Optimizing the community resource specialist to address social needs in primary care: results from a pragmatic quality improvement evaluation.

BACKGROUND: Social care integration in health systems is on the rise in the United States, particularly since the National Committee for Quality Assurance introduced screening and intervention as HEDIS metrics. These policy levers outpace empirical knowledge to guide how best to operationalize social care. This study reports results from a quality improvement initiative to implement social care in an integrated health system. METHODS: A quantitative effectiveness evaluation was conducted across 32 clinics in Kaiser Permanente Washington, which had recently embedded Community Resource Specialists (CRS) in their primary care teams and integrated a social health screener into their electronic health record. Using a pragmatic design with propensity score matched comparison group (PSC), we compared two intervention arms (both of whom completed a social health screener): (1) CRS-S who engaged in only a single CRS visit and (2) CRS-M who engaged in at least two CRS visits. Patients completed a survey shortly after their qualifying primary care encounter and approximately three months later that assessed the following domains: social health, patient experience with the care team, and health and functioning; healthcare utilization was obtained from the electronic health record. Patients from each arm were then purposefully sampled for qualitative interviews. RESULTS: Quantitative results suggest that CRS-M patients experienced exacerbated social risk severity and food insecurity over three months, but improved financial risk. For the majority of domains, no differences were observed between arms, though CRS-M demonstrated poorer coping over time whereas PSC patients showed higher use of instrumental and emotional support coping strategies. CRS-M reported worse health and need for more help with activities of daily living, but improvements in trust in their care team. Qualitative results showcased, by design, the positive potential impact of working with a CRS across all domains of interest, especially social and mental health. CONCLUSION: This quality improvement evaluation of social care integration using the CRS illustrates a potential pathway for activating social support and healthcare relationships in primary care, but more rigorous designs and longer-term follow up are needed to explore if this pathway leads to improvements in patient or population health and healthcare utilization.