# Comparing Implementation Strategies for Social Needs Programs:  A Natural Study of Two Pragmatic Trials

> **NIH AHRQ R18** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2022 · $379,470

## Abstract

Project Abstract
Despite increased recognition that patients’ social needs shape health trajectories and
growing evidence that identifying and addressing these needs can impact health
outcomes, little is known about how best to incorporate social needs screening and
community referral programs into the practice of care delivery. A strong body of research
in this area is needed to inform quality measure development, payment and incentive
models, and other emerging policy initiatives that promote medical and social care
integration as one part of a comprehensive strategy for improving health and decreasing
health inequities. The necessary implementation research to inform these efforts is
particularly challenging since comparative research in this field requires real world
delivery settings that are investing in integrated care and where it is feasible to trial
different strategies. The proposed study provides a unique opportunity to conduct
comparative research by taking advantage of two existing, funded programs in
community health centers serving low-income populations, which are most likely to
benefit from the implementation of social screening and intervention programs. The two
programs being leveraged for this comparative trial are the Oregon demonstration of the
Center for Medicare and Medicaid Innovation’s Accountable Health Communities (AHC)
and OCHIN’s Approaches to CHC Implementation of SDH Data Collection and Action
(ASCEND) trial. The concurrent and overlapping initiatives provide an opportunity to
conduct the first comparative study on social needs screening and intervention program
implementation in this field. The four group natural study design proposed for the
combined trial enables us to compare the relative effectiveness of ASCEND’s rich
implementation supports with the Oregon AHC site’s financial incentives, as well as to
compare each individual implementation strategy with the programs’ combined effects
and with non-intervention controls. The five-year, mixed methods proposal includes
quantitative evaluation of the extent of screening and referrals during both active
implementation and an 18 month maintenance phase, as well as a comparison of the
program costs for each study arm. The study also involves qualitative data collection that
will complement the quantitative analyses in order to help us understand contextual
factors influencing the adoption, implementation, and maintenance of social programs
and the impacts of these programs on staff, clinicians, and clinic workflow.

## Key facts

- **NIH application ID:** 10380643
- **Project number:** 5R18HS026435-04
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Laura Gottlieb
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $379,470
- **Award type:** 5
- **Project period:** 2019-07-01 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10380643

## Citation

> US National Institutes of Health, RePORTER application 10380643, Comparing Implementation Strategies for Social Needs Programs:  A Natural Study of Two Pragmatic Trials (5R18HS026435-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10380643. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*