Annals of Family Medicine

NOVEMBER 20, 2024

Setting or Dataset: We used data from Epic on social needs screening and Compass Rose utilization. A Compass Rose episode was automatically generated in the patient’s medical record in Epic if patients indicated that they had at least one of the four social risk factors on the screening tool.

Referral 130

Referral Community Transportation Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: In May 2023, Mayo Clinic implemented a revised screening tool to assess social determinants of health (SDOH) for its patients. Objective: To assess the impact of a question on need for assistance with social risk factors identified through routine screening. Study Design and Analysis: Descriptive analysis of secondary data.

Primary Care 130

Primary Care Referral Routine Screenings Patients 130

Annals of Family Medicine

NOVEMBER 20, 2024

Instrument: The discussion guide included questions on 1) identifying shared social care priorities across the three groups, and 2) describing best practices, facilitators, and barriers around screening and referral for social needs learned from existing and past collaborative models.

Community 130

Community Diabetes Referral Screening 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context Social determinants of health (SDOH) such as access to care and economic stability negatively impact colorectal cancer (CRC) screening rates. Results Among 159,491 adults age 50-75 eligible for CRC screening/surveillance, younger, male, non-white patients were less likely to be up to date on CRC testing.

Screening 130

Screening Primary Care Relationship Transportation 130

Center for Family Medicine (CFM)

SEPTEMBER 1, 2024

At Center for Family Medicine , we offer free pregnancy screenings. At Center for Family Medicine, we noticed that often pregnant women face several barriers when it comes to getting prenatal care. For example, some women don’t have insurance, and some women don’t have access to transportation.

Family Medicine 52

Family Medicine DO IT Transportation 52

Annals of Family Medicine

NOVEMBER 20, 2024

family medicine, general internal medicine, endocrinology) affiliated with an academic medical center serving a diverse population in a mid-western metropolitan area. Setting: Ambulatory clinics (e.g.,

Primary Care 130

Primary Care Diabetes Management Provider 130

Annals of Family Medicine

NOVEMBER 20, 2024

family medicine, general internal medicine, endocrinology) at an urban academic medical center in the Midwest. Population Studied: Adults (≥18 years) who receive care at an affiliated clinic, screen positive for food insecurity, have a T2D diagnosis, and an A1c level > 7.5%. Setting: Ambulatory clinics (e.g.,

Diabetes 130

Diabetes Clinic Transportation Internal Medicine 130