scholarly journals Universal Screening of Social Determinants of Health at a Large US Academic Medical Center, 2018

2020 ◽  
Vol 110 (S2) ◽  
pp. S219-S221
Author(s):  
Dodi Meyer ◽  
Eva Lerner ◽  
Alex Phillips ◽  
Katarina Zumwalt
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Universal Screening ◽  
Medical Center ◽  
Academic Medical Center ◽  
Social Needs ◽  
Determinants Of Health ◽  
System Level ◽  
Presbyterian Hospital ◽  
Academic Medical

Universal screenings for social determinants of health (SDOH) are feasible at the health system level and enable institutions to identify unmet social needs that would otherwise go undiscovered. NewYork-Presbyterian Hospital implemented SDOH screenings together with clinical screenings in four outpatient primary care sites. Aligning SDOH screening with clinical screening was crucial for establishing provider buy-in and ensuring sustainability of screening for SDOH. Despite some challenges, universal screening for SDOH has allowed NewYork-Presbyterian Hospital to identify unmet needs to improve population health.

Assessing social determinants of health in a safety-net oncology population: Use of an EHR-based screening and referral system.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19072-e19072
Author(s):  
Rebecca N. W. Tsai ◽  
Muhammad M. Qureshi ◽  
Stephanie Losi ◽  
Michael A. Dyer ◽  
Minh Tam Truong ◽  
...  
Keyword(s):  
Head And Neck ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Radiation Oncology ◽  
Medical Center ◽  
Safety Net ◽  
Social Needs ◽  
Determinants Of Health ◽  
Oncology Patients ◽  
Safety Net Hospital

e19072 Background: Routine electronic health record (EHR)-based screening and resource referral to address social determinants of health (SDOH) have been established in adult primary care clinics and the emergency department of New England’s largest safety-net hospital. The burden of SDOH in safety-net oncology patients is less well-studied. This study aimed to understand the social needs of this vulnerable patient population and evaluate the need for implementation of SDOH screening in the oncology clinic. Methods: Patients with lung or head and neck cancer seen in consultation in the Department of Radiation Oncology at Boston Medical Center between 3/2019-1/2020 were identified. EHRs were reviewed for receipt of THRIVE, an EHR-based screening and referral model addressing SDOH. Associations between patient demographics and SDOH screening were evaluated. Results: A total of 104 head and neck (n = 53; 51%) and lung (n = 51; 49%) patients were identified. Median age was 65 years (interquartile range 57.5-72). The majority of patients were male (71.2%), and English-speaking (82%). Whites, Blacks, and Asians comprised 43%, 38%, and 3% of patients, respectively. Fifteen patients were Hispanic (14%). Patients were most likely to have private health insurance (n = 41; 39%), followed by joint Medicare-Medicaid plans including senior and community health plans for elderly (n = 27; 26%), Medicaid (n = 17; 16%), and Medicare (n = 17; 16%). 83 of 104 patients (79.8%) were screened for at least one SDOH domain, with 55 patients (66%) screened before presentation in radiation oncology clinic. Transportation to medical appointments (16%), food insecurity (14%), and inability affording medications (10%) were the most prevalent concerns among these oncology patients. Housing insecurity, utilities, caregiving, unemployment, and education were identified social concerns for 4-5% of patients. The majority of patients who had at least one social need requested resources to assist them (71%). Age, gender, race, language, and insurance status were not associated with receipt of the SDOH screener (p≥0.1). Conclusions: Safety-net oncology patients report significant social needs. Routine SDOH screening and resource referral should be considered in these vulnerable patients.

Abstract P385: Pregnancy Care Must Do More to Meet Women's Social Needs: A Systematic Review of Interventions Addressing the Social Determinants of Health

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Ana Reyes ◽  
Rabih Dahdouh ◽  
Precious Akanyirige ◽  
Araceli Estrada ◽  
Maria R Young ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Needs ◽  
Determinants Of Health ◽  
Cochrane Library ◽  
Risk Screening ◽  
Pregnancy Care ◽  
The Social ◽  
In Pregnancy

Introduction: Consistent evidence has shown that the social determinants of health (SDoH) play an important role in shaping overall health. As health systems become more focused on improving the health of populations, there is an urgent need for interventions that address upstream factors such as the social determinants of health. Such interventions have not been widely studied and even less work exists in the realm of maternal health. But as maternal and infant mortality remain critical issues, there is great opportunity for the study and development of interventions to address social needs in pregnancy care. Hypothesis: We assessed the hypothesis that most existing interventions addressing the social needs of pregnant women would focus only on identifying social risks, while fewer would connect patients with resources in the community. We expected that most studies would not provide evaluations of effectiveness. Methods: We conducted a database search of MEDLINE, Embase, Cochrane Library, CINAHL, Scopus, and Web of Science to capture literature published between January 1970 and April 2019. A team of reviewers screened titles and abstracts for interventions that were issued in a clinical setting and addressed at least one SDoH as defined by the World Health Organization. Results: Preliminary results revealed 25 studies. All consisted of some form of risk screening and four included a referral process. Interventions addressing intimate partner violence were most numerous followed by psychosocial factors and cigarette smoking. Financial needs were assessed in one study. Eight studies included an evaluation process. Staff carrying out the interventions were primarily research staff, nurse practitioners or nurse midwives. Conclusions: In conclusion, more must be done to connect pregnant women with social resources. As unmet social needs put women at higher risk for poor outcomes in pregnancy, action should be taken to more seamlessly integrate social needs interventions into clinical workflows. Focus should expand beyond traditional social risk screening to capture a wider range of needs including financial stability, housing, and transportation. These are particularly important during pregnancy because adequate prenatal care requires women to be more engaged with the health care system than they would to maintain baseline health.

scholarly journals Addressing Social Needs in Health Care Settings: Evidence, Challenges, and Opportunities for Public Health

2020 ◽  
Vol 42 (1) ◽  
Author(s):  
Matthew W. Kreuter ◽  
Tess Thompson ◽  
Amy McQueen ◽  
Rachel Garg
Keyword(s):  
Public Health ◽  
Health Care ◽  
Social Determinants Of Health ◽  
Social Services ◽  
Social Determinants ◽  
Safety Net ◽  
Social Needs ◽  
Determinants Of Health ◽  
Health Improvement ◽  
Health Care Settings

There has been an explosion of interest in addressing social needs in health care settings. Some efforts, such as screening patients for social needs and connecting them to needed social services, are already in widespread practice. These and other major investments from the health care sector hint at the potential for new multisector collaborations to address social determinants of health and individual social needs. This article discusses the rapidly growing body of research describing the links between social needs and health and the impact of social needs interventions on health improvement, utilization, and costs. We also identify gaps in the knowledge base and implementation challenges to be overcome. We conclude that complementary partnerships among the health care, public health, and social services sectors can build on current momentum to strengthen social safety net policies, modernize social services, and reshape resource allocation to address social determinants of health. Expected final online publication date for the Annual Review of Public Health, Volume 42 is April 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Using ICD-10-based Social Determinants of Health Categories to Assess Patients Risk for Acute Care Utilization

2021 ◽  
Author(s):  
Peter H. Nguyen ◽  
James Wang ◽  
Pamela Garcia-Filion ◽  
Deborah Dominick ◽  
Hamed Abbaszadegan ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Services ◽  
Acute Care ◽  
Social Determinants ◽  
Hospital Admissions ◽  
Medical Center ◽  
Determinants Of Health ◽  
Care Utilization ◽  
Icd 10 ◽  
Acute Care Utilization

ABSTRACTObjectiveSocial determinants of health (SDoH) play a pivotal role in health care utilization and adverse health outcomes. However, the optimal method to identify SDoH remains debatable. We ascertained SDoH based on International Classification of Disease 10 (ICD-10) codes in patient electronic health records (EHR) to assess the correlation with acute care utilization, and determine if social services interventions reduced care utilization.MethodsWe analyzed retrospective data for active patients at a Department of Veterans Affairs Medical Center (VAMC) from 2015-2017. Eleven categories of SDoH were developed based on existing literature of the social determinants; the relevant ICD-10 codes were divided among these categories. Emergency Room (ER) visits, hospital admissions, and social work visits were determined for each patient in the cohort.ResultsIn a cohort of 44,401 patients, the presence of ICD-10 codes within the EHR in the 11 SDoH categories was positively correlated with increased acute care utilization. Veterans with at least one SDoH risk factor were 71% (95%CI: 68% - 75%) more likely to use the ED and 71% (95%CI: 65%-77%) more likely to be admitted to the hospital. Utilization decreased with social service interventions.ConclusionThis project demonstrates a potentially meaningful method to capture patient social risk profiles through existing EHR data in the form of ICD-10 codes, which can be used to identify the highest risk patients for intervention with the understanding that not all SDoH codes are uniformly used and some SDoHs may not be captured.

scholarly journals Teaching Family Medicine Residents How to Identify and Address Social Determinants of Health

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Lisa Schoenberger ◽  
Rajaa Mourabet ◽  
Binju Bose ◽  
Qian Gu ◽  
Benita Benjamin ◽  
...  
Keyword(s):  
Family Medicine ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Screening Tool ◽  
Primary Care Providers ◽  
Practical Experience ◽  
Social Needs ◽  
Determinants Of Health ◽  
Care Providers ◽  
Family Medicine Residents

Introduction: This educational program aimed to teach family medicine residents how to address social determinants of health. The literature reviewed suggested that curricula addressing social needs of patients were sporadic and failed to provide residents with practical ways to apply the knowledge. The program objectives were to provide residents with a thorough understanding of social determinants of health and to provide a practical experience where they could address social needs. Methods: The program consisted of four didactic sessions in which the residents discussed why addressing social determinants of health is important, designed a screening tool, and were educated on how to assess and communicate with patients. As a longitudinal experience, the residents used the screening tool in their clinic and connected patients with resources. We performed a mixed-methods data analysis to determine if program goals were met. Results: Survey data showed a statistically significant change in the comfort, understanding, and consistency of addressing social determinants of health. Reflections showed similar results. Residents recognized the importance of being aware of social needs, having conversations with patients about their needs, and considering cost when they implement treatment plans.  Conclusions: Family medicine residents are the future primary care providers for our communities. Therefore, it is important to equip them with the knowledge and ability to address all of the factors affecting their patients’ health. Graduates will be able to apply this knowledge to their future patients, and educators can be assured family physicians have the skills to address social determinants of health.

Organization- and System-Level Factors Influencing Implementation Overview of Case Studies

2018 ◽  
Author(s):  
Stephanie B. Wheeler
Keyword(s):  
Case Studies ◽  
Psychosocial Support ◽  
Medical Center ◽  
Academic Medical Center ◽  
System Level ◽  
Differential Outcomes ◽  
System P ◽  
Academic Medical ◽  
Patient Reported ◽  
Integrated Health Care System

Organization- and health system-level determinants of cancer outcomes are critical to understand. Studies focusing only on individual- or provider-level factors contributing to differential outcomes may mask the important, and often far-reaching, influence of organizational and system-wide structures, policies, norms, and behaviors that drive outcomes. This chapter explores case studies including implementation of patient reported outcomes symptom monitoring within a large academic medical center; cancer patient navigation programs to reduce social, economic, cultural, and system barriers to timely cancer care; how psychosocial support has been integrated into community-based and Veterans Administration (VA) oncology programs; and implementing Lynch syndrome testing within a VA integrated health care system.

scholarly journals Anchor Institutions: Best Practices to Address Social Needs and Social Determinants of Health

2020 ◽  
Vol 110 (3) ◽  
pp. 309-316
Author(s):  
Howard K. Koh ◽  
Amy Bantham ◽  
Alan C. Geller ◽  
Mark A. Rukavina ◽  
Karen M. Emmons ◽  
...  
Keyword(s):  
Best Practices ◽  
Community Health ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Web Sites ◽  
Lessons Learned ◽  
Social Needs ◽  
Determinants Of Health ◽  
Current Status ◽  
Anchor Institutions

“Anchor Institutions”—universities, hospitals, and other large, place-based organizations—invest in their communities as a way of doing business. Anchor “meds” (anchor institutions dedicated to health) that address social needs and social determinants of health have generated considerable community-based activity over the past several decades. Yet to date, virtually no research has analyzed their current status or effect on community health. To assess the current state and potential best practices of anchor meds, we conducted a search of the literature, a review of Web sites and related public documents of all declared anchor meds in the country, and interviews with 14 key informants. We identified potential best practices in adopting, operationalizing, and implementing an anchor mission and using specific social determinants of health strategies, noting early outcomes and lessons learned. Future dedicated research can bring heightened attention to this emerging force for community health.

Call to Action: Addressing Social Determinants of Health in Pharmacy Practice

2021 ◽  
pp. 106002802110408
Author(s):  
Julie Kalabalik-Hoganson ◽  
Ayse Elif Ozdener-Poyraz ◽  
Denise Rizzolo
Keyword(s):  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Health Risks ◽  
Social Determinants ◽  
Pharmacy Practice ◽  
Social Needs ◽  
Determinants Of Health ◽  
Call To Action ◽  
Physician Practices ◽  
The Impact

Social determinants of health (SDOH) are conditions in which individuals are born, live, work, learn, play, and age that affect health, risks, functioning, and outcomes. SDOH are recognized barriers to care, risk factors for certain diseases, and associated with poorer health outcomes. Screening for SDOH in physician practices and hospitals is reportedly low. The accessibility of pharmacists and established relationships with patients make pharmacy settings ideal for identifying and mitigating social needs. An evaluation of the impact of SDOH on health outcomes and opportunities for pharmacists to embed screening into practice is warranted.

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