Assessing broadband access, quality, and use of the federal internet subsidies to support access in a safety–net setting

Background: Adverse social conditions are stigmatizing and, when addressed in clinical settings, could compromise healthcare experiences.Objective: Test the non-inferiority hypothesis that CommunityRx, a low-intensity, high-scale, universallydelivered social care assistance intervention, does not compromise healthcare experiences.Methods: Two RCTs randomized participants to usual care or usual care plus CommunityRx: (1) CommunityRx-Hunger enrolled parents (N = 640) of hospitalized children from an urban children's hospital (11/2020-6/22) and (2) CommunityRx-Dementia enrolled dementia caregivers (N = 343) from an urban academic medical center (12/20-2/2024).Beginning during discharge for CommunityRx-Hunger and following an ambulatory appointment for CommunityRx-Dementia, the intervention included education about social conditions, personalized information about local resources and ongoing navigator support.Healthcare experiences, assessed 1 week post-intervention initation, included: (1) Discrimination in Medical Settings Scale (range 7-35, higher scores = more discrimination) and ( 2) satisfaction with care (CommunityRx-Hunger: Child HCAHPS, CommunityRx-Dementia: General Satisfaction domain of the Patient Satisfaction Questionnaire) (range 0-100, higher scores = higher satisfaction).The a priori noninferiority margins (control minus intervention) were: CommunityRx-Hunger, -0.9 (discrimination) and 1.6 (satisfaction) and CommunityRx-Dementia: -1.0 (discrimination) and 7.6 (satisfaction).Results: Most participants identified as female (CommunityRx-Hunger: 94%; CommunityRx-Dementia: 78%) and Black (CommunityRx-Hunger: 79%; CommunityRx-Dementia: 81%).Most CommunityRx-Hunger participants had household incomes <$50 k/year (79%) (versus 36% of CommunityRx-Dementia participants).For both groups, discrimination experiences among intervention partcipants were noninferior to controls (CommunityRx-Hunger: control mean 10.3, SD 4.7; intervention 10.0, SD 4.6; difference = 0.2, 90% CI -0.5, 0.9; CommunityRx-Dementia: control 9.3, SD 3.4; intervention 9.2, SD 3.5; difference 0.1, 95% CI: -0.7, 0.9).Among CommunityRx-Hunger participants, evidence was insufficient to support noninferiority for satisfaction with discharge (difference = 2.3, 90% CI -1.2, 5.8).Among CommunityRx-Dementia participants, satisfaction with care was noninferior between groups (control 69.6, SD 21.8; intervention 71.4,SD 19.3; difference -1.9, 95% CI: -6.4,2.7).Conclusions: Findings suggest a low intensity, high scale social care intervention does not have negative impacts on care experiences.