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A Systematic Review of Interventions on Patients’ Social and Economic Needs

      Context

      Healthcare systems are experimenting increasingly with interventions to address patients’ social and economic needs. This systematic review examines how often and how rigorously interventions bridging social and medical care have been evaluated.

      Evidence acquisition

      The review included literature from PubMed published between January 2000 and February 2017. Additional studies were identified by reference searches and consulting local experts. Included studies were based in the U.S.; addressed at least one social or economic determinant of health (e.g., housing, employment, food insecurity); and were integrated within the medical care delivery system. Data from included studies were abstracted in June 2015 (studies published January 2000–December 2014) and in March 2017 (studies published January 2015–February 2017).

      Evidence synthesis

      Screening of 4,995 articles identified 67 studies of 37 programs addressing social needs. Interventions targeted a broad range of social needs and populations. Forty studies involved non-experimental designs. There was wide heterogeneity in outcome measures selected. More studies reported findings associated with process (69%) or social or economic determinants of health (48%) outcomes than health (30%) or healthcare utilization or cost (27%) outcomes. Studies reporting health, utilization, or cost outcomes reported mixed results.

      Conclusions

      Healthcare systems increasingly incorporate programs to address patients’ social and economic needs in the context of care. But evaluations of these programs to date focus primarily on process and social outcomes and are often limited by poor study quality. Higher-quality studies that include common health and healthcare utilization outcomes would advance effectiveness research in this rapidly expanding field.
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      References

        • Braveman P.
        • Egerter S.
        • Williams D.R.
        The social determinants of health: coming of age.
        Annu Rev Public Health. 2011; 32: 381-398https://doi.org/10.1146/annurev-publhealth-031210-101218
        • Marmot M.
        • Bell R.
        Fair society, healthy lives.
        Public Health. 2012; 126: S4-S10https://doi.org/10.1016/j.puhe.2012.05.014
        • Adler N.E.
        • Stewart J.
        Preface to the biology of disadvantage: socioeconomic status and health.
        Ann N Y Acad Sci. 2010; 1186: 1-4https://doi.org/10.1111/j.1749-6632.2009.05385.x
        • Larson K.
        • Halfon N.
        Family income gradients in the health and health care access of U.S. children.
        Matern Child Health J. 2010; 14: 332-342https://doi.org/10.1007/s10995-009-0477-y
        • Victorino C.C.
        • Gauthier A.H.
        The social determinants of child health: variations across health outcomes—a population-based cross-sectional analysis.
        BMC Pediatr. 2009; 9: 53https://doi.org/10.1186/1471-2431-9-53
        • Kaplan G.A.
        • Shema S.J.
        • Leite C.M.
        Socioeconomic determinants of psychological well-being: the role of income, income change, and income sources during the course of 29 years.
        Ann Epidemiol. 2008; 18: 531-537https://doi.org/10.1016/j.annepidem.2008.03.006
        • Koch C.G.
        • Li L.
        • Kaplan G.A.
        • et al.
        Socioeconomic position, not race, is linked to death after cardiac surgery.
        Circ Cardiovasc Qual Outcomes. 2010; 3: 267-276https://doi.org/10.1161/CIRCOUTCOMES.109.880377
        • Weinreb L.
        • Wehler C.
        • Perloff J.
        • et al.
        Hunger: its impact on children’s health and mental health.
        Pediatrics. 2002; 110: e41https://doi.org/10.1542/peds.110.4.e41
        • Kondo N.
        Socioeconomic disparities and health: impacts and pathways.
        J Epidemiol. 2012; 22: 2-6https://doi.org/10.2188/jea.JE20110116
        • Adler N.E.
        • Stewart J.
        Socioeconomic status and health in industrial nations: social, psychological, and biological pathways.
        Ann N Y Acad Sci. 896. 1999: 1-500
        • Marmot M.
        Social determinants of health inequalities.
        Lancet. 2005; 365: 1099-1104https://doi.org/10.1016/S0140-6736(05)74234-3
        • Cutts D.B.
        • Meyers A.F.
        • Black M.M.
        • et al.
        U.S. housing insecurity and the health of very young children.
        Am J Public Health. 2011; 101: 1508-1514https://doi.org/10.2105/AJPH.2011.300139
        • National Quality Forum
        Risk adjustment for socioeconomic status or other sociodemographic factors.
        National Quality Forum, Washington, DC2014 (Accessed March 27, 2017)
        • Institute of Medicine of the National Academies Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records
        Capturing Social and Behavioral Domains in Electronic Health Records: Phase 2.
        National Academies Press, Washington, DC2014
        • Berwick D.M.
        • Nolan T.W.
        • Whittington J.
        The triple aim: care, health, and cost.
        Health Aff (Millwood). 2008; 27: 759-769https://doi.org/10.1377/hlthaff.27.3.759
        • Bachrach D.
        • Pfister H.
        • Wallis K.
        • Lipson M.
        • Manatt Health Solutions
        Addressing patients’ social needs: an emerging business case for provider investment.
        The Commonwealth Fund, New York, NY2014 (Accessed March 27, 2017)
        • Taylor L.A.
        • Coyle C.E.
        • Ndumele C.
        • et al.
        Leveraging the Social Determinants of Health: What Works?.
        Yale Global Health Leadership Institute: Blue Cross Blue Shield Foundation Massachusetts, 2015
        • Institute for Alternative Futures
        Community Health Centers: Leveraging the Social Determinants of Health.
        Institute for Alternative Futures, Alexandria2012
        • The Menges Group
        Positively impacting social determinants of health: how safety net health plans lead the way.
        Association for Community Affiliated Plans, Washington, DC2014 (Accessed March 27, 2017)
        • Taylor L.A.
        • Tan A.X.
        • Coyle C.E.
        • et al.
        Leveraging the social determinants of health: what works?.
        PLoS One. 2016; 11: e0160217https://doi.org/10.1371/journal.pone.0160217
      1. Chen M, Unruh M, Pesko M, et al. Hospitals’ engagement in population health: moving past the medicine and into the community. Health Affairs Blog. http://healthaffairs.org/blog/2016/04/05/hospitals-engagement-in-population-health-moving-past-the-medicine-and-into-the-community/. Published 2016. Accessed October 24, 2016.

        • Gottlieb L.M.
        • Garcia K.
        • Wing H.
        • Manchanda R.
        Clinical interventions addressing nonmedical health determinants in Medicaid Managed Care.
        Am J Manag Care. 2016; 22: 370-376
        • Gottlieb L.
        • Ackerman S.
        • Wing H.
        • Manchanda R.
        Understanding Medicaid Managed Care investments in members’ social determinants of health.
        Popul Health Manag. 2017; (In press. Online January 18)https://doi.org/10.1089/pop.2016.0092
        • Alley D.E.
        • Asomugha C.N.
        • Conway P.H.
        • Sanghavi D.M.
        Accountable Health Communities—addressing social needs through Medicare and Medicaid.
        N Engl J Med. 2016; 374: 8-11https://doi.org/10.1056/NEJMp1512532
        • Shier G.
        • Ginsburg M.
        • Howell J.
        • Volland P.
        • Golden R.
        Strong social support services, such as transportation and help for caregivers, can lead to lower health care use and costs.
        Health Aff (Millwood). 2013; 32: 544-551https://doi.org/10.1377/hlthaff.2012.0170
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4: 1https://doi.org/10.1186/2046-4053-4-1
        • Gottlieb L.
        • Manchanda R.
        • Sandel M.
        Practical strategies in addressing social determinants of health in clinical settings.
        in: King T.E. Wheeler M.B. Medical Management of Vulnerable and Underserved Patients: Principles, Practice, and Populations. Second Edition. McGraw-Hill Education, Columbus, OH2016
        • Guyatt G.H.
        • Oxman A.D.
        • Kunz R.
        • et al.
        What is “quality of evidence” and why is it important to clinicians?.
        BMJ. 2008; 336: 995-998https://doi.org/10.1136/bmj.39490.551019.BE
        • Herman D.B.
        • Conover S.
        • Gorroochurn P.
        • Hinterland K.
        • Hoepner L.
        • Susser E.S.
        Randomized trial of critical time intervention to prevent homelessness after hospital discharge.
        Psychiatr Serv. 2011; 62: 713-719https://doi.org/10.1176/ps.62.7.pss6207_0713
        • Tomita A.
        • Herman D.B.
        The impact of critical time intervention in reducing psychiatric rehospitalization after hospital discharge.
        Psychiatr Serv. 2012; 63: 935-937https://doi.org/10.1176/appi.ps.201100468
        • Krieger J.W.
        • Takaro T.K.
        • Song L.
        • Weaver M.
        The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers.
        Am J Public Health. 2005; 95: 652-659https://doi.org/10.2105/AJPH.2004.042994
        • Williams S.G.
        • Brown C.M.
        • Falter K.H.
        • et al.
        Does a multifaceted environmental intervention alter the impact of asthma on inner-city children?.
        J Natl Med Assoc. 2006; 98: 249-260
        • Tomita A.
        • Herman D.B.
        The role of a critical time intervention on the experience of continuity of care among persons with severe mental illness after hospital discharge.
        J Nerv Ment Dis. 2015; 203: 65-70https://doi.org/10.1097/NMD.0000000000000224
        • Beck A.F.
        • Henize A.W.
        • Kahn R.S.
        • Reiber K.L.
        • Young J.J.
        • Klein M.D.
        Forging a pediatric primary care-community partnership to support food-insecure families.
        Pediatrics. 2014; 134: e564-e571https://doi.org/10.1542/peds.2013-3845
        • Smith S.
        • Malinak D.
        • Chang J.
        • et al.
        Implementation of a food insecurity screening and referral program in student-run free clinics in San Diego, California.
        Prev Med Rep. 2017; 5: 134-139https://doi.org/10.1016/j.pmedr.2016.12.007
        • Cohen A.J.
        • Richardson C.R.
        • Heisler M.
        • et al.
        Increasing use of a healthy food incentive: a waiting room intervention among low-income patients.
        Am J Prev Med. 2017; 52: 154-162https://doi.org/10.1016/j.amepre.2016.11.008
        • Fox C.K.
        • Cairns N.
        • Sunni M.
        • Turnberg G.L.
        • Gross A.C.
        Addressing food insecurity in a pediatric weight management clinic: a pilot intervention.
        J Pediatr Health Care. 2016; 30: e11-e15https://doi.org/10.1016/j.pedhc.2016.05.003
        • Morales M.E.
        • Epstein M.H.
        • Marable D.E.
        • Oo S.A.
        • Berkowitz S.A.
        Food insecurity and cardiovascular health in pregnant women: results from the food for families program, Chelsea, Massachusetts, 2013-2015.
        Prev Chronic Dis. 2016; 13: E152https://doi.org/10.5888/pcd13.160212
        • Seligman H.K.
        • Lyles C.
        • Marshall M.B.
        • et al.
        A pilot food bank intervention featuring diabetes-appropriate food improved glycemic control among clients in three states.
        Health Aff (Millwood). 2015; 34: 1956-1963https://doi.org/10.1377/hlthaff.2015.0641
        • Silverstein M.
        • Mack C.
        • Reavis N.
        • Koepsell T.D.
        • Gross G.S.
        • Grossman D.C.
        Effect of a clinic-based referral system to Head Start: a randomized controlled trial.
        JAMA. 2004; 292: 968-971https://doi.org/10.1001/jama.292.8.968
        • Sanders L.M.
        • Gershon T.D.
        • Huffman L.C.
        • Mendoza F.S.
        Prescribing books for immigrant children: a pilot study to promote emergent literacy among the children of Hispanic immigrants.
        Arch Pediatr Adolesc Med. 2000; 154: 771-777https://doi.org/10.1001/archpedi.154.8.771
        • Bailey R.
        • Rhee K.B.
        Reach Out and Read: promoting pediatric literacy guidance through a transdisciplinary team.
        J Health Care Poor Underserved. 2005; 16: 225-230https://doi.org/10.1353/hpu.2005.0020
        • Silverstein M.
        • Iverson L.
        • Lozano P.
        An English-language clinic-based literacy program is effective for a multilingual population.
        Pediatrics. 2002; 109 (E76–E76)https://doi.org/10.1542/peds.109.5.e76
        • Needlman R.
        • Toker K.H.
        • Dreyer B.P.
        • Klass P.
        • Mendelsohn A.L.
        Effectiveness of a primary care intervention to support reading aloud: a multicenter evaluation.
        Ambul Pediatr. 2005; 5: 209-215https://doi.org/10.1367/A04-110R.1
        • Mendelsohn A.L.
        • Huberman H.S.
        • Berkule S.B.
        • Brockmeyer C.A.
        • Morrow L.M.
        • Dreyer B.P.
        Primary care strategies for promoting parent-child interactions and school readiness in at-risk families: the Bellevue Project for Early Language, Literacy, and Education Success.
        Arch Pediatr Adolesc Med. 2011; 165: 33-41https://doi.org/10.1001/archpediatrics.2010.254
        • Mendelsohn A.L.
        • Mogilner L.N.
        • Dreyer B.P.
        • et al.
        The impact of a clinic-based literacy intervention on language development in inner-city preschool children.
        Pediatrics. 2001; 107: 130-134https://doi.org/10.1542/peds.107.1.130
        • Dubowitz H.
        • Feigelman S.
        • Lane W.
        • Kim J.
        Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model.
        Pediatrics. 2009; 123: 858-864https://doi.org/10.1542/peds.2008-1376
        • Dubowitz H.
        • Lane W.G.
        • Semiatin J.N.
        • Magder L.S.
        The SEEK model of pediatric primary care: can child maltreatment be prevented in a low-risk population?.
        Acad Pediatr. 2012; 12: 259-268https://doi.org/10.1016/j.acap.2012.03.005
        • Dubowitz H.
        • Lane W.G.
        • Semiatin J.N.
        • Magder L.S.
        • Venepally M.
        • Jans M.
        The safe environment for every kid model: impact on pediatric primary care professionals.
        Pediatrics. 2011; 127: e962-e970https://doi.org/10.1542/peds.2010-1845
        • Feigelman S.
        • Dubowitz H.
        • Lane W.
        • Grube L.
        • Kim J.
        Training pediatric residents in a primary care clinic to help address psychosocial problems and prevent child maltreatment.
        Acad Pediatr. 2011; 11: 474-480https://doi.org/10.1016/j.acap.2011.07.005
        • Gillum T.L.
        • Sun C.J.
        • Woods A.B.
        Can a health clinic-based intervention increase safety in abused women? Results from a pilot study.
        J Womens Health (Larchmt). 2009; 18: 1259-1264https://doi.org/10.1089/jwh.2008.1099
        • Klevens J.
        • Kee R.
        • Trick W.
        • et al.
        Effect of screening for partner violence on women’s quality of life: a randomized controlled trial.
        JAMA. 2012; 308: 681-689https://doi.org/10.1001/jama.2012.6434
        • Krasnoff M.
        • Moscati R.
        Domestic violence screening and referral can be effective.
        Ann Emerg Med. 2002; 40: 485-492https://doi.org/10.1067/mem.2002.128872
        • McCaw B.
        • Berman W.H.
        • Syme S.L.
        • Hunkeler E.F.
        Beyond screening for domestic violence: a systems model approach in a managed care setting.
        Am J Prev Med. 2001; 21: 170-176https://doi.org/10.1016/S0749-3797(01)00347-6
        • Short L.M.
        • Hadley S.M.
        • Bates B.
        Assessing the success of the WomanKind program: an integrated model of 24-hour health care response to domestic violence.
        Women Health. 2002; 35: 101-119https://doi.org/10.1300/J013v35n02_07
        • Ulbrich P.M.
        • Stockdale J.
        Making family planning clinics an empowerment zone for rural battered women.
        Women Health. 2002; 35: 83-100https://doi.org/10.1300/J013v35n02_06
        • Zachary M.J.
        • Schechter C.B.
        • Kaplan M.L.
        • Mulvihill M.N.
        Provider evaluation of a multifaceted system of care to improve recognition and management of pregnant women experiencing domestic violence.
        Womens Health Issues. 2002; 12: 5-15https://doi.org/10.1016/S1049-3867(01)00142-6
        • Coker A.L.
        • Smith P.H.
        • Whitaker D.J.
        • Le B.
        • Crawford T.N.
        • Flerx V.C.
        Effect of an in-clinic IPV advocate intervention to increase help seeking, reduce violence, and improve well-being.
        Violence Against Women. 2012; 18: 118-131https://doi.org/10.1177/1077801212437908
        • Cook J.A.
        • Leff H.S.
        • Blyler C.R.
        • et al.
        Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness.
        Arch Gen Psychiatry. 2005; 62: 505-512https://doi.org/10.1001/archpsyc.62.5.505
        • Hamilton A.B.
        • Cohen A.N.
        • Glover D.L.
        • et al.
        Implementation of evidence-based employment services in specialty mental health.
        Health Serv Res. 2013; 48: 2224-2244https://doi.org/10.1111/1475-6773.12115
        • Ottomanelli L.
        • Barnett S.D.
        • Goetz L.L.
        Effectiveness of supported employment for veterans with spinal cord injury: 2-year results.
        Arch Phys Med Rehabil. 2014; 95: 784-790https://doi.org/10.1016/j.apmr.2013.11.012
        • Sinnott P.L.
        • Joyce V.
        • Su P.
        • Ottomanelli L.
        • Goetz L.L.
        • Wagner T.H.
        Cost-effectiveness of supported employment for veterans with spinal cord injuries.
        Arch Phys Med Rehabil. 2014; 95: 1254-1261https://doi.org/10.1016/j.apmr.2014.01.010
        • Beck A.F.
        • Klein M.D.
        • Schaffzin J.K.
        • Tallent V.
        • Gillam M.
        • Kahn R.S.
        Identifying and treating a substandard housing cluster using a medical-legal partnership.
        Pediatrics. 2012; 130: 831-838https://doi.org/10.1542/peds.2012-0769
        • Klein M.D.
        • Beck A.F.
        • Henize A.W.
        • Parrish D.S.
        • Fink E.E.
        • Kahn R.S.
        Doctors and lawyers collaborating to HeLP children—outcomes from a successful partnership between professions.
        J Health Care Poor Underserved. 2013; 24: 1063-1073https://doi.org/10.1353/hpu.2013.0147
        • O’Sullivan M.M.
        • Brandfield J.
        • Hoskote S.S.
        • et al.
        Environmental improvements brought by the legal interventions in the homes of poorly controlled inner-city adult asthmatic patients: a proof-of-concept study.
        J Asthma. 2012; 49: 911-917https://doi.org/10.3109/02770903.2012.724131
        • O’Toole J.K.
        • Burkhardt M.C.
        • Solan L.G.
        • Vaughn L.
        • Klein M.D.
        Resident confidence addressing social history: is it influenced by availability of social and legal resources?.
        Clin Pediatr (Phila). 2012; 51: 625-631https://doi.org/10.1177/0009922812438081
        • Pettignano R.
        • Caley S.B.
        • Bliss L.R.
        Medical-legal partnership: impact on patients with sickle cell disease.
        Pediatrics. 2011; 128: e1482-e1488https://doi.org/10.1542/peds.2011-0082
        • Pettignano R.
        • Caley S.B.
        • McLaren S.
        The health law partnership: adding a lawyer to the health care team reduces system costs and improves provider satisfaction.
        J Public Health Manag Pract. 2012; 18: E1-E3https://doi.org/10.1097/PHH.0b013e31823991a9
        • Rodabaugh K.J.
        • Hammond M.
        • Myszka D.
        • Sandel M.
        A medical-legal partnership as a component of a palliative care model.
        J Palliat Med. 2010; 13: 15-18https://doi.org/10.1089/jpm.2009.0203
        • Ryan A.M.
        • Kutob R.M.
        • Suther E.
        • Hansen M.
        • Sandel M.
        Pilot study of impact of medical-legal partnership services on patients’ perceived stress and wellbeing.
        J Health Care Poor Underserved. 2012; 23: 1536-1546https://doi.org/10.1353/hpu.2012.0179
        • Teufel J.A.
        • Brown S.L.
        • Thorne W.
        • Goffinet D.M.
        • Clemons L.
        Process and impact evaluation of a legal assistance and health care community partnership.
        Health Promot Pract. 2009; 10: 378-385https://doi.org/10.1177/1524839907312702
        • Teufel J.A.
        • Werner D.
        • Goffinet D.
        • Thorne W.
        • Brown S.L.
        • Gettinger L.
        Rural medical-legal partnership and advocacy: a three-year follow-up study.
        J Health Care Poor Underserved. 2012; 23: 705-714https://doi.org/10.1353/hpu.2012.0038
        • Waitzkin H.
        • Getrich C.
        • Heying S.
        • et al.
        Promotoras as mental health practitioners in primary care: a multi-method study of an intervention to address contextual sources of depression.
        J Community Health. 2011; 36: 316-331https://doi.org/10.1007/s10900-010-9313-y
        • Weintraub D.
        • Rodgers M.A.
        • Botcheva L.
        • et al.
        Pilot study of medical-legal partnership to address social and legal needs of patients.
        J Health Care Poor Underserved. 2010; 21: 157-168
        • Becker M.G.
        • Hall J.S.
        • Ursic C.M.
        • Jain S.
        • Calhoun D.
        Caught in the crossfire: the effects of a peer-based intervention program for violently injured youth.
        J Adolesc Health. 2004; 34: 177-183https://doi.org/10.1016/S1054-139X(03)00278-7
        • Garg A.
        • Butz A.M.
        • Dworkin P.H.
        • Lewis R.A.
        • Thompson R.E.
        • Serwint J.R.
        Improving the management of family psychosocial problems at low-income children’s well-child care visits: the WE CARE Project.
        Pediatrics. 2007; 120: 547-558https://doi.org/10.1542/peds.2007-0398
        • Garg A.
        • Marino M.
        • Vikani A.R.
        • Solomon B.S.
        Addressing families’ unmet social needs within pediatric primary care: the Health Leads model.
        Clin Pediatr (Phila). 2012; 51: 1191-1193https://doi.org/10.1177/0009922812437930
        • Garg A.
        • Sarkar S.
        • Marino M.
        • Onie R.
        • Solomon B.S.
        Linking urban families to community resources in the context of pediatric primary care.
        Patient Educ Couns. 2010; 79: 251-254https://doi.org/10.1016/j.pec.2009.10.011
        • Kitchen A.
        • Brook J.
        Social work at the heart of the medical team.
        Soc Work Health Care. 2005; 40: 1-18https://doi.org/10.1300/J010v40n04_01
        • Paris R.
        For the dream of being here, one sacrifices…”: voices of immigrant mothers in a home visiting program.
        Am J Orthopsychiatry. 2008; 78: 141-151https://doi.org/10.1037/0002-9432.78.2.141
        • Dicker R.A.
        • Jaeger S.
        • Knudson M.M.
        • et al.
        Where do we go from here? Interim analysis to forge ahead in violence prevention.
        J Trauma. 2009; 67: 1169-1175https://doi.org/10.1097/TA.0b013e3181bdb78a
        • Kangovi S.
        • Mitra N.
        • Grande D.
        • et al.
        Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial.
        JAMA Intern Med. 2014; 174: 535-543https://doi.org/10.1001/jamainternmed.2013.14327
        • Garg A.
        • Toy S.
        • Tripodis Y.
        • Silverstein M.
        • Freeman E.
        Addressing social determinants of health at well child care visits: a cluster RCT.
        Pediatrics. 2015; 135: e296-e304https://doi.org/10.1542/peds.2014-2888
        • Bronstein L.R.
        • Gould P.
        • Berkowitz S.A.
        • James G.D.
        • Marks K.
        Impact of a social work care coordination intervention on hospital readmission: a randomized controlled trial.
        Soc Work. 2015; 60: 248-255https://doi.org/10.1093/sw/swv016
        • Smith R.
        • Dobbins S.
        • Evans A.
        • Balhotra K.
        • Dicker R.A.
        Hospital-based violence intervention: risk reduction resources that are essential for success.
        J Trauma Acute Care Surg. 2013; 74: 976-980https://doi.org/10.1097/TA.0b013e31828586c9
        • Juillard C.
        • Cooperman L.
        • Allen I.
        • et al.
        A decade of hospital-based violence intervention: benefits and shortcomings.
        J Trauma Acute Care Surg. 2016; 81: 1156-1161https://doi.org/10.1097/TA.0000000000001261
        • Juillard C.
        • Smith R.
        • Anaya N.
        • Garcia A.
        • Kahn J.G.
        • Dicker R.A.
        Saving lives and saving money: hospital-based violence intervention is cost-effective.
        J Trauma Acute Care Surg. 2015; 78: 252-257https://doi.org/10.1097/TA.0000000000000527
        • Berkowitz S.A.
        • Hulberg A.C.
        • Hong C.
        • et al.
        Addressing basic resource needs to improve primary care quality: a community collaboration programme.
        BMJ Qual Saf. 2016; 25: 164-172https://doi.org/10.1136/bmjqs-2015-004521
        • Berkowitz S.A.
        • Hulberg A.C.
        • Standish S.
        • Reznor G.
        • Atlas S.J.
        Addressing unmet basic resource needs as part of chronic cardiometabolic disease management.
        JAMA Intern Med. 2017; 177: 244-252https://doi.org/10.1001/jamainternmed.2016.7691
        • Sege R.
        • Preer G.
        • Morton S.J.
        • et al.
        Medical-legal strategies to improve infant health care: a randomized trial.
        Pediatrics. 2015; 136: 97-106https://doi.org/10.1542/peds.2014-2955
        • Hassan A.
        • Scherer E.A.
        • Pikcilingis A.
        • et al.
        Improving social determinants of health: effectiveness of a web-based intervention.
        Am J Prev Med. 2015; 49: 822-831https://doi.org/10.1016/j.amepre.2015.04.023
        • Haas J.S.
        • Linder J.A.
        • Park E.R.
        • et al.
        Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial.
        JAMA Intern Med. 2015; 175: 218-226https://doi.org/10.1001/jamainternmed.2014.6674
        • Gottlieb L.M.
        • Hessler D.
        • Long D.
        • et al.
        Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial.
        JAMA Pediatr. 2016; 170: e162521https://doi.org/10.1001/jamapediatrics.2016.2521
        • Nguyen A.L.
        • Angulo M.
        • Haghi L.L.
        • et al.
        A clinic-based pilot intervention to enhance diabetes management for elderly Hispanic patients.
        J Health Environ Educ. 2016; 8: 1-6
        • Onyekere C.
        • Ross S.
        • Namba A.
        • Ross J.C.
        • Mann B.D.
        Medical student volunteerism addresses patients’ social needs: a novel approach to patient-centered care.
        Ochsner J. 2016; 16: 45-49
        • Klein M.D.
        • Schumacher D.J.
        • Sandel M.
        Assessing and managing the social determinants of health: defining an entrustable professional activity to assess residents’ ability to meet societal needs.
        Acad Pediatr. 2014; 14: 10-13https://doi.org/10.1016/j.acap.2013.11.001
        • Fitzpatrick-Lewis D.
        • Ganann R.
        • Krishnaratne S.
        • Ciliska D.
        • Kouyoumdjian F.
        • Hwang S.W.
        Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review.
        BMC Public Health. 2011; 11: 638https://doi.org/10.1186/1471-2458-11-638
        • Hwang S.W.
        • Burns T.
        Health interventions for people who are homeless.
        Lancet. 2014; 384: 1541-1547https://doi.org/10.1016/S0140-6736(14)61133-8
        • Yeager Pelatti C.
        • Pentimonti J.M.
        • Justice L.M.
        Methodological review of the quality of reach out and read: does it “work”?.
        Clin Pediatr (Phila). 2014; 53: 343-350https://doi.org/10.1177/0009922813507995
        • Mossabir R.
        • Morris R.
        • Kennedy A.
        • Blickem C.
        • Rogers A.
        A scoping review to understand the effectiveness of linking schemes from healthcare providers to community resources to improve the health and well-being of people with long-term conditions.
        Health Soc Care Community. 2015; 23: 467-484https://doi.org/10.1111/hsc.12176
      2. Beeson T, McAllister BD, Regenstein M. Making the case for medical-legal partnerships: a review of the evidence. http://medical-legalpartnership.org/wp-content/uploads/2014/03/Medical-Legal-Partnership-Literature-Review-February-2013.pdf. Published 2013. Accessed March 27, 2017.

        • Gottlieb L.
        • Ackerman S.
        • Wing H.
        • Adler N.
        Evaluation activities and influences at the intersection of medical and social services.
        J Health Care Poor Underserved. 2016; (In press. Online October 27)
        • Geiger H.J.
        The first community health centers: a model of enduring value.
        J Ambul Care Manage. 2005; 28: 313-320https://doi.org/10.1097/00004479-200510000-00006
        • American Academy of Pediatrics Council On Community
        Poverty and child health in the United States.
        Pediatrics. 2016; 137
      3. American Academy of Family Physicians. Social determinants of health policy. www.aafp.org/about/policies/all/social-determinants.html. Published 2013. Accessed March 27, 2017.

      4. American Academy of Family Physicians. Poverty and health—the family medicine perspective (position paper). www.aafp.org/about/policies/all/policy-povertyhealth.html. Accessed March 27, 2017.

      5. National Association of Community Health Centers, Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association, Institute for Alternative Futures. Accelerating Strategies to Address the Social Determinants of health: Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences. www.nachc.org/research-and-data/prapare/toolkit/. Published 2016. Accessed April 23, 3017.

      6. Oregon Primary Care Association. SDOH: tools & resources. www.orpca.org/initiatives/social-determinants-of-health/251-sdoh-tools-resources. Accessed March 27, 2017.

      7. Manchanda R, Gottlieb L. Upstream risks screening tool and guide V2.6. www.aamc.org/download/442878/data/chahandout1.pdf. Published 2015. Accessed March 27, 2017.

      8. National Center for Medical-Legal Partnership (NCMLP). The Medical-Legal Partnership Toolkit: Phase I: Laying the Groundwork. http://medical-legalpartnership.org/mlptoolkit/. Published 2015. Accessed March 27, 2017.

        • Barnett K.
        • Somerville M.H.
        Hospital community benefits after the ACA: Schedule H and hospital community benefit—opportunities and challenges for the states.
        Hospital Community Benefit Program. 2012; (Issue Brief (October 2012).) (Accessed March 27, 2017)