- Most health centers serving safety net patients measure the social determinants of health in a similar way, making the process uniform and conducive to wide-spread intervention, according to a study published in the Journal of the American Board of Family Medicine.
The social determinants of health – factors such as where patients are born, work, live, and play that affect health outcomes – are becoming more prominent within the healthcare industry. The social determinants of health can point to certain health disparities within a population, specifically in health centers and federally qualified health centers (FQHCs), the researchers said.
Uncovering the social determinants of health and addressing them is critical for improving the health of populations because these factors affect patient health and the possibility of developing a chronic condition later in life.
Addressing social needs begins with an effective strategy to assess those needs. Healthcare professionals must determine which social factors are driving widespread health disparities to intervene. Thus, conducting a social determinants of health assessment is key to improving patient and population health.
Little is currently known about how health centers and FQHCs conduct these assessments. There is room for significant variation, including the common social determinants a health center checks for, or how they collect social data from patients.
The research team looked at health centers and FQHCs across Michigan to observe commonalities in social determinant screening through a partnership between the University of Michigan and the Michigan Primary Care Association.
The researchers investigated the screening processes at a total of 23 health centers with 167 delivery sites. This accounted for 59 percent of the Michigan consortium.
Health centers generally look at a core set of 13 common social determinants of health, with a limited level of variation. Determinants such as demographics, employment status, family and living arrangements, and mental health appeared in 100 percent of the social determinant assessments.
Forty percent of health centers also included questions about culture and functional status.
“HCs across the state are routinely implementing SDH screening into clinical care across many domains, and that there is broad de facto consensus regarding core domains, despite regional differences in the populations served and the services available,” the researchers reported. “Further, the 15 core domains we empirically identified are largely aligned with recommended screening guidelines established by multiple national and expert bodies”
Nearly three-quarters of respondents reported that they do not screen for smoking or drug and alcohol use in their social determinants assessments, a peculiar find, the researchers said. The medical community has widely accepted that these substances can be key indicators of patient health. Not screening for them could allow certain information fall through the cracks.
The team posited that health centers may screen for substance use habits in another portion of the patient care encounter.
There were some inconsistencies with screening method, the researchers found. Patient-self reporting for social determinant assessments was the most common method, with 41 percent of health centers leveraging that strategy. Another popular method was using clinic staff members to administer the screening. The researchers did not make judgment on which screening method was better or more efficient.
These variations, although limited, point to further research, the team said. Future investigators should examine whether these administrative differences yield differences in results. Additionally, future studies may investigate whether testing variations are tied to regional resources or social needs.
Further study is also required to understand how the social determinants of health affect patient wellness, the team said.
“Evidence is still needed to assess the association of screening for [social determinants of health (SDH)] with patient health outcomes and quality of life,” the researchers noted. “Yet, as SDH increasingly move under the umbrella of health and health care, it will be important to ensure screening practices are methodologically sound and evidence-based.”
Despite the limited variation between testing strategies, the many commonalities between different health center assessments were good news, the researchers asserted. Using a standard social health assessment enables health centers to better address these issues across multiple communities.
“Both in Michigan and nationally, consistent measures are greatly needed to monitor SDH across a national population of differing communities, values, and resources,” the researchers said. “Selecting these measures will be critically important to ensure proper monitoring of and feedback on how HCs and other providers identify needs and take necessary action steps to improve health.”
Healthcare policymakers should continue to advocate for core social determinants of health assessments, without which many health centers would not be able to target their patient interventions.
“Without consistent measures across communities, the ability to monitor the influence of SDH on health outcomes, health care utilization, and costs will be limited,” the researchers concluded. “In addition, uniform core measures allow for increasing leverage of SDH data in the current landscape of changing payment reforms.”