Unmet Social Needs Study
Cardiovascular Disease, Hypertension, Diabetes Mellitus
About this trial
This is an interventional other trial for Cardiovascular Disease focused on measuring Social Determinants of Health, Veterans, Cardiovascular Diseases
Eligibility Criteria
Inclusion Criteria:
Veterans enrolled in one of three VA medical centers:
- 1) VA Boston Healthcare System
- 2) Corporal Michael J. Crescenz VA Medical Center (Philadelphia)
- 2) Ralph H. Johnson VA Medical Center (Charleston)
- Veterans with, or at risk for, cardiovascular disease (CVD) who had at least 1 PC visit in the prior year
CVD patients are defined as those with International Classification of Disease 10 (ICD10) diagnoses indicating:
- coronary artery disease
- cerebrovascular disease
- peripheral artery disease
- Patients at-risk for CVD are defined as having diagnoses of hypertension, diabetes mellitus (DM), or hyperlipidemia
Exclusion Criteria:
- Impaired decision-making
- Illiterate or have limited or no English proficiency
Sites / Locations
- VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Ralph H. Johnson VA Medical Center, Charleston, SC
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
Screening
Awareness
Assistance
Participants in this arm will be screened for unmet social needs and receive a post card that includes a list of generic VA crisis and homeless hotlines.
Participants in this arm will be screened for unmet social needs, receive a post card that includes a list of generic VA crisis and homeless hotlines, and receive a Resource Sheet tailored to the unmet needs identified in the unmet need screen. The Resource Sheet will include the names of available resources within the VA and/or local community that can help to address the identified need(s) and contact information and hours of operation.
Participants in this arm will be screened for unmet social needs, receive a post card that includes a list of generic VA crisis and homeless hotlines, receive a tailored Resource Sheet, and be offered assistance from a Social Worker. If accepted, the SW will contact the participant and work with them over a period of 8 weeks to help facilitate their connection to resources than can help to address the unmet need(s) identified in the unmet need screen.