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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 3 of 3 Research Studies DisplayedFraze TK, Beidler LB, Fichtenberg C
Resource brokering: efforts to assist patients with housing, transportation, and economic needs in primary care settings.
This study reviewed how 29 diverse health care organizations assisted patients with housing, transportation, and economic needs in primary care settings. Semistructured interviews were conducted with leaders and frontline staff. Organizations used case management programs to assist patients with social needs through referrals to community-based organizations (CBOs) and regular follow-up. About one-half incorporated care into established case management programs, and the remaining described standalone programs. While all organizations referred patients to CBOs, some also provided more intense services such as assistance in completing patients’ applications for services or conducting home visits. Challenges described by the organizations include: 1) effectively engaging CBOs; 2) obtaining buy-in from clinical staff; 3) considering patients' perspectives; and 4) ensuring program sustainability.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Fichtenberg C .
Resource brokering: efforts to assist patients with housing, transportation, and economic needs in primary care settings.
Ann Fam Med 2021 Nov-Dec;19(6):507-14. doi: 10.1370/afm.2739..
Keywords: Social Determinants of Health, Primary Care, Care Management
Nguyen KH, Fields JD JD, Cemballi AG
The role of community-based organizations in improving chronic care for safety-net populations.
Researchers conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for those living in socio-economically deprived contexts. Participants were patients with chronic illnesses in San Francisco neighborhoods with high chronic disease rates, community leaders serving the same neighborhoods, or providers from San Francisco's public health care delivery system. The researchers identified several key themes. They concluded that their results contributed new evidence toward the community domain of the Chronic Care Model, and health care systems must intentionally partner with community-based organizations to address social determinants of health and improve community resources for chronic care management.
AHRQ-funded; HS026383.
Citation: Nguyen KH, Fields JD JD, Cemballi AG .
The role of community-based organizations in improving chronic care for safety-net populations.
J Am Board Fam Med 2021 Jul-Aug;34(4):698-708. doi: 10.3122/jabfm.2021.04.200591..
Keywords: Community Partnerships, Chronic Conditions, Social Determinants of Health, Care Management
Fleming MD, Guo C, Knox M
Impact of social needs case management on use of medical and behavioral health services: secondary analysis of a randomized controlled trial.
This research letter describes a secondary analysis that was conducted of a randomized encouragement study that assigned Medicaid beneficiaries with high risk for acute care use to social needs case management or to be administratively observed in the control group from August 2017 through December 2018. These services connect patients to resources such as food assistance, housing, transportation, or income benefits in addition to facilitating access to health care and behavioral health services. The study group included adults 18 years or older, who are residents of Contra Costa County in California, and enrolled in full-scope Medicaid. The case management enrollees were assigned to a case manager who assessed their needs, created a patient-centered care plan, and provided ongoing support including community resource referrals, coordination with primary care providers, and collaboration on applications for public benefits. Case managers had diverse backgrounds and included public health nurses, social workers, substance misuse counselors, mental health clinicians, homeless service specialists, and community health workers. Case management was offered either in-person or by remote telephonic services for 1 year. About 40% (n = 8577) of enrolled patients used the services. There were 21,422 intervention group enrollments and 22,839 in the weighted control group. The intervention group had significantly higher rates of primary care visits compared with the control group. No differences were found between the treatment groups for specialty care visits, behavioral health visits, psychiatric emergency visits, or jail intakes.
AHRQ-funded; HS027648.
Citation: Fleming MD, Guo C, Knox M .
Impact of social needs case management on use of medical and behavioral health services: secondary analysis of a randomized controlled trial.
Ann Intern Med 2023 Aug; 176(8):1139-41. doi: 10.7326/m23-0876..
Keywords: Medicaid, Vulnerable Populations, Social Determinants of Health, Care Management, Care Coordination