The U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality has awarded a nearly $2 million grant to the Virginia Commonwealth University School of Medicine Department of Family Medicine and Population Health to test a model of care that aims to better connect primary care clinicians with community resources and health system services.

People who struggle with multiple chronic conditions often also have unmet social needs, unhealthy behaviors and other mental health challenges, said Alex Krist, M.D., a professor of family medicine in the School of Medicine who will lead the research funded by the grant.

Krist, who is the co-director of community-engaged research at the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research, will lead a research team that includes VCU investigators along with community partners and colleagues at the University of Colorado and University of Texas Health Science Center. The research was informed by a pilot grant awarded to Krist by the Wright Center, through which he and colleagues tested a social needs screening tool that will be used for the study.