Sustaining and scaling a clinic-based approach to address health-related social needs

MaryCatherine Arbour; Placidina Fico; Baraka Floyd; Samantha Morton; Patsy Hampton; Jennifer Murphy Sims; Sidney Atwood; Robert Sege

doi:10.3389/frhs.2023.1040992

Sustaining and scaling a clinic-based approach to address health-related social needs

Front Health Serv. 2023 Feb 17:3:1040992. doi: 10.3389/frhs.2023.1040992. eCollection 2023.

Authors

MaryCatherine Arbour¹, Placidina Fico¹, Baraka Floyd², Samantha Morton³, Patsy Hampton⁴, Jennifer Murphy Sims⁵, Sidney Atwood¹, Robert Sege⁶

Affiliations

¹ Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.
² Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States.
³ MLPB, Boston, MA, United States.
⁴ Center for the Study of Social Policy, Washington, D.C., United States.
⁵ Early Intervention Services, UCSF Benioff Children's Hospital, Oakland, CA, United States.
⁶ Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States.

Abstract

Objective: Scaling evidence-based interventions (EBIs) from pilot phase remains a pressing challenge in efforts to address health-related social needs (HRSN) and improve population health. This study describes an innovative approach to sustaining and further spreading DULCE (Developmental Understanding and Legal Collaboration for Everyone), a universal EBI that supports pediatric clinics to implement the American Academy of Pediatrics' Bright Futures™ guidelines for infants' well-child visits (WCVs) and introduces a new quality measure of families' HRSN resource use.

Methods: Between August 2018 and December 2019, seven teams in four communities in three states implemented DULCE: four teams that had been implementing DULCE since 2016 and three new teams. Teams received monthly data reports and individualized continuous quality improvement (CQI) coaching for six months, followed by lighter-touch support via quarterly group calls (peer-to-peer learning and coaching). Run charts were used to study outcome (percent of infants that received all WCVs on time) and process measures (percent of families screened for HRSN and connected to resources).

Results: Integrating three new sites was associated with an initial regression of outcome: 41% of infants received all WCVs on time, followed by improvement to 48%. Process performance was sustained or improved: among 989 participating families, 84% (831) received 1-month WCVs on time; 96% (946) were screened for seven HRSN, 54% (508) had HRSN, and 87% (444) used HRSN resources.

Conclusion: An innovative, lighter-touch CQI approach to a second phase of scale-up resulted in sustainment or improvements in most processes and outcomes. Outcomes-oriented CQI measures (family receipt of resources) are an important addition to more traditional process-oriented indicators.

Keywords: data driven adaptation; evidence based interventions in primary care; interdiscipinarity approach; pediatric primary care; quality improvement; scale - up; social determinansts of health; well child care.

Grants and funding

DULCE expansion was funded by The JPB Foundation through the Center for the Study of Social Policy.