Comparison of Screening Practices Across FQHC Sites: Key Findings From Theme 1
| Subthemes | Site 1 | Site 2 | Site 3 | Site 4 | Site 5 |
|---|---|---|---|---|---|
| Identification of patients | Targeted rollout Started with Medicaid patients as a pilot program Layers of screening—in which all care team members were encouraged to perform social needs screening with patients at any point of contact. | All patients, starting with new patient appointment Screening conducted by telephone with CHW, in person by case/care management RNs, and medical providers | Targeted rollout Started with patients enrolled in specific programs at their first new patient appointment Sometimes medical team would ask for resources for patients not part of targeted rollout | All patients, starting with new patient appointment | Targeted rollout Started with patients aged 18 years and older, those referred by physicians, and patients with high ED utilization Expanded to behavioral health, prenatal visits Front desk distributed screening to all new patients and patients with health care maintenance exams |
| Team members performing screening | Front desk at initial new patient appointment CHW, case/care managers as needed Layers of screening | CHW by telephone before first new patient appointment Case/care managers, mental health referral as needed Layers of screening | CHW Case/care managers as needed | MAs, CHWs Layers of screening | CWH initially Added MAs and case/care managers as screeners Layers of screening |
| Screening approach | Standardized | Standardized Tailored to population (eg, younger, older) | Standardized Adaptations for specific communities (eg, Black, Hispanic) | Standardized | Standardized |
| Screening tool | PRAPARE initially, then moved to screening tool from the Northern Physicians Organization (as part of SIM) | PRAPARE | Internally developed | PRAPARE (internally customized) | PRAPARE |
| Mode of screening | Paper, plan to embed via NextGen/iPad Patient fills out the paper, hands it back to staff, then sent to CHW who follows up afterward | Embedded in EHR Questions asked verbally by staff, then entered into EHR | Paper, then scanned into EHR Moving to PRAPARE tool, embedded in EHR | Paper, then manually entered into EHR Moving to Next-Gen/NextPen to be fully integrated | Embedded in EHR |
| Role linking patient to resources | CHW, case/care manager | CHW | CHW | CHW | CHW |
CHW = community health worker; ED = emergency department; EHR = electronic health records; FQHC = Federally Qualified Health Center; MA = medical assistant; NextGen = EHR product (NextGen Healthcare Inc); NextPen = EHR product that captures patient data by digital pen (NextGen Healthcare Inc); PRAPARE = Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences; RN = registered nurse; SIM = State Innovation Model program.