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Accountable Care Delivery Congress Spring 2018

Dr Rachel Gold Outlines the Challenges of Screening for Social Determinants of Health Issues

With little evidence, it is still difficult to know how to screen patients for social determinants of health issues, explained Rachel Gold, PhD, MPH, investigator at the Kaiser Permanente Northwest Center for Health Research and lead research scientist at OCHIN.


With little evidence, it is still difficult to know how to screen patients for social determinants of health issues, explained Rachel Gold, PhD, MPH, investigator at the Kaiser Permanente Northwest Center for Health Research and lead research scientist at OCHIN.

Transcription: 

What are the challenges of figuring out which patients to screen for social determinants of health issues and how to screen them? 

The biggest challenge is that there’s no evidence right now and no one has studied or effectively proven which social determinants are the most important to screen for which patients to affect which outcomes. We know that social determinants broadly affect health, mostly its driven by poverty. We can’t necessarily intervene with poverty, so we try to intervene around housing, the way this poverty manifests in more pragmatic ways. How do we intervene with housing, food insecurity, transportation needs, or child care needs? We need to figure out which patients need to be screened. In the community health center setting, when we screen patients for social determinants needs, they all tested positive. 99% of patients reported some kind of a social need, so that’s important to understand. I think, it’s probably useful to screen most patients and to at least get some kind of a baseline established, but we really don’t have very good evidence right now on, again, which patients need to be screened for which social determinant, and because we know that there’s evidence that that’ll lead to some kind of an approved outcome. So, I think the biggest challenge right now is we’re trying to figure out who to screen for what, and we don’t have evidence to support that decision-making.  

There’s a lot of interest in looking at community level social determinants, and how those have effect on health. That’s the same idea. Could we use some information about a patient’s community to identify which patients should have the screening for their personal needs, or not? That might work, but, again, there hasn’t been enough patient-reported social needs documented in data sets that we can work with to do the analyses to figure out what’s effective. So, that’s probably why my interest has been on, first, figuring out how we can document this data and start collecting this data on patients. We’re not sure if it is more effective to screen for housing, food, or whatever for which patients, and we’re casting a broad net right now. But, I’m really hoping we’re going to be able to, as a scientific community and a public health community, narrow down onto the factors that are most important.  

There’s another part of this question, which is, what are you going to do with the data? What do you need it for? Is it that you want to make a referral to a community resource? Is it that you want to just know what’s going on, so that your care plan can be changed? Is it that you want to be collecting data for a policy reason? If you’re the medical director of a community clinic, you can then go to your legislators and say, “hey, half of our patients are coming in with food insecurity, but there aren’t enough food resources in the community.” It depends on what you want to use the data for. So, there’s a ton of decisions that we need to make that we don’t have evidence yet to base those decisions on, and that’s, I think, the biggest challenge we’re facing now.  

 
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