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Compass Rose for Generating Community-based Referrals via Epic: Best Practices and Lessons Learned [Social determinants and vulnerable populations]

Annals of Family Medicine

Study Design and Analysis: We used information gathered from site visits and team meetings to understand how Compass Rose was being utilized across sites. Setting or Dataset: We used data from Epic on social needs screening and Compass Rose utilization.

Referral 130
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Risks and Needs: Lessons Learned from Assessing Patients Willingness to Receive Help for Social Risks in Primary Care [Social determinants and vulnerable populations]

Annals of Family Medicine

Population Studied: 13 urban and rural primary care practices located across Mayo Clinic sites in Minnesota, Wisconsin, and Florida. Outcome Measures: social risk factors, whether patients wanted assistance with their risk factors, and measures related to connection to community resources.

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Addressing diabetes management in the context of social needs: a qualitative study of primary care providers [Diabetes and endocrine disease]

Annals of Family Medicine

A recent review of national diabetes treatment guidelines recommended adjustments to DM to reduce financial strain (eg, selecting lower cost medications), as well as directly intervening in response to an identified social need (eg, referral to a community-based service).

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Health-Related Social Needs Increase and Persist following Onset of COVID-19 Pandemic [Social determinants and vulnerable populations]

Annals of Family Medicine

Context: Health-related social needs (HRSN), such as housing, food, and transportation, play a major role in overall patient health and well-being. The Coronavirus-19 (COVID-19) pandemic amplified HRSN disparities, adding stress to social support systems.

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EMS Intervention to Reduce Falls: Carmen Quatman and Katie Quatman-Yates

GeriPal

So Carmen and Katie developed an EMS Community Partnership program. They created a seamless link between this Community Partnership program and 911 calls for falls. Eric and I enjoyed talking with Carmen and Katie about this innovative and common sense approach to addressing falls in the community. What can we do as a community?

Community 115
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Implementing Palliative Care in Nursing Homes: A Podcast wtih Connie Cole, Kathleen Unroe, and Cari Levy

GeriPal

Kathleen 14:03 I mean, back to Cari’s, you know, what Cari was talking about, about financial barriers to palliative care services in the nursing home setting. Eric 14:32 So there’s financial disincentives for interdisciplinary palliative care teams. Like, yeah, utilization of hospice has increased pretty well.