Work

Operationalizing social health integration in primary care: A mixed-methods implementation evaluation

Year: 2026

Type: preprint

Abstract: Background: US health care systems are rapidly expanding care for health-related social needs. As a result, implementation of interventions continues to outpace evidence on how to operationalize social health integration (SHI) effectively. The National Academies of Sciences, Engineering, and Medicine (NASEM) describes three SHI domains within health care delivery: awareness, adjustment, and assistance. This paper reports the implementation evaluation of a SHI program developed and tested in two primary care clinics within an integrated health system. Methods: We used a concurrent triangulation mixed-methods design, guided by the RE-AIM framework, to evaluate SHI implementation from July 2021 through January 2023. Quantitative data included EHR-derived screening rates and patient engagement rates with two social health assistance programs: a local clinic-based community resource specialist (CRS) program and a centralized Connections Call Center (CCC). Qualitative data were collected through semi-structured interviews with 50 patients and 27 clinic staff and primary care providers. Results Active implementation support was essential for achieving an 80% screening rate, and rates declined to 60-65% once support ended. Despite EHR integration and provider education, adjustment of care by providers based on social needs screening data remained rare. CRS achieved significantly higher engagement than CCC (42.0% vs. 27.4%; χ²=12.41, p=0.0004), including among older adults (49.4% vs. 27.9%; p=0.004), younger adults aged 18-40 (38.3% vs. 20.0%; p=0.006), and non-white patients (49.2% vs. 24.5%; p=0.006). In qualitative interviews, few patients successfully connected with a referred resource, largely due to eligibility barriers and outdated referral information. Conclusions: Effective SHI implementation requires sustained, specific strategies across all three NASEM domains[EW1] . Screening gains were transient without ongoing facilitation, and care adjustment remained largely absent despite EHR and educational supports. Clinic-based assistance reached older adults and non-white patients at significantly higher rates than a centralized model, suggesting that local, care team-embedded support may be better positioned to reach populations at highest risk for social needs. Sustained facilitation and equity-centered intervention design are essential foundations for moving beyond screening alone toward a fully integrated social health model.

Source: Research Square

DOI: 10.21203/rs.3.rs-9227497/v1