Completing the Patient Story with Social Determinants of Health
Imagine you are a patient at Houston Methodist. You arrive at the hospital and the care team immediately begins to assess your condition. They take your vitals and ask you questions about your and your family’s health histories. Although securing these details are critical to helping you heal, the care team may miss other factors that could complete your health story.
These often-missing pieces are socioeconomic and demographic factors commonly referred to as social determinants of health. According to the World Health Organization, social determinants of health, such as education, unemployment, housing, income, safety, transportation, environment, food insecurity and access to affordable health services can “shape the conditions of daily life.”
At HM, we’re working to better recognize social determinants of health to improve our patients’ health. For example: a history of food insecurities could contribute to malnutrition and diabetes; a lack of reliable transportation may impede a patient’s ability to attend follow-up appointments; or lower levels of education may necessitate additional efforts to explain at-home medication instructions. Poverty can impact people’s decisions to seek timely medical care, because they can’t afford it, which is a major cause of health inequity.
A Call to Action: Getting the Complete Story
Until recently, health care institutions like HM were not capturing social determinants of health data, so a critical part of the patient story was left unwritten. That changed this past year when the Centers for Medicare & Medicaid Services (CMS) issued the CMS Framework for Health Equity 2022-2032, which set requirements for health organizations to improve the collection and reporting of social determinants of health patient data, adopt policies to address inequities and improve access to health care. (For more on patient access, read this article with Tesha Montgomery, the senior vice president for system patient access.)
“We know social determinants of health play an important role in helping to ensure the well-being of our patients, and we’re committed to finding new tools to bring greater awareness of how they impact every patient’s overall health outcome,” said Lisa Stephenson, MSN, chief nursing informatics officer.
Rewriting the Story with Epic
In response, HM leaders announced that access to health care is a top priority for our organization. We have added tools and screening questions to Epic, which promote social determinants of health awareness. You may see these as part of MyChart’s eCheck-in process before an appointment. When you check-in for an appointment, you will be asked questions that focus on food scarcity and transportation. These questions are part of Epic’s social determinants of health section, an upfront identifier that helps our clinicians recognize when non-health risk factors are present. When the social determinants of health risk factor is high, Epic suggests community referral resources that clinicians can share with patients.
The social determinants of health section covers 12 domains, including alcohol use, depression, food insecurity, living situation, personal safety, utilities, physical activity, medication affordability, stress, social connections, tobacco use and transportation needs.
“Using social determinants of health to identify patients at risk for negative outcomes is part of a larger effort to help patients connect with needed services at Houston Methodist and in our broader community,” said Ryane Jackson, HM vice president of community benefits. “It’s an essential part of how we continue to keep the patient at the center of everything we do.”
The Next Chapter of Social Determinants of Health
Keeping the patient at the center of everything includes a responsibility to promote health care access in all our communities. This is intrinsic to our I CARE values. Groups like our Office of DEI and Community Benefits as well as operational partners like the Health Equity Steering Committee are working to build employee awareness and improve outreach in underserved communities.
“Health equity and DEI go hand in hand. As we raise the level of consciousness surrounding diversity, equity and inclusion, we can reduce obstacles to health equity, including systemic injustices and the lack of opportunity confronting all demographics, including specific genders, ages, races and cultural backgrounds,” said Arianne Dowdell, HM vice president and chief diversity, equity and inclusion officer.
Beyond identifying socioeconomic concerns, HM teams are developing systems to gather the required Centers for Medicare & Medicaid Services (CMS) data and analyze it to identify equity gaps that may be included on each hospital’s performance dashboard. These are scheduled to launch in June 2023.
With more emphasis on social determinants of health, we are taking steps to ensure the well-being of our patients and the greater Houston community. We are looking at every factor that impacts health to complete the patient’s story, so we can treat the whole patient.
