March 2022

In This Issue: HSR&D Research on Social Determinants
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The Effect of Screening and Referral for Social Determinants of Health on Veterans’ Outcomes

Feature Article

Takeaway: This study is expected to provide much-needed evidence to document the burden of Veterans’ unmet needs, inform how best to address these needs, and assess how such a process could affect adherence (e.g., to medications and appointments), healthcare use, and clinical outcomes.

Despite medical advances, up to 70% of health outcomes are due to social determinants of health (SDH) – the conditions in which people live and work that shape whether basic needs (e.g., housing, food) are met. Currently, VA systematically screens for two unmet needs: homelessness and food insecurity. This ongoing study (February 2021 – January 2024) seeks to implement comprehensive screening of eight unmet needs (housing, food insecurity, utility insecurity, transportation, legal problems, employment, safety, and social isolation), and to compare the effect of referral mechanisms of varying intensity on Veterans’ connection to resources, reduction of unmet needs, treatment adherence, reduced preventable hospitalizations, and clinical outcomes.

Methods

In phase one of this mixed-methods study, investigators will implement a three-armed randomized controlled trial at three VA sites to compare outcomes among Veterans randomized within each site to one of three study conditions: 1) screening only; 2) screening plus provision of tailored resource sheets; or 3) screening plus resource sheets plus social work support. For each Veteran, investigators will examine associations of unmet needs with baseline outcomes – and will longitudinally examine the impact of each approach on connection to new SDH resources and follow-up outcomes over a 12-month period. In phase two of the study, investigators will conduct interviews with Veterans and representatives of the VA- and community-based programs to which Veterans are referred to identify facilitators and barriers and potential explanatory factors related to the relative success of the interventions.

Findings

None to report at this time.

Anticipated Impact

This study will provide much needed evidence to document the burden of Veterans’ unmet needs in regard to social determinants of health. In addition, findings are expected to inform how best to address unmet SDH needs – and to identify how such a process can affect adherence (to medications and appointments), healthcare use, and clinical outcomes.

Principal Investigator:  Deborah Gurewich, PhD, is part of HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR) in Boston, MA

Publications

None to report at this time.

View study abstract