Engaging primary care nurses and Veterans to develop and test processes to identify and assist Veterans with unmet social needs

About This Grant

Significance to VA: Identifying and assisting Veterans with unmet social needs, like food insecurity and housing instability, is critical to achieve health equity. Recognizing its importance, the Joint Commission recently listed assessment of patients’ social needs and provision of information about resources and support services as a National Patient Safety Goal (NPSG.16.01.01). Effective efforts to assess and assist Veterans with unmet social needs largely do not exist in many VHA clinics. Only a fraction of Veterans experiencing food and/or housing insecurity are being identified. Additionally, Veterans who are identified and provided with a list of resources still struggle to connect with services. A potential solution could exist with nurses. Nurses comprise the largest healthcare workforce in the VA and could be a major force multiplier in reducing gaps in service and care with respect to identifying and assisting Veterans with unmet needs. The proposed study aligns with the updated VA HSR research priorities by: (1) contributing to efforts to address health disparities through development of an intervention to identify and assist Veterans with unmet social needs, (2) employing engagement science, a HSR foundational learning health systems method, through application of human- centered design, (3) engaging Veterans and frontline primary care staff to facilitate study design and intervention development, and (4) responding to the need for research on nursing workforce and practice, specifically the role of nursing to address social drivers of health to improve health equity. Innovation and Impact The proposed research will use human-centered design to empower frontline primary care staff, including nurses- who have been largely overlooked in research- and Veterans to co-design clinical application of pathways to identify and assist Veterans with unmet social needs. Specific Aims are to: 1. Discover the current state of how Veterans with unmet social needs are identified and assisted in VA primary care settings. 2. Co-design and test an intervention to identify and assist Veterans with unmet social needs. Methodology: Aim 1 will use a combination of methods including direct field observations (n=30) of current clinical care as it related to identifying and assisting Veterans with unmet social needs across three primary care clinics. We will also interview Veterans (n=30) whose clinical care we observe to learn their experiences. We will then survey all primary care staff affiliated with the Houston VA and interview 30 to 45 frontline primary care staff (i.e., RNs, LVNs, and MSAs) to learn what supports and hinders their ability to identify and assist Veterans with unmet social needs. In Aim 2, a design team of Veterans (n=6) and primary care staff (n=10-15) will co-design an intervention to identify and assist Veterans with unmet social needs. The co-designed intervention will include education and workflow processes. We will then pilot the intervention at two primary care clinics sequentially to allow for rapid refinement using feedback from focus groups (n=2 per site) with primary care staff/providers and interviews with Veterans (n=15 per site). Path to Translation/Implementation: Products from this research will be shared with the VHA Offices of Health Equity, Nursing Services, and Food Security. Post pilot, the intervention will continue process improvements with operational partners via quality improvement / quality assessment projects. Simultaneously, the research team will prepare for a larger pragmatic trial to evaluate the intervention for effectiveness in identifying and assisting Veterans with unmet social needs in effort to ultimately reduce health inequities.