Increasing Warm Handoffs: Optimizing Community Based Referrals in Primary Care Using QI Methodology
Open accessAbstract
Social and environmental factors have an outsized effect on one's health. Children are particularly impacted by the adverse effects of poverty. While social determinants of health (SDH) screening in healthcare settings has proliferated there remain gaps in best practices for screening processes. As research has shown that patient navigation leads to an improvement in unmet social needs and family-reported child health, warm handoffs may be a key factor in assuring that the social needs of families are effectively addressed. Using quality improvement (QI) methods our pediatric clinic worked to increase the warm handoff rate between Community Health Workers (CHWs) and patients with unmet social needs. CHW warm handoff rates increased two-fold over the intervention period. Our results illustrate that QI methods can be used to optimize workflows to increase warm handoffs with CHWs. This is important as health centers work to improve their social needs screening and referral programs.
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Warm handoffs help reduce fragmentation, clarify roles, and prevent caregivers from being left to coordinate alone.
“Warm handoffs, direct, relational transitions where responsibility is transferred with the caregiver rather than to them, help reduce fragmentation, clarify roles, and prevent caregivers from being left to coordinate alone [33,34,35,36].”
From Home care comparison (2026) · cites this paper as [34]
The Introduction defines warm handoffs as transfers of care between team members in front of the patient, and the Methods describe community health workers helping families navigate referrals. The paper does not establish that warm handoffs reduce fragmentation, clarify roles, or prevent caregivers from having to coordinate care alone. (LLM, conf=0.82)
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- Authors
- Sanderson, D., Braganza, S., Philips, K., Chodon, T., Whiskey, R., Bernard, P., Rich, A., & Fiori, K.
- Affiliations
- Albert Einstein College of Medicine (US)
- Bronx Community Health Network, Bronx, NY, USA
- Corresponding author
- Sanderson, Dana
- Venue
- Journal of Primary Care & Community Health
- Publisher
- SAGE Publications
- Published
- 2021-01
- Volume
- 12
- Pages
- 21501327211023883-21501327211023883
- ISSN
- 2150-1319 (ISSN-L)
- 2150-1327
- PMC
- PMC8202298
- OpenAlex
- W3171717528
- Cited by
- 14
- References
- 10
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 2
- FWCI
- 1.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Primary Care & Community Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- warm handoff, community health workers, social determinants of health, social needs screening, patient navigation, referral systems, pediatric primary care, health centers, workflow optimization, child poverty
- MeSH terms
- Child, Community Health Workers, Humans, Primary Health Care, Referral and Consultation, Quality Improvement, Patient Handoff
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