Healthcare quality in patients experiencing health-related social needs in a federally qualified health center network in Brooklyn, New York.

Abstract

To examine associations between patient-reported health-related social needs (HRSNs) and clinical quality measure (CQM) performance in an urban federally qualified health center (FQHC) network. This cross-sectional study included adult patients (≥18 years) screened for HRSNs at a general internal medicine clinic, Clinic-1, and a prenatal healthcare clinic, Clinic-2, within a FQHC network, between January 1, 2018, and July 31, 2022. HRSNs were assessed across 9 domains. Performance was assessed for 13 process and 2 outcome-based CQMs at Clinic-1 and 5 process-based CQMs at Clinic-2. Prevalence ratios (PR) were estimated using logistic regression to compare CQM performance by HRSN status, adjusted for relevant demographic, clinical, and clinician factors. At Clinic-1, reporting a HRSN was associated with lower hemoglobin A1c control (PR, 0.81; 95%CI, 0.69, 0.95). At Clinic-2, reporting a HRSN was associated with higher cervical cancer screening (PR, 1.07; 95%CI, 1.03, 1.11). No other CQMs differed significantly by HRSN status. HRSNs were not associated with differences in performance for most CQMs at this FQHC network. Exceptions were observed negative associations with diabetes A1c control and positive associations with cervical cancer screening. Further research is needed to elucidate mechanisms through which unmet HRSNs impact CQMs across care settings.