ArticleJournal of primary care & community health
Social Needs Assessment and Linkage to Community Health Workers in a Large Urban Hospital System.
Article in Journal of primary care & community health. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 12 citations in OpenAlex.
- Defining the Social Needs Service Cascade: Evidence From A Multistakeholder Qualitative Study.Medical care research and review : MCRR · 2026Article
- Mobilizing community assets to address health equity: Evaluation of the Communities Organizing to Promote Equity (COPE) project in Kansas.Public health in practice (Oxford, England) · 2026Article
- Motivational Interviewing is "Journal of patient experience · 2025Article
- Assessing community health needs in Jeddah Second Health Cluster: A qualitative descriptive study.Journal of education and health promotion · 2025Article
- Fungal infection-related conditions and outcomes in severe COVID-19: a nationwide case-control study.BMC infectious diseases · 2024Observational
- Advancing social care integration in health systems with community health workers: an implementation evaluation based in Bronx, New York.BMC primary care · 2024Article
- Barriers and Facilitators to the Implementation of a Health-Related Social Needs Screening and Referral Intervention in the Bronx.Journal of primary care & community healthArticle
- Impact of a Housing and Health Focused Residency Curriculum on Community Health Worker Utilization for Unmet Housing Needs.Journal of primary care & community healthArticle
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesIdentifying social needs is a growing priority in primary care, but there is significant variation in how patients access services to meet such needs. This study identifies predictors of successful linkage with a community health worker (CHW) among patients with social needs seen in an outpatient setting.
methodsThis study uses a cross-sectional analysis of social needs assessments administered in an urban health system between April 2018 and December 2019. Social needs included: food insecurity, housing quality, housing instability, healthcare cost, healthcare related transportation, utilities, care for dependents, legal assistance, safety, and getting along with household members. Patients with at least 1 social need and accepting help were included in the analysis. On contact with a CHW, patients were entered into a separate database. The primary outcome was successful "linkage," defined by having a positive social needs assessment in the medical record and a corresponding record in the CHW database. Multivariate logistic regression was used to assess predictors of linkage.
resultsAmong patients with at least 1 social need accepting help, 25% (758/3064) were linked to a CHW. Positive predictors included female gender (OR 1.28 [95% CI 1.01-1.63]), Spanish language preference compared to English (1.51 [1.14-1.03]), and having a food related need (1.35 [1.03-1.79]). Negative predictors included age 18 to 65 (0.34 [0.17-0.71] for age 18-24) and 0 to 5 (0.45 [0.24-0.78]) compared to over 65, non-Hispanic White race compared to Hispanic race (0.39 [0.18-0.84]), and having needs of getting along with household members (0.52 [0.38-0.71]) and safety (0.64 [0.42-0.98]).
conclusionsTwenty-five percent of patients who had at least 1 social need and were accepting help had a successful CHW linkage. Predictors of linkage suggest areas of further system-level improvements to screening and referral interventions to target at risk patients and communities.
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