title: Addressing basic resource needs to improve primary care quality: a community collaboration programme.
abstract: BACKGROUND
  Unmet basic resource needs, such as difficulty affording healthcare, medications, food and housing, may contribute to worse healthcare quality indicators, but interventions are hampered by lack of specific knowledge regarding the distribution of unmet basic resource needs and their association with priority clinical conditions and health service use patterns.
  
  
  METHODS
  Cross-sectional study of primary care patients in two urban academic practices from 1 October 2013 to 30 April 2014. Patients were screened for unmet needs and enrolled in a programme to link them with community resources. Key measures included patient report of unmet basic resource needs, clinical conditions prioritised by quality improvement programmes (hypertension, diabetes and depression), and health service use patterns such as frequent emergency department (ED) visits (>2 in the preceding year) and frequent clinic 'no-shows' (>1 in the preceding year).
  
  
  RESULTS
  416 patients with unmet needs were included, and compared with 2750 patients who did not report needs. The most common types of needs reported were: difficulties affording healthcare (46.5%), food (40.1%) and utilities (36.3%). Patients who reported unmet needs were more likely to have depression (17.8% vs 9.5%, p<0.0001), diabetes (32.7% vs 20.4%, p<0.0001), hypertension (54.3% vs 46.3%, p=0.002), be frequent ED users (11.3% vs 5.4%, p<0.0001), and have frequent 'no-shows' to clinic (21.6% vs 11.9%, p<0.0001).
  
  
  CONCLUSIONS
  Difficulty affording healthcare and food are particularly common needs among patients with priority conditions. Strategies to identify and address unmet needs as part of routine care may be an important way to improve healthcare quality.
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Seth A
authors.identifier: http://orcid.org/0000-0003-1030-4297
authors.initials: SA
authors.lastname: Berkowitz
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: A Catherine
authors.initials: AC
authors.lastname: Hulberg
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Clemens
authors.initials: C
authors.lastname: Hong
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Stowell
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Tirozzi
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Carine Y
authors.initials: CY
authors.lastname: Traore
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006295:Health Resources; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement; D011787:Quality of Health Care; D014505:Urban Population
keywords: Chronic disease management; Healthcare quality improvement; Patient-centred care