Food Insecurity Screening and Intervention Strategies in Pediatric Primary Care Practices: A Mixed Methods Study

Classified as probably not a substantial claim.

The Consolidated Framework for Implementation Research is a determinants framework that guides understanding of facilitators and barriers critical for implementation.

“The Consolidated Framework for Implementation Research (CFIR) is a determinants framework that provides a guide to understand facilitators and barriers critical for implementation.12”

• cites [12] Damschroder, 2009, Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science, Implement Sci sourceSupported

May combine two claims.

Childhood food insecurity is associated with poor dietary quality, poor educational performance, cardiometabolic risk factors, mental health disorders, and increased pediatric hospitalizations.

“These include poor dietary quality and educational performance, development of cardiometabolic risk factors and mental health disorders, and increased pediatric hospitalizations.3”

• cites [3] Hartline-Grafton, 2021, Food insecurity and health: practices and policies to address food insecurity among children, Acad Pediatr sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Interviews were analyzed using rapid qualitative analysis, a previously validated team-based method.

“Interviews were analyzed using rapid qualitative analysis, an intensive, team-based analysis method that has been previously validated.20,21”

• cites [20] Hamilton A. Qualitative Methods in Rapid Turn-Around Health Services Research. PowerPoint Slides. Health Services Research & Development Cyberseminar. 〈https://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=780〉.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [21] Taylor, 2018, Can rapid approaches to qualitative analysis deliver timely, valid findings to clinical leaders? A mixed methods study comparing rapid and thematic analysis, BMJ Open sourceSupported

Classified as probably not a substantial claim. May combine two claims.

Prior studies have described food insecurity screening and intervention in single health centers, hospital settings, or regions and have explored health-related social needs screening more broadly.

“Prior studies have described FI screening and intervention in single health centers, hospital settings, or regions and explored HRSN screening and interventions more broadly.6–8”

• cites [6] De Marchis, 2019, Interventions addressing food insecurity in health care settings: a systematic review, Ann Fam Med sourcePartly supported

  The Results and References describe food-insecurity screening and interventions in health centers, clinics, and hospitals, supporting that part of the sentence. But the Inclusion and Exclusion Criteria (p. 437) require studies to address food insecurity specifically; this review does not establish the broader claim about health-related social-needs screening and interventions. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [7] Berry, 2020, Social needs screening and referral program at a large US public hospital system, 2017, Am J Public Health sourceSupported
• cites [8] Markowitz, 2022, Food insecurity screening and intervention in United States children's hospitals, Hosp Pediatr sourceNot checked — no full text of the source

May combine two claims.

Few studies have explored current food insecurity processes in pediatric primary care using a framework such as CFIR, and even fewer have done so among practices with innovative food insecurity processes.

“Few have explored current FI processes in pediatric primary care settings using a framework such as CFIR, with even fewer exploring these factors among practices with innovative and novel FI processes.13”

• cites [13] Taher, 2022, An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines, BMC Public Health sourcePartly supported

  The Abstract Methods and Background describe a CFIR-based study of food-insecurity screening processes in two primary-care initiatives. They do not establish that few studies have examined these processes, identify the settings as pediatric primary care, or support the narrower claim about how rarely innovative practices have been studied. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Online referral platforms that both refer to community-based organizations and complete follow-up are seen in the literature as a promising innovation.

“Few leveraged online referral platforms to both refer to CBOs and complete follow-up, which are seen in the literature as a promising innovation.10,11”

• cites [10] McPeak Hinz, 2023, Addressing health-related social needs through systematic screening and integration of a social care technology platform, NEJM Catalyst sourceNot checked — no full text of the source
• cites [11] Beidler, 2022, More than just giving them a piece of paper: interviews with primary care on social needs referrals to community-based organizations, J Gen Intern Med sourceSupported

May combine two claims.

Implementation of cross-sector referral partnerships can be complex with low uptake, and evidence on their effectiveness is mixed.

“However, as raised by participants, the implementation of these partnerships can be complex, resulting in low uptake24 and evidence on their effectiveness in facilitating resource connection and follow-up is mixed.25”

• cites [24] Fichtenberg, 2024, If you build it, they may not come: understanding factors influencing use of a community resource referral technology, Health Serv Res sourceSupported
• cites [25] Alderwick, 2021, The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews, BMC Public Health sourcePartly supported

  The Discussion reports mixed evidence on the impact of cross-sector collaboration on health services, with some studies suggesting improved access to services. It does not establish mixed effectiveness specifically for resource connection and follow-up. In the citing sentence, low uptake is attached to citation 24, not this source’s citation 25. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Prior research has shown variable health care utilization and cost outcomes among patients receiving health-related social needs assistance.

“As prior research has demonstrated variable health care utilization and cost outcomes among patients receiving HRSN assistance within national and local studies,30–32”

• cites [30] Garg, 2023, A social care system implemented in pediatric primary care: a cluster RCT, Pediatrics sourcePartly supported

  The Discussion (page not provided) reports varied health care utilization outcomes: higher immunization adherence, but more emergency department visits and hospitalizations among children in the WE CARE intervention. The paper does not report cost outcomes, and its community-health-center trial does not establish the claim about outcomes across national and local studies. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [31] Parish, 2023, Health care impacts of resource navigation for health-related social needs in the accountable health communities model, Health Affairs sourceNot checked — no full text of the source
• cites [32] W. Parish, J. Renaud, L. Rojas Smith, S. O’Connor. Accountable Health Communities (AHC) Model Evaluation: Third Evaluation Report. 2024. 〈https://www.cms.gov/priorities/innovation/data-and-reports/2024/ahc-3rd-eval-report〉.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The social services sector has addressed food insecurity and other health-related social needs longer than the health care sector, so health care may not be best positioned to lead food insecurity efforts.

“Importantly, as the social services sector has been addressing FI and other HRSNs for much longer than the health care sector, the health care sector may not be best positioned to lead FI efforts.26”

• cites [26] Fraze, 2022, "It's Not Just the Right Thing … It's a Survival Tactic": disentangling leaders' motivations and worries on social care, Med Care Res Rev sourcePartly supported

  The Results section says administrators viewed community-based organizations as having deep expertise in addressing social risks and as likely better positioned to improve social conditions. The Discussion adds that having those organizations lead may be more effective than centering social care in medical settings. The paper does not establish that social services have addressed food insecurity or other social needs for much longer than health care has; no page numbers were provided in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Evidence comparing the impact of different food insecurity interventions is limited, and clinical practices continue to vary by setting and funding.

“With even more limited evidence comparing the impact of these different interventions, there continues to be significant variation in clinical practices depending on clinic setting (ie, inpatient vs outpatient) and available funding.6,8,23”

• cites [6] De Marchis, 2019, Interventions addressing food insecurity in health care settings: a systematic review, Ann Fam Med sourcePartly supported

  The Discussion says that heterogeneous interventions and outcomes hindered comparisons across studies, supporting the claim that comparative evidence is limited. It describes a range of health care settings but does not establish that clinical practices vary specifically between inpatient and outpatient settings or because of available funding. Page numbers were not provided in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [8] Markowitz, 2022, Food insecurity screening and intervention in United States children's hospitals, Hosp Pediatr sourceNot checked — no full text of the source
• cites [23] Holley, 2019, A systematic review of the evaluation of interventions to tackle children's food insecurity, Curr Nutr Rep sourcePartly supported

  The Discussion says the evidence about what works for children’s food insecurity is limited by weak evaluations and inconsistent measures; it also notes variation in intervention design. It does not establish that clinical practices vary between inpatient and outpatient settings or according to available funding. Page numbers are unavailable in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The SIREN social care logic model suggests several nuanced mechanisms by which health-related social needs intervention may improve health and decrease unnecessary health care utilization.

“This finding is reflected in the Social Interventions Research & Evaluation Network (SIREN) social care logic model, which suggests several nuanced mechanisms by which HRSN intervention may improve health and decrease unnecessary health care utilization.29”

• cites [29] Gottlieb, 2024, Revising the logic model behind health care's social care investments, Milbank Q sourceSupported

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

Nearly half of participants were unsure whether their clinic belonged to a clinically integrated network or accountable care organization.

“Nearly half of participants were not sure if their clinic was part of a network to improve care and reduce cost, such as a clinically integrated network (CIN) or accountable care organization (ACO).”

May combine two claims.

Clinics have integrated food insecurity screening and interventions, but streamlined documentation and billing remain limited.

“While clinics have integrated FI screening and interventions, streamlined documentation and billing remain limited.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The interview sample included 28 pediatric physicians and 16 social care staff.

“The interview sample included 28 pediatric physicians and 16 social care staff.”

May combine two claims.

Most clinics used a standard screening questionnaire, while few also evaluated the urgency of food insecurity.

“While most clinics utilized a standard screening questionnaire, few clinics additionally evaluated the urgency of FI (Fig. 2).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most pediatric practices were associated with academic practices (89%).

“Most pediatric practices were located in the South (n = 12, 44%), in urban regions (n = 19, 70%) (Table 1), and were associated with academic practices (n = 24, 89%).”

May combine two claims.

Three qualitative themes were identified: variability in food insecurity screening, intervention, and documentation processes; multilevel barriers; and a need for policy and payment reforms.

“Three overarching qualitative themes were identified from the interviews: 1) FI screening, intervention, and documentation processes varied across primary care clinics; 2) Multilevel barriers hindered efforts to address FI; and 3) Policy and payment reforms are needed to support the integration of FI screening and intervention in health systems and effectively assist families experiencing FI.”

May combine two claims.

Novel interventions included multicomponent food programs and automated WIC referrals through the EHR.

“Novel clinical interventions to address FI and other HRSNs included multicomponent food interventions, which simultaneously addressed food needs and nutrition and employment needs, and automated referrals to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) through the EHR.”

May combine two claims.

Most clinics did not directly help patients enroll in federal nutrition programs due to limited staff capacity, but all referred to such programs as a food resource.

“Most clinics did not directly assist patients with enrollment in federal nutrition programs due to limited staff capacity, but all referred to federal nutrition programs as a food resource from their clinical setting.”

May combine two claims.

Half of clinics screened for food insecurity at all well child visits (52%), while others screened at all clinic visits (13%) or at specific intervals (22%).

“Half screened for FI at all well child visits (n = 14, 52%), while others screened at all clinic visits (n = 3, 13%) or at specific time intervals (ie, every 3 or 6 months; n = 6, 22%; Fig 2).”

May combine two claims.

Clinics using Z-codes found them useful for tracking needs and follow-up, while non-users were unaware or concerned about unintended consequences.

“Those utilizing Z-codes felt that this was useful for tracking a patient’s needs and providing follow-up care, while those who did not use Z-codes were either not aware of this possibility or felt there may be unintended consequences for patients (Fig. 2).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Closed-loop food insecurity referral systems were strongly desired.

“Closed-loop FI referral systems, which would allow providers to know if patients have accessed food resource referrals, were strongly desired.”

May combine two claims.

Screening approaches were often adapted to these concerns, with some clinics screening frequently or discussing the purpose of screening.

“FI screening approaches were often adapted based on these concerns with some clinics opting to screen frequently to increase patient comfort with screening or intentionally discussing the purpose of FI screening with patients.”

May combine two claims.

Most clinics using Z-codes manually entered food insecurity codes, while a couple developed automated EHR documentation.

“The majority of these clinics manually entered FI codes, with a couple of clinics developing an automated EHR documentation process.”

May combine two claims.

Barriers to increasing food insecurity training in residency programs were limited curricular time and frequent resident turnover.

“Barriers reported to increasing FI training in current residency programs were limited curricular time for intensive resident training and frequent resident turnover at clinics.”

May combine two claims.

About two-thirds of clinics could not bill for food insecurity screening or intervention, and a small percentage were unsure.

“About two-thirds of clinics could not bill for FI screening or addressing FI, with a small percent unsure if their clinic could bill.”

May combine two claims.

Over half of clinics had on-site food distributions; most distributed prepackaged bags, while a few allowed patients to select preferred items.

“Over half of clinics had on-site food distributions; most distributed prepackaged bags of food, while a few allowed for patients to select their preferred food items.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The pediatric practices studied were predominantly located in the South (44%) and in urban areas (70%).

“Pediatric practices were predominately in the South (44%) and in urban (70%) locations.”

May combine two claims.

The study included 27 clinical practices, and 25 of them participated in an interview.

“The study included a total of 27 clinical practices, with 25 of these clinics participating in an interview (Fig. 1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Concerns about unintended consequences included that food insecurity documentation could create bias in future health care encounters.

“These consequences included concerns that FI documentation could create bias during future health care encounters.”

May combine two claims.

Providers most commonly distributed a resource list due to limited cross-sector communication and staff bandwidth, acknowledging it was insufficient to ensure resource connection or reduce food insecurity.

“Despite this perspective, we found that providers most commonly distributed a resource list to families due to clinic limitations with cross-sector communication and staff bandwidth, acknowledging this was not sufficient to ensure resource connection or to reduce FI experienced by families.1”

• cites [1] Montez, 2021, Addressing food insecurity among children—pediatrician beliefs, practices, and resource needs, Acad PediatrNot checked yet

  Not checked in the free run.

May combine two claims.

The results show widely streamlined use of food insecurity screening tools, with interventions modified to clinic capacity and patient population.

“Our results demonstrate the widely streamlined use of FI screening tools with interventions modified to clinics’ capacity and patient population.”

May combine two claims.

Providers wanted reimbursement for their work, but few could bill for food insecurity under current policies.

“While providers desired reimbursement for their work, few could bill for FI under current policies.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Automated platforms were perceived to limit patient privacy and burden community-based organizations.

“However, automated platforms were felt to limit patient privacy, as data collected in the health care system was shared with external partners, and were thought to be burdensome for CBOs, as they were required to opt in and document referral outcomes.”

Classified as probably not a substantial claim. May combine two claims.

Participants felt food insecurity intervention was a more meaningful metric than screening, and that downstream outcome metrics would be challenging.

“Nonetheless, participants felt FI intervention was a more meaningful metric than screening and that quality metrics for more downstream outcomes, such as reducing FI or improving health outcomes, would be challenging to achieve.”

Classified as probably not a substantial claim. May combine two claims.

Funding from value-based payment models or health systems was seen as a potential way to sustain food insecurity interventions, which were largely grant-funded with uncertain futures.

“Funding from VBP models or health systems was felt to be a potential pathway for sustaining FI interventions, as existing FI interventions were largely funded through short-term grants, and many were uncertain about the future of these funding sources.”

May combine two claims.

The study identified a wide range of food insecurity screening and intervention practices and opportunities for payment and policy reforms to support clinical integration.

“In this mixed-methods study among pediatric clinics, we identified a wide range of FI screening and intervention practices and opportunities for payment and policy reforms to support integration into clinical settings.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants felt the Child Tax Credit was beneficial for low-income families.

“Additionally, participants felt the Child Tax Credit was a beneficial program for low-income families.”

Classified as probably not a substantial claim.

Participants suggested opportunities to support food insecurity screening and intervention that would make the work more feasible and sustainable.

“Participants suggested opportunities to support FI screening and intervention that would make this work more feasible and sustainable.”

Classified as probably not a substantial claim. May combine two claims.

Participants wanted reimbursement for time spent addressing food insecurity and stable financial or operational support.

“Finally, participants desired reimbursement for time spent addressing FI and stable financial and/or operational support to augment their clinics’ FI efforts (Table 3).”

May combine two claims.

Nearly all clinics used standardized food insecurity screening tools and resource lists, but implementation of screening, food distribution, referrals, and EHR documentation varied due to funding, staffing, and clinician opinion.

“While nearly all clinics used standardized FI screening tools and addressed FI through provision of a resource list, the implementation of screening, on-site food distribution, direct FI referrals, and EHR documentation varied due to funding limitations, staff constraints, and clinician opinion.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A few participants wanted funding for staff such as community health workers to assist with food insecurity referrals.

“A few participants wanted funding for staff to assist with FI referrals, such as community health workers.”

May combine two claims.

About 40% of clinics participated in at least one pediatric value-based payment model, but only half of those models required health-related social needs or food insecurity screening.

“Approximately 40% of clinics were known to participate in at least 1 pediatric VBP model, but only half of these models required HRSN or FI screening.”

May combine two claims.

Many barriers hinder food insecurity efforts, but the inability to form closed-loop cross-sector partnerships is a key barrier.

“Many barriers hinder practices’ FI efforts, but the inability to form closed-loop, cross-sector partnerships is a key barrier.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some participants believed the health system may not be best suited to address food insecurity, with social service or school sectors better suited.

“Moreover, some believed the health system may not be the most well-suited to address FI, with the social service or school sector better suited for this work.”

May combine two claims.

Participants were open to quality or performance metrics for food insecurity but preferred incentivizing interventions over screening-focused metrics.

“Participants were open to utilizing quality or performance metrics to support FI processes. However, they preferred incentivization of FI interventions, as this would be more valuable than metrics focused primarily on screening.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Other clinics assessed referral outcomes at subsequent visits.

“Other clinics assessed referral outcome at subsequent visits.”

May combine two claims.

Additional barriers included limited staff, high patient volume, and difficulty reaching families by phone.

“Additional barriers included limited staff, high patient volume, and difficulty reaching families by phone (Table 2).”

Probably not a substantial claim: may not pass S3 (load-bearing).

One clinic was working to financially support community-based organization participation in its integrated online platform.

“One clinic was working to financially support CBO participation in their integrated online platform.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Once food insecurity was identified, providers viewed connecting patients to SNAP and/or WIC as the best long-term solution.

“Once FI was identified, providers viewed connecting patients to SNAP and/or WIC as the best long-term solution to addressing FI, as previously shown.4”

• cites [4] A. Ashbrook, K. Essel, K. Montez D. Bennett-Tejes Screen and Intervene: A Toolkit for Pediatricians to Address Food Insecurity. 2021. January 2021 〈https://frac.org/wp-content/uploads/FRAC_AAP_Toolkit_2021.pdf〉.Not checked yet

  Not checked in the free run.

May combine two claims.

Food insecurity screening was largely standardized, while interventions varied widely by clinic context and resources.

“While we found FI screening was largely standardized, FI interventions varied widely depending on clinic context and resources.”

May combine two claims.

Almost all clinical food insecurity interventions were grant-supported, and few clinics received financial support from clinically integrated networks, accountable care organizations, or value-based payment models.

“We found that almost all clinical FI interventions were supported by grants, and few clinics received financial support from emerging practice and payment structures, such as CINs, ACOs, or VBP models.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The interview guide was piloted with two participants.

“The interview guide was piloted with 2 participants.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interviews were audio-recorded and transcribed verbatim.

“Interviews were conducted via Zoom, audio-recorded, and transcribed verbatim.”

May combine two claims.

Pediatric practices increasingly screen for and address food insecurity in line with AAP and Food Research & Action Center recommendations, but implementation varies widely.

“While pediatric practices are increasingly screening for and addressing FI in line with American Academy of Pediatrics (AAP) and Food Research & Action Center recommendations, there is widespread variability in how these recommendations are implemented in clinical practices.4,5”

• cites [4] A. Ashbrook, K. Essel, K. Montez D. Bennett-Tejes Screen and Intervene: A Toolkit for Pediatricians to Address Food Insecurity. 2021. January 2021 〈https://frac.org/wp-content/uploads/FRAC_AAP_Toolkit_2021.pdf〉.Not checked yet

  Not checked in the free run.

• cites [5] Council on Community Pediatrics and Committee on Nutrition, 2015, Promoting food security for all children, Pediatrics sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interviews continued until saturation was reached, defined as no new themes and balanced geographic representation.

“Interviews were conducted until saturation was reached, which was determined when no new themes emerged, and until all geographic regions had balanced representation in the sample.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Summary templates were verified by a second team member for completeness and accuracy, and discrepancies were reconciled through team discussions.

“Summary templates were verified by a second team member for completeness and accuracy. Discrepancies were reconciled through team discussions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All interview transcripts were verified for accuracy.

“All interview transcripts were verified for accuracy (V.N., A.H.).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Study team members met monthly to identify and reach consensus on emerging themes.

“Study team members met monthly to identify and reach consensus on emerging themes based on review of the matrix.”

May combine two claims.

Food insecurity disproportionately affects Black and Hispanic children and children in single-parent households.

“FI, defined as the lack of access to enough food to live an active and healthy lifestyle, disproportionately impacts Black and Hispanic children and children living in a single-parent household.2”

• cites [2] M.P. Rabbitt, M. Reed-Jones, L.J. Hales, M.P. Burke. Household Food Security in the United States in 2023. 2024. doi: 10.32747/2024.8583175.ers. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Interviewers had no prior relationships with participants.

“Interviewers did not have relationships with participants prior to the interview.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Interviews were conducted by two team members with training and experience in qualitative research.

“Interviews were conducted by 2 team members (G.J., L.S.) with training and experience in qualitative research.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Consolidated Criteria for Reporting Qualitative Research checklist was used to report qualitative methods.

“The Consolidated Criteria for Reporting Qualitative Research Checklist was used for reporting qualitative methods.18”

• cites [18] Tong, 2007, Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups, Int J Qual Health Care sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

The findings may inform development of health-related social needs policies and reimbursement practices in new health care delivery and payment models.

“These findings may be drawn upon in the development of HRSN policies and reimbursement practices within novel health care delivery structures and payment models.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Health policies such as Medicaid state plan amendments allowing reimbursement of community health workers addressing social needs may be important.

“Health policies, such as Medicaid state plan amendments allowing for reimbursement of community health workers addressing social needs, may be important as well.33”

• cites [33] C. Rush, E. Higgins, S. Wilkniss. State Approaches to Community Health Worker Financing through Medicaid State Plan Amendments. 2022. Decemeber 7. 〈https://nashp.org/state-approaches-to-community-health-worker-financing-through-medicaid-state-plan-amendments/〉.Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Demographic information from providers and social care staff was not collected, so more granular individual data cannot be presented.

“Further, demographic information from providers and social care staff was not collected, so we are not able to present more granular data about the individuals in the study.”

May combine two claims.

The study used a convenience sample selected by national reputation or publications, which may have biased findings.

“Additionally, in order to meet the study goal of synthesizing current practices and identifying innovation, we utilized a convenience sample, selected based on national reputation or publications in peer-reviewed journals, which may have biased the findings.”

May combine two claims.

Health systems engaging in and leading health-related social needs efforts can have consequences, including diverting funds from community programs and detracting from equitable health care delivery.

“In fact, there can be consequences to health systems engaging in and leading efforts to address HRSNs, including diverting funds from community programs, and detracting from ensuring equitable delivery of health care services.27”

• cites [27] Glied, 2023, Health systems and social services—a bridge too far?, JAMA Health Forum sourceNot checked — no full text of the source

May combine two claims.

Qualitative outcomes were not stratified by physician and social care staff, so differences by role cannot be differentiated.

“We did not stratify qualitative outcomes by physician and social care staff independently, and we cannot differentiate how varying providers may have had differing recommendations based on their role in the health system.”