Using Social Determinants of Health in Patient-Centered Care

June 15, 2017 - The social determinants of health (SDOH) are becoming increasingly relevant in the healthcare space. As the healthcare industry continues toward patient-centered care, experts are exploring patient health outside of the hospital’s four walls.

“Social determinants of health are ‘the structural determinants and conditions in which people are born, grow, live, work and age,’” according to a report from the Kaiser Family Foundation. “They include factors like socioeconomic status, education, the physical environment, employment, and social support networks, as well as access to health care.”

Essentially, the social determinants of health are all of the external factors that affect health outside of the doctor’s office. These factors are critical to understanding patient health and care considering that nearly all of a patient’s life is lived outside of the clinic’s four walls.

Research indicates the SDOH has a profound effect on health outcomes. Patients who live in polluted environments may face exacerbated respiratory issues, or patients in rural areas might have limited healthcare access. Negative impacts from SDOH contributed to nearly one-third of patient deaths in 2011, researchers have found.

Understanding certain social factors will help providers better target their patient outreach and engagement efforts. From identifying patients who need more community support to overcoming obstacles keeping patients from receiving the care they need, a comprehension of the social determinants of health will help providers deliver better person-centered healthcare.

READ MORE: What Providers Should Know to Improve Patient Access to Healthcare

Using social determinants data for patient outreach

Healthcare professionals can use the SDOH to determine which patients need stronger provider outreach. Understanding a patient’s socioeconomic status, for example, may inform a provider of certain social services that can help the patient better understand her health risks.

Building a relationship with a community center may help a provider understand a life circumstance that has set back a patient, or discouraged her from interacting with her healthcare providers and other caregivers. Knowing that a patient works her job at nights could open doors to understanding her appointment scheduling issues.

However, providers need adequate data to effectively deliver this patient outreach. These data points will likely come from multiple sources, according to Heritage Medical Systems President and CEO Mark Wagar.

“We learned early to gather as much information as we can, not just from when the patient presents, but information from insurance companies, from databanks, and, if the patient will permit you, family and other community members,” Wagar said in a past interview with PatientEngagementHIT.com. “You need as much of that information as possible.”

From there, providers can paint a portrait of the patient and better interact with her and her community support systems.

“You need to get this completely round view of their entire life circumstances, not just their physical health condition aspects, and then figure out what the best way to communicate with that person is,” Wagar explained.

Health technology can help support these data collection endeavors. EHRs are potential data stores for SDOH data, and the patient portal and other patient-facing tools can help collect some of this information from the patient.

A 2015 policy brief from the American Academy of Nursing asserted that EHRs are integral to leveraging social determinant information.

“Clinical care currently accounts for only 20 percent of health outcomes,” the issue brief noted. “To improve care and population health outcomes, healthcare providers must address other factors, including social determinants of health. To do this, we must first focus on addressing the variability in capturing and documenting social determinants in order to use this health data to benefit patients.”

SDOH and health equity, healthcare access

The SDOH are also directly tied to health equity. Certain social factors have an influence over a patient’s ability to access her healthcare or meaningfully engage with the industry. Accounting for and eventually overcoming SDOH barriers will be critical to enhancing care for all patients.

“Addressing social determinants of health is a primary approach to achieving health equity. Health equity is ‘when everyone has the opportunity to 'attain their full health potential' and no one is 'disadvantaged from achieving this potential because of their social position or other socially determined circumstance,’” says the CDC on its website.

“Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities,” the CDC wrote.

Patients with mental illness or behavioral health issues, for example, might face stigma and eventually opt out of receiving treatment.

Separate research suggests that non-English-speaking, minority, or low-income patients also face perceived stigma that bars them from actively participating in their health. One study showed that 40 percent of low-income patients feel disrespected after a care encounter and walk away less likely to access treatment again.

Social factors, such as living environment and geography, may hinder health equity. Patients living in rural areas may have limited access to any type of healthcare provider, facing prohibitive travel times or other convenience-related barriers.

While telehealth has emerged as one solution to that determinant, the industry has also encountered issues with the technology. Where broadband and internet access are difficult to find, rural patients are often left without telehealth access.

AMIA recently urged the FCC to categorize broadband access as an SDOH and to implement policies to protect broadband access in these areas.

“AMIA believes that access to broadband is, or soon will be recognized as, a social determinant of health,” said AMIA President and CEO Douglas B. Fridsma, MD, PhD, FACP, FACMI.

“Race, ethnic, and age disparities in patient portal use and readiness and preferences for using digital communication for health-related purposes have shown to be significant, and this, in turn, reduces their ability to participate in many new and exciting mHealth solutions,” Fridsma continued. “These groups would benefit from an environment that would foster a low-cost broadband option with access that would be open and as ubiquitous as possible.”

As healthcare continues to tip toward value-based and patient-centered healthcare, more information is likely to arise on the social determinants of health and how to use them to improve patient care.

Clinicians treating a patient will rely on social factors and an understanding of the patient’s life outside of the doctor’s office. Using that information, healthcare professionals can both target outreach efforts and close care access gaps.