectional and prospective associations between neighborhood environments and blood pressure and hypertension among 3851 Hispanic/Latinos enrolled in the Hispanic Community Health Study/Study of Latinos San Diego, CA cohort. Addresses from Visit 1 (2008-2011) were geocoded and neighborhood characteristics were determined as part of the SOL CASAS ancillary study. Home addresses were geocoded and home areas created using 800 m circular radial buffers. Neighborhood indices socioeconomic deprivation, residential stability, and social disorder were created using Census and other publicly available data. Walkability was computed as density of intersections, retail spaces, and residences. Greenness was measured via satellite imagery using the Normalized Difference Vegetation Index. Visit 1 and Visit 2 (2014-2017) clinical outcomes included systolic (SBP) and diastolic (DBP) blood pressure, as well as prevalent and 6-year incident hypertension, defined as SBP/DBP ≥140/90 mmHg or antihypertensive medication use. Complex survey regression models adjusted for covariates revealed cross-sectional associations between greater walkability and lower SBP (B = -0.05; 95% CI: -0.09, -0.003). In prospective analyses, greater neighborhood social disorder was related to increasing SBP (B = 0.05; 95% CI: 0.01, 0.09) and DBP (B = 0.07; 95% CI: 0.02, 0.12) over time. Greater socioeconomic deprivation (OR = 1.47; 95% CI: 1.06, 2.04) and greater social disorder (OR = 1.25; 95% CI: 1.02, 1.54) were associated with higher odds of incident hypertension. All other associations were not significant. Beyond individual-level characteristics, greater neighborhood social disorder and socioeconomic deprivation were related to adverse changes in blood pressure over 6 years among Hispanics/Latinos. Neighborhood social environment may help identify, or be an area for future intervention for, cardiovascular risk among Hispanics/Latinos.