Screening for Social Determinants of Health in Michigan Health Centers

Abstract

Objective: Through an academic-community partnership with a statewide consortium of health centers (HCs) in Michigan, we characterize the current scope of screening for social determinants of health (SDH).Methods: We requested copies of forms used to screen for SDH at the 39 HC organizations in Michigan. Using content analysis, we examined variation in screening domains and processes. We present descriptive analyses of HC characteristics and patient demographics.Results: We received screening documentation from 23 of the 39 HCs (59%), representing 167 delivery sites. We found broad empiric consensus regarding a core set of 13 SDH screening domains that align with nationally recommended screening guidelines. Two additional domains, Culture and Functional Status, were screened for by <40% of HCs. While patient self-report is the most frequent mode of SDH screening (41%), many HCs use staff members to administer the screening documents.Conclusions: HCs across a large and diverse state are screening for SDH and largely agree on core SDH screening domains. Using existing empiric data from frontline providers can inform potential best practices in SDH screening. (J Am Board Fam Med 2017;30:418 -427.)

Part II: A Qualitative Study of Social Risk Screening Acceptability in Patients and Caregivers

“…This growth can be attributed to recent recommendations from medical professional associations and, importantly, new financial incentives from payers and government programs, such as Medicare's Accountable Health Communities. 1−5 Research on these programs to date has demonstrated that they are feasible to implement 6,7 and may help to reduce specific social risk factors and improve health. 8−15 However, relatively little research has explored patient perspectives on these initiatives, which is critical for patient-centered implementation.…”

Variation in Electronic Health Record Documentation of Social Determinants of Health Across a National Network of Community Health Centers

“…22−27 Although studies suggest that systematic EHR-based SDH screening is feasible, there are substantial barriers to adoption, including the need for appropriate training and staffing models, the burden of fitting yet another task into already short primary care visits, and the lack of infrastructure to address identified needs. 28−31 With the exception of a handful of peer-reviewed papers describing the rollout of SDH screening tools across a single state 32 or within a particular healthcare organization, 33 very little is known about how frequently EHR-based SDH screening is taking place or which SDH domains are documented most often. This paper describes patterns of adoption after the rollout of an EHR-based SDH screening tool across a national network of more than 100 primary care CHCs who share a centrally managed instance of Epic EHR.…”

Decision letter for "Socioeconomic position is associated with glycemic control in youth and young adults with type 1 diabetes"

“…As shown in previous feasibility studies, an iterative process which includes a pilot phase before implementing an SDOH program is necessary for ensuring provider compliance, patient satisfaction, and effective EHR integration. 4,10 Piloting the process in paper form and collaborating with Operational and IT leadership helped us to identify and anticipate major barriers in our workflow and develop a more streamlined and automated solution by leveraging the functionality of our EHR. This helped us to avoid spending time and resources on developing and redeveloping the EHR solution.…”

“…[1][2][3] Unmet social needs contribute to poor health, increased risk of chronic diseases, and unnecessary emergency department visits and hospitalizations among patients, particularly among those living in socioeconomically disadvantaged communities in the United States. 4,5 As such, systematically addressing unmet social needs has become increasingly salient in the context of recent health policy reforms that incentivize health care systems to respond to SDOH and improve population health as a strategy for reducing excessive costs. One such policy reform is the introduction of Accountable Care Organizations (ACOs), where health systems are paid a contractually agreed upon amount per patient for all health care needs, incentivizing efficient and effective care to maintain patients' health.…”