Social determinants of health (SDOH) account for 80-90 percent of modifiable contributors to a patient’s health outcome, making the issue critically important for care teams to identify and address. SDOH cover a range of factors such as housing, economic conditions, education, job opportunities, and transportation.
These varying factors can make it difficult for physicians and clinicians to identify SDOH at the point of care—especially if a patient often travels between different care settings. It can also be challenging to track patients and ensure continuity of care if contact information changes frequently due to homelessness or financial instability.
In 2019, Reaction Data polled 61 decision makers at healthcare organizations across the nation. The results, featured in the Social Determinants of Health report, shed light on how SDOH are being addressed throughout the country.
Surveyed participants reported their organization had the following technologies and services in place to support SDOH:
- Care coordination: 20%
- EHR: 18%
- Telehealth: 14%
- Data analytics: 13%
- External transportation services: 12%
- Mobile applications: 9%
- Connected home monitoring: 5%
- AI: 4%
- Wearable technology trackers: 3%
- Other: 2%
Care coordination came out as the top choice for technology supporting SDOH—and for good reason. Patients struggling with social determinants often have complex needs that can’t be met at a single point of care. About half of surveyed primary care physicians, nurse practitioners, and physician assistants reported referring SDOH patients to community resources. In the Reaction Data report, 30 percent of respondents said that their organizations had established community partnerships to support SDOH.
The Better Outcomes [thru] Bridges (BOB) program, launched by Providence Health in 2018, facilitates community-centered care by involving case managers, primary care providers, behavioral health specialists, emergency physicians, and leaders of churches and other community organizations.
This group came together to discuss the needs of individuals that were affected by SDOH and frequenting the emergency department (ED). Solutions for lasting health were identified and care plans for at-risk individuals were then entered into Collective’s platform—enabling effective care coordination when a patient sought emergency care. By focusing on social determinants of health, the BOB program was able to reduce ED utilization by 41 percent.
Addressing SDOH has other benefits too. The Social Determinants of Health report found the following benefits of investing in SDOH:
- Over 30% said health outcomes improved
- Over 25% said the number of treatment plans increased
- Over 15% said detecting patient needs had improved
- 10% said the cost of care decreased
There are few things that can affect a person’s health outcomes the way social determinants do. SDOH impact everything from getting proper nutrition to affording medication. Taking advantage of the available technology can help physicians, case managers, social workers, nurses, health plans, and other care team members get on the same page and help improve outcomes for patients who might otherwise slip through the cracks.
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