According to the Centers for Disease Control and Prevention (CDC), social determinants of health (SDOH) are defined as the conditions in which a person lives, learns, works, and plays; essentially, SDOH are the factors of our lives affecting our physical and mental wellbeing.
Doctors have long known that these factors majorly impact an individual’s health literacy, quality-of-life, and outcomes. In fact, one study published in the Public Health Reports states that social and environmental determinants and individual behavior make up about 70% of the risk factors for premature death. This means that while healthcare delivery can be instrumental, the factors influencing a patient before an adverse health event occurs could be the root of a larger problem. Incorporating the consideration of these factors into care plans can help providers improve outcomes, lower rates of chronic disease, and better engage patients in their own health.
The Impacts of Social Determinants
Social determinants of health impact many aspects of a patient’s life outside the hospital. For example, if a patient does not have a grocery store near her, she may not have access to healthy food and may be overweight or even malnourished as a result. If a person lives in a house or building with many smokers, he may exhibit respiratory issues beyond his control. If she cannot access reliable transportation, making it to a doctor’s appointment could be nearly impossible. If a child or parent doesn’t receive quality education about their health, they will have a harder time making healthy choices or reacting to negative health events.
Several studies have shown the impact of social determinants on health and how they can affect a person’s wellbeing in the long run. Recent studies have shown that even a zip code can provide crucial information about a patient’s background and explain variances between populations. Despite this, physicians often have a hard time accessing this information in a way that can meaningfully influence the care they deliver to a specific patient.
Incorporating SDOH Data
Despite the growing evidence of the serious impacts of social determinants on a patient’s health, especially those who may be part of a low-income or otherwise vulnerable population, little movement has been made to effectively integrate this information into care. According to Deloitte, while 88% of hospitals screen for social needs, almost 40% of hospitals report having no capabilities to measure the associated outcome. In order to make the data usable, physicians need a background on the patient before making care decisions, and also need a way to understand their patient’s life outside the hospital to be able to make realistic recommendations to improve health.
Many current systems are ill-designed to support this type of data, but the shift to value-based care is offering new opportunities to integrate information about a patient’s background and lifestyle in a meaningful manner to produce improved outcomes. However, it’s also crucial that this data be incorporated directly into the clinician’s workflow. Studies have shown that poorly integrated EHRs are contributing to staggering amounts of physician burnout; to create programs that physicians will put into use, they need to be well-integrated into existing workflows. New systems and data types now available to health systems — as well as new reimbursement and quality regulations — can offer more of an opening to integrate information about a patient’s home, income, and education in a meaningful way.
For example, the National Association for Community Health Centers (NACHC) has begun a national initiative to “help health centers and other providers collect the data needed to better understand and act on their patients’ social determinants of health.” The Protocol for Responding to and Assessing Patient’s Assets, Risks and Experiences (PRAPARE) is a combination of a screening tool, a patient engagement tool, and a library of resources. Several hospitals and health systems are participating in a pilot of the program that integrates PRAPARE into the EHR to be able to better assess and make decisions within the clinician’s workflow.
Likewise, Cerner is currently developing and implementing a system that integrates SDOH screening into the clinical workflow via the EHR. The goal is to help providers better understand a patient’s background, so that they can also offer a “social care plan” in addition to a traditional care plan, as well as improved recommendations and links to community resources.
Programs which integrate SDOH data directly into a clinician’s workflow in an actionable manner that allow a physician to make decisions based on this information can improve patient care and help to provide usable resources for a patient outside the hospital, which can directly improve outcomes.
Remote patient monitoring programs present a unique opportunity to apply this information in continuous care. By using a patient’s background, location, income, education and other information as contributing factors to their likelihood of developing and managing their chronic diseases, clinicians can better tailor long-term, remote programs for patients in a way that makes care easier and more accessible.
Integrating this data also drives beneficial interactions with the larger community. Through partnerships with community organizations to combat negative social determinants of health, like the lack of food access or quality education, hospitals and health systems can give patients additional resources to positively impact their health. By connecting a patient to a food bank in the area, a free clinic down the street, or even their local library — and providing them with the needed education to take advantage — providers can take more realistic steps to improve a patient’s health in a way that is actually practical in his or her life.
Social Determinants in Overall Health
The impact of using SDOH to make care decisions is not surprising. A recent study showed that areas with a higher ratio of social spending to health spending had improved outcomes in several areas — including lower rates of obesity and asthma, and lower mortality rates from lung cancer and type 2 diabetes, among others. With more agile technology and digital health systems that make integrating additional data points possible and practical, incorporating social determinants of health into everyday care is now becoming a viable option. Moreover, this information can give doctors a better understanding of an individual’s life in an easily digestible manner; it gives clinicians the opportunity to better provide tailored care and community resources. When armed with this information and appropriate health treatment, patients are better able to take this knowledge and improve their health outside the hospital, resulting in better care for high-risk populations and lower costs for health systems.
Social determinants are indicative of a person’s lifestyle, situational barriers, and how their unique experiences affect his or her health directly. By better understanding and incorporating this information into programs of care, providers can directly and dynamically improve health for their patients while lowering costs.