政策要点州和联邦付款人正在积极考虑增加在医疗保健环境中采用社会风险筛查和干预措施的策略,包括通过使用财政激励措施。与俄勒冈州社区卫生中心(CHC)的社会护理相关的活动提供了一个独特的机会,可以探索社会风险筛查和导航的服务费用支付是否以及如何影响CHC活动。CHC工作人员,临床医生,和行政领导人往往不知道现有的用于社会风险筛查和导航服务的财务付款。按照目前的设计,服务费支付不太可能对CHC社会护理实践产生重大影响。
背景:出现了越来越多的国家政策,以鼓励医疗保健提供系统询问并尝试解决患者的社会风险,例如,食物,住房,运输不安全,在护理交付环境中。在这项研究中,我们探讨了社区卫生中心(CHC)工作人员如何看待按服务收费支付对临床团队参与这些活动的当前和潜在影响.
方法:我们采访了42名临床医生,一线员工,和来自12个俄勒冈州CHC临床站点的行政领导关于他们的社会护理计划,包括旨在促进社会风险筛查和转介社会服务的现有或预期财务付款的作用。使用归纳和演绎主题分析方法对数据进行分析。
结果:我们将发现分为三类:参与者对现有或预期的财务激励措施的认识,用于奖励美元,以及临床实践中财务激励对社会护理活动的感知影响。缺乏对现有激励措施的认识意味着这些激励措施不会影响负责进行筛查和提供转介的员工的行为。奖励资金的当前或预期有意义的用途包括支付社会护理人员,提供社会服务,并支持额外的筹款工作。前线工作人员报告说,诊所社会护理实践的最大动力是提供响应迅速的社会服务的能力。诊所领导/经理指出,要采取财务激励措施来实质性改变CHC做法,将需要足够大的付款来扩大社会护理劳动力。
结论:向CHC支付用于社会风险筛查和导航服务的小额服务费用不太可能显著影响CHC社会护理实践。完善财务激励的设计-例如,通过提高临床团队对激励措施的认识,将筛查与资金充足的社会服务联系起来,以及改变激励金额以支持社会护理人员需求-可能会增加CHC对社会护理实践的吸收。
Policy Points State and federal payers are actively considering strategies to increase the adoption of social risk screening and interventions in health care settings, including through the use of financial incentives. Activities related to social care in Oregon community health centers (CHCs) provided a unique opportunity to explore whether and how fee-for-service payments for social risk screening and navigation influence CHC activities. CHC staff, clinicians, and administrative leaders were often unaware of existing financial payments for social risk screening and navigation services. As currently designed, fee-for-service payments are unlikely to strongly influence CHC social care practices.
A growing crop of national policies has emerged to encourage health care delivery systems to ask about and try to address patients\' social risks, e.g., food, housing, and transportation insecurity, in care delivery contexts. In this study, we explored how community health center (CHC) staff perceive the current and potential influence of fee-for-service payments on clinical teams\' engagement in these activities.
We interviewed 42 clinicians, frontline staff, and administrative leaders from 12 Oregon CHC clinical sites about their social care initiatives, including about the role of existing or anticipated financial payments intended to promote social risk screening and referrals to social services. Data were analyzed using both inductive and deductive thematic analysis approaches.
We grouped findings into three categories: participants\' awareness of existing or anticipated financial incentives, uses for incentive dollars, and perceived impact of financial incentives on social care activities in clinical practices. Lack of awareness of existing incentives meant these incentives were not perceived to influence the behaviors of staff responsible for conducting screening and providing referrals. Current or anticipated meaningful uses for incentive dollars included paying for social care staff, providing social services, and supporting additional fundraising efforts. Frontline staff reported that the strongest motivator for clinic social care practices was the ability to provide responsive social services. Clinic leaders/managers noted that for financial incentives to substantively change CHC practices would require payments sizable enough to expand the social care workforce as well.
Small fee-for-service payments to CHCs for social risk screening and navigation services are unlikely to markedly influence CHC social care practices. Refining the design of financial incentives-e.g., by increasing clinical teams\' awareness of incentives, linking screening to well-funded social services, and changing incentive amounts to support social care staffing needs-may increase the uptake of social care practices in CHCs.