Healthcare professionals seek a standardized universal method for collecting and using social determinants of health (SDOH) data, according to new research.1

“Social determinants of health contribute to 50% of health outcomes,” says Sophia Kostelanetz, MD, MPH, lead study author and assistant clinical professor at Vanderbilt University School of Medicine. “Although the relative impact of one social determinant of health over another remains unclear, their relationship with a patient’s overall health is indisputable.”

The issue is that SDOH data collection is inconsistent in clinical practice. “This study demonstrates that healthcare professionals seek a standardized universal strategy for collecting, leveraging, and disseminating social determinants of health data,” she says.

Kostelanetz and colleagues determined healthcare professionals across all disciplines reported important barriers to screening for SDOH, including:

  • Lack of resources to address social needs;
  • Lack of time to ask about SDOH;
  • Lack of support staff to ask about social needs;
  • Lack of training to respond to social needs once identified.

“Qualitative interviews supported survey findings and described barriers, including lack of time, resources, standardized approaches, and professional burnout,” Kostelanetz explains. “On a systems level, the lack of a standardized universal approach would certainly require institutional leadership and funding for implementation, although these themes were not explored in this study.”

Kostelanetz and colleagues found nearly all survey respondents identified social workers as the most appropriate people to screen for social needs, and that information about patient’s social needs could be used to improve patient care and communication with patients. Survey respondents also agreed patients’ SDOH information could be used to improve trust, and screening for SDOH should be a standard part of care.

The researchers also determined health professionals screened more routinely for health behaviors, such as alcohol and drug use, than for SDOH.

“We were surprised that health professionals readily identified the discrepancy between the social determinants of health domains they identified as important, such as health literacy, housing, and financial strain, and those domains that are routinely assessed in their clinical setting,” Kostelanetz says. “Notably, social workers perceived barriers to implementation the least. These findings suggest the greater knowledge of assessing and addressing social determinants of health may play a critical role in facilitating universal screening for social determinants of health.”

Based on the findings, the most important factors to consider when implementing universal SDOH screening include:

  • Providing appropriate health system resources for screening, support services, and referral to institutional resources, community organizations, and public health agencies;
  • Partnering with community organizations to bolster resources;
  • Health professional education to improve provider awareness and use of existing resources;
  • Addressing barriers related to healthcare professionals’ perceived inability to address needs;
  • Leveraging the unique expertise of social workers;
  • Focusing on the SDOH most likely to affect outcomes, such as food insecurity, transportation, and housing;
  • Providing each team member access to SDOH information in a shared electronic health record (EHR) platform.

An EHR-based assessment with documentation and dissemination of social needs could serve as a driver for increasing health professional awareness, Kostelanetz says.

Improving screening and collection of SDOH data requires funding. This may be improving.

“Notably, the changing landscape of payment models may provide incentive for these needed systems changes,” Kostelanetz explains. “In the fee-for-service environment, limited resources existed to provide compensation for assessing and addressing social determinants of health.”

But as payment models increasingly shift to value-based systems of accountable care organizations and bundled payments that target outcomes improvements, health systems will have greater incentive to address patients’ social needs and allocate resources to improve outcomes.

“New legislation and national coalitions have formed with increasing attention to advancing the funding and policy agenda as well as electronic health record functionality for social determinants of health assessment, and coding with Z-codes and data interoperability,” Kostelanetz adds.

REFERENCE

  1. Kostelanetz S, Pettapiece-Phillips M, Weems JA, et al. Health care professionals’ perspectives on universal screening of social determinants of health: A mixed-methods study. Popul Health Manag 2021;Oct 25. doi: 10.1089/pop.2021.0176. [Online ahead of print].