Impact of philanthropic investment on integrating social determinants of health into diabetes care at US federally qualified health centers.

Study objective: Assess the impact of a change in a philanthropic funding strategy toward focusing on the inclusion of responses to the social determinants of health (SDOH) in diabetes care. Design: Retrospective analysis of routinely collected clinical and social determinants of health data. Setting: Federally Qualified Health Centers Across the United States who were selected to receive funding after applying. Participants: People living with diabetes who received care support that was partially or wholly supported from philanthropic funding provided by Direct Relief. Interventions: The primary intervention was the injection of funding from Direct Relief to support the integration of interventions responsive to the SDOH. Example interventions include referral to SDOH support, home based monitoring, inclusion of community health workers, virtual care, and community-based care. Main outcome measures: The primary outcome measure was the change in HbA1c from baseline to two to four months for all patients contributing data. Results: Participants in the HBHC program demonstrated a reduction in glycosylated hemoglobin of -1.25 points ([95 % CI, -1.45 - -1.06], p < 0.01) after 60-to-119-days. Participants with family and housing needs, nutrition needs, and social and emotional health needs had statistically significantly higher baseline HbA1c's than patients without these needs. Conclusion: Future philanthropically supported efforts should encourage integration of SDOH interventions into clinical services for under-resourced patients living with diabetes. Additional prospective, controlled studies should be completed to more definitively determine the impact of investment on specific interventions designed to respond to the most frequently encountered SDOH needs.