The realization that clinical care alone may not be enough to influence health outcomes has led to an increasing need to understand the impact of social and economic factor on one’s health. As healthcare organizations continue to implement technologies and strategies to bring targeted, value based care to their patients and communities, the demand to access and integrate patient information from non-traditional data sources as risen substantially. Information gleamed from “social determinants of health” may be the under-leveraged tool to improve patient outcomes and reduce healthcare costs.
What are Social Determinants to Health?
Social determinants of health (SDOH) are non-medical factors that affect a person’s health. According to the World Health Organization, SDOHs are conditions in which people are born, grow, live, work and age1. Social determinants are often categorized into the following categories2:
Examples of SDOHs to Improve Care
Data has shown that only 20% of patient outcomes are driven directly by the clinical care and services provided to them, while 80% is determined by environment, social determinants and behavioral factors3. Understanding how to leverage data from the various types of SDOH, can help healthcare providers make informed decisions at the point of care to drive improved outcomes while lowering costs. Here are a few examples:
Economic Stability: Being unemployed or having low income can make it difficult to get proper access to care or maintain the care you need. Knowing a patient is experiencing financial hardship or is uninsured may prompt a physician to find an alternative drug or write a prescription for generic drug rather than a name brand drug. Another example – understanding that a patient works multiple jobs or is unable to afford child care to keep medical appointments, physicians can possibly find alternatives in appointment times or inform the patient of child care services at the hospital/clinic to help alleviate some of these barriers.
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Neighborhood & Physical Environment: The emotional, physical and social stress and associated limitations with unstable or unsafe housing can directly impact care. If a clinician can access a patient’s geographic location data they can better understand a patient’s access to a hospital/clinic, pharmacy, grocery store or public transportation and provide more personalized care based related to these factors – e.g. sending a patient for follow-up care closer to their home or identifying a grocery store accessible via public transportation and possibly, if a patient lives in a rural community, provide access to care via alternative care methods such as telehealth.
Education: Health literacy allows patients to understand their conditions and the treatments that will improve their overall wellbeing, yet only 12 percent of adults are “proficient” in the art of understanding their health, according to the National Assessment of Adult Literacy4. Healthcare professionals who are able to obtain education level data can alter their verbal and written communications to ensure that their patients fully understand their health information – conditions, treatments, insurance, medications etc. They may also be able to provide additional resources or alternative communication options (e.g. interpreter) to help increase their understanding and adherence to care as well as further engaging them to make the right decision for their wellbeing.
Food: 40 million people face hunger in the U.S. today — including more than 12 million children and nearly five million seniors5. Inability to afford or have access to nutritious food can lead to increased risk factors and adverse health outcomes. Understanding a patient’s access to safe and healthy food options, can better equip physicians to proactively provide resources to their patients to help mitigate some of these barriers, such as offering information to local community based food banks or programs.
Community & Social Context: Loneliness is one of the biggest and most underreported public health threats and the stress of social isolation can lead to premature cognitive decline and dementia, increased risk of cardiovascular disease, exasperation of depression and anxiety, and premature death4. A strong social support system can provide positive effects on one’s health. Leveraging knowledge on a patient’s social support network can help care teams provide access and resources to support groups, social services, local health fairs, community fitness centers, and the like to promote preventative and improved care options.
Healthcare Systems: Many people face barriers that prevent or limit access to needed health care services – lack of health insurance, poor access to transportation, and limited health care resources – which may increase the risk of poor health outcomes and health disparities6. If patients cannot afford out of pocket costs for care, providers can help patients find alternative, lower cost treatment options (e.g. generic vs brand name drugs). Or, knowing a patient does not have access to transportation can allow care teams to provide information on mobile clinics near their neighborhoods or suggest ridesharing or telehealth options to help keep important medical appointments.
Challenges to Widespread Use
Though SDOH provide undeniable value there are a few key challenges to its widespread implementation and use:
- Technology: SDOH data is information rich, but often times go uncollected or is dispersed among many systems, making it a challenge to integrate, access, analyze and leverage to its full potential. Current clinical systems are simply not equipped to support this type of data or to be integrated into the clinical workflow, making it challenging to effectively utilize SDOH information before care decisions are made.
- Governance and Consensus: Who will collect the data and how will it be made available to providers is a key question. Shared tools that capture descriptions of social factors and the protocols and interventions that address them do not exist, making it difficult to find a common language to develop a shared body of knowledge that can be leveraged across organziations7. Also, what about patient consent – will patients allow healthcare, social and community organizations to tap into their lives with such a fine microscope?
- Communication & Coordination: Stronger partnerships and ongoing communications between healthcare systems, social services and community based resources is key. Understanding each organizations available resources and tracking what happens after each referral and folding that information back into the workflow is imperative to maintain continuity and mitigate the gaps in delivery of care.
Having the right technologies and strategies to allow clinicians seamless access and integration of this data at the point of care and coordinating care across social and community organizations will be critical to unlocking the true value of SDOH and transforming patient care by treating the whole person and not just the condition.
What do you think – can integrating SDOH truly improve patient outcomes?
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