Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), CLASSROOM_SCHOOL, PROFESSIONAL_CAREGIVER, Outreach (caregiver), Communication Tools, Distribution of Promotional Items (Classroom/School)

Intervention Description: In Michigan, a school-based outreach effort was piloted using existing school communication tools to identify children who are currently uninsured and may be eligible for state-subsidized health insurance. School districts were provided with two health insurance status collection forms to be included with the free and reduced school lunch application, and as part of the student registration packet and welcome materials for school. Completed forms were sent to a state registered application-assisting agency to ensure families can access the coverage and services they need. A final step in the process is outreach to eligible respondents by the Michigan Primary Care Association to help ensure that they receive information and access to the healthcare coverage and services they need.

Intervention Results: As a result of the survey, 156 children were identified as not having health insurance. This represents more than 44% of the 358 children who are eligible for State subsidized health insurance, in the participating school districts, but are uninsured. Integrating the collection of health insurance status into routine school communication channels is an effective way to identify children who do not have health insurance and may be eligible for state subsidized benefits.

Conclusion: 1. The Michigan Department of Community Health should lead the effort to work with the Michigan Department of Education to modify the Free and Reduced Lunch Application to capture whether or not the applicant has health insurance. 2. The Michigan Department of Community Health should lead the effort to incorporate into the direct certified free and reduced lunch eligibility process a systematic check as to whether or not the applicant has State subsidized health insurance. 3. The Michigan Department of Community Health should provide resources from the expected performance bonus to work with schools across the State to implement these changes.

Study Design: Cross-sectional pilot study

Setting: Schools (School districts in Van Buren County, Michigan)

Population of Focus: Uninsured children

Data Source: Survey data

Sample Size: 8,999 children

Age Range: School-aged children

Intervention Components (click on component to see a list of all articles that use that intervention): Communication Tools, Presentation/meeting/information Session (Classroom),

Intervention Description: The intervention in the study involved engaging adolescents with anti-smoking motivational messages and forming repeated implementation intentions on how to refuse offers of cigarettes. The intervention consisted of eight sessions, each led by a teacher and designed to be matched in duration and frequency across the intervention and control conditions. The sessions took place separately to data collection in classroom time and were designed to be age-appropriate and engaging. During these sessions, adolescents engaged with motivational materials (anti-smoking messages or pro-homework messages) and completed implementation intention sheets related to the target behavior (not smoking in the intervention condition; completing homework in the control condition)

Intervention Results: Schools were randomly allocated (September–October 2012) to intervention (n = 25) or control (n = 23). At follow-up, among 6,155 baseline never smokers from 45 retained schools, ever smoking was significantly lower (RR = 0.83, 95% CI [0.71, 0.97], p = .016) in intervention (29.3%) compared with control (35.8%) and remained so controlling for demographics. Similar patterns observed for any smoking in last 30 days. Less consistent effects were observed for regular smoking and breath carbon monoxide levels. Economic analysis yielded an ICER of $134 per ever smoker avoided at age 15–16 years.

Conclusion: This pragmatic trial supports the use of repeated implementation intentions about how to refuse the offer of a cigarette plus antismoking messages as an effective and cost-effective intervention to reduce smoking initiation in adolescents.

Study Design: Cluster randomized controlled trial

Setting: 36 Secondary schools in the UK

Population of Focus: Researchers, public health professionals, educators, policymakers

Sample Size: Roughly 3672 adolescents

Age Range: ages 11-14 at baseline, 15-16 at follow up

Intervention Components (click on component to see a list of all articles that use that intervention): Communication Tools, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool,

Intervention Description: The intervention description in the study "Increasing Warm Handoffs: Optimizing Community Based Referrals in Primary Care Using QI Methodology" included several key components aimed at improving the warm handoff process and referral workflow. Some of the interventions implemented during the study period are as follows: 1. Dedicating CHW Space: The study involved dedicating space near providers for Community Health Workers (CHWs) and creating electronic CHW schedules and warm handoff blocks. 2. Improving Communication: Efforts were made to improve communication with providers using email and huddle reminders, as well as posting informative signs in exam rooms to facilitate the warm handoff process. 3. Workflow Enhancements: Workflow enhancements were implemented, including the creation of warm handoff blocks in the electronic medical record (EMR) and the CHW's schedule, as well as the co-location of CHWs with pediatricians for a specified period each week. 4. Regular Updates and Reminders: Monthly update emails were sent to the entire clinic staff, providing program data, workflow reminders, and success stories of patients who were referred to community resources. Additionally, workflow reminders were placed in exam rooms to prompt and enable providers to conduct warm handoffs. 5. Leadership Engagement: Leadership buy-in to the workflow changes was emphasized, and monthly emails were used to keep providers and staff updated on the screening and referral workflow and improvement initiatives. Success stories of patients who connected with a referral resource were shared to positively reinforce referral behavior. These interventions were part of the Plan-Do-Study-Act (PDSA) cycles performed during the study and were aimed at optimizing the warm handoff process and increasing the effectiveness of referrals for patients with unmet social needs.

Intervention Results: 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.

Conclusion: Yes, the study reported statistically significant findings related to the impact of the interventions on increasing warm handoffs with Community Health Workers (CHWs) and improving the referral process for patients with unmet social needs. Specifically, the study found the following statistically significant results: 1. CHW Referral Rate: The study reported a significantly higher referral rate in the intervention period compared to the baseline period (P = 0.03). 2. Warm Handoff Rate: The study found a statistically significant increase in the warm handoff rate between families requesting assistance with unmet social needs and CHWs over the intervention period compared to the baseline period (P < 0.001). These statistically significant findings indicate that the quality improvement (QI) interventions implemented during the study had a significant impact on increasing the warm handoff rate and improving the referral process for patients with unmet social needs.

Study Design: The study design used in the research article is a quality improvement (QI) project. The study aimed to optimize community-based referrals in primary care using QI methodology. The authors used Plan-Do-Study-Act (PDSA) cycles to test and implement interventions aimed at increasing the warm handoff rate between patients with unmet social needs requesting assistance and Community Health Workers (CHWs). The study used a pre-post design, comparing the baseline period to the intervention period, to evaluate the effectiveness of the interventions. The study did not use a randomized controlled trial (RCT) design, which is commonly used in clinical research to evaluate the effectiveness of interventions.

Setting: The setting for the study was a pediatric clinic affiliated with the Albert Einstein College of Medicine and Montefiore Medical Group in Bronx, NY, USA. The study took place at an academic-affiliated Federally Qualified Health Center (FQHC) where providers and residents are accustomed to partaking in Quality Improvement (QI) and research projects. The clinic served underserved communities and aimed to optimize community-based referrals in primary care using QI methodology.

Population of Focus: The target audience for the study includes healthcare professionals, particularly those working in pediatric primary care settings, as well as professionals involved in community health and social services. Additionally, individuals and organizations involved in quality improvement initiatives within healthcare settings may also find the study relevant. The findings and recommendations of the study are likely to be of interest to practitioners, researchers, and policymakers seeking to improve social needs screening and referral programs, especially in underserved communities.

Sample Size: The sample size for the study was not explicitly mentioned in the provided excerpts. However, the study reported that a total of 3100 patients were screened for social needs in the baseline period, and 6278 patients were screened in the intervention period. Additionally, the study mentioned that 527 patients (8.4%) were referred to a Community Health Worker (CHW) in the intervention period. While the specific sample size for the intervention group was not provided, the study's findings were based on the outcomes observed during the intervention period involving the referred patients.

Age Range: The provided excerpts from the study "Increasing Warm Handoffs: Optimizing Community Based Referrals in Primary Care Using QI Methodology" did not explicitly mention the specific age range of the study participants. However, based on the context of the study, which focused on pediatric care and addressing the social needs of families, it can be inferred that the study likely involved children and their families. The study primarily focused on the impact of warm handoffs and referrals in a pediatric clinic, indicating that the age range of the study participants likely encompassed children and possibly their caregivers or family members.