CCTs to Address Social Needs in a Primary Care Clinic
Condition: Health-Related Behavior
Study type: Interventional

Summary: 
      This is a study of conditional cash transfers (CCTs) to address social needs impacting the
      health of low-income patients in West Philadelphia who screen positive for financial strain,
      transportation needs, or food insecurity. Participants will be randomized to receive a CCT at
      enrollment. All participants will be interviewed at time of enrollment and again in 6 months
      to investigate if a CCT affected objective health outcomes, individual health goals, and
      self-rated perceptions of health.
    

Detailed description: 
      This is a randomized trial of the effect of conditional cash transfers (CCTs) on West
      Philadelphia residents who are patients at two Division of General Internal Medicine primary
      care clinics located at 3701 Market Street. Currently, our practice administers social
      determinants of health (SDOH) screening questionnaires which are available to review as part
      of a patients electronic medical record. Eligible patients will have been flagged as having
      at least 1 of 3 social needs: financial resource strain, transportation needs, and food
      insecurity. From this pool, patients with Medicare and Medicaid insurance who live in low
      income neighborhoods in Philadelphia will be recruited. Eligible participants will be older
      than 18 years old with at least 1 chronic medical condition including obesity, diabetes,
      hypertension, chronic kidney disease, coronary artery disease, chronic lung disease, active
      smoker, and stroke. Eligible patients will be randomized to either the CCT arm or control.
      Verbal consent will be obtained from all participants allowing the study team to collect
      personal health information and conduct audio-recorded semi-structured patient interviews.
      Personal health information will include demographics, chronic medical conditions, weight,
      blood pressure, cigarettes per day, and last hemoglobin A1c. Utilization outcomes such as ED
      visits, hospital admissions, and primary care office visits using Epic will be recorded. This
      data will be collected in REDCap at the time of enrollment and at the end of the 6-month
      study period. Patient interviews will be conducted by a research assistant. The participants
      will have the option of conducting the interviews in-person using a private room within the
      primary care clinic or virtually using a secure telehealth platform. Translation services
      will be provided, if needed. The patient will first complete the Short Form-12 (SF-12)
      survey, a validated multidimensional generic measure of health-related quality of life. For
      interviews conducted in-person, a paper version of the SF-12 will be given to the patients
      and collected at the end of the interview. For interviews conducted virtually, the
      interviewer will orally present the SF-12 survey to the participant and record the answers in
      a paper format. The interviewer will then conduct an audio-recorded semi-structured
      enrollment interview exploring patient perceptions about the social need flagged in the SDOH
      screening questionnaire, how it impacts health, and asked to set a personal health goal to
      achieve over the next 6 months. Participants who were randomized to receive the CCT will be
      asked to use it towards the SDOH risk factor flagged by the social needs assessment. If the
      patient chooses to spend money on something not related to identified social need, there will
      be no punitive financial repercussions or payback required. The CCT will be given in the form
      of a pre-loaded electronic debit card like the Clincard. The study team will not review
      expenses of participants during or after the study is complete. Six months after the initial
      interview, all participants will again complete the SF-12 survey and the research assistant
      will conduct audio-recorded semi-structured exit interviews either in-person or virtually.
      These interviews will explore whether the patients achieved their health goal. Participants
      who received the CCT will be asked additional questions exploring whether the CCT helped
      achieve that goal. At the end of each interview, audio tapes will be sent for external
      transcription by a HIPAA compliant transcription service and then analyzed with the help of
      the research assistant working with the study team.
    

Intervention name(s): Conditional Cash Transfer; Semi-structured interviews
Intervention type(s): Other; Other
Intervention description(s): CCTs will be given to participants in the form of a pre-loaded debit card.; Research team will conduct semi-structured interviews exploring how social determinants of health and social needs impact health. Participants will be asked to set a health goal. 6 months after the initial interview, the team will interview the patients again and evaluate whether that health goal was achieved.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research