Collecting SDOH
“Within the past 12 months, how often did you worry that your food would run out before you got money to buy more?”
Recently I’ve been part of conversations about asking social determinants of health (SDOH) related questions, like this food insecurity example, to patients as part of a provider visit. Screening surveys would seem the best way to pinpoint social needs in patients that come in for treatment. However, it isn’t an easy task, for many reasons, and even if you could survey every patient- and get accurate answers- a group of patients don’t necessarily provide insight into the entire community being served.
These conversations reminded me of my recent annual primary care visit at one of Boston’s major medical centers. First, I was asked a couple of screening questions by the woman who checked my insurance status. Then I was then asked a couple more questions by the receptionist in my PCP’s office. And when I made it to the medical assistant who checked my weight and vital signs, she handed me a list of questions with verbal instructions to tell her if my answer was yes to any of them and went off to do something. I was in an open area, with another medical assistant sitting next to me working on a computer. The first question was “Have you had thoughts of suicide?” Even if I had, would I be likely to answer candidly in that setting? If I was asked whether I had enough money to buy food, would I answer truthfully?
Sensitivity as to how and when to ask patients such questions is critical. This is true of so many things which are often best addressed in privacy with the provider. However, the provider is often overloaded, so these questions are often delegated to others. What I’ve described from my personal experience, and what I have heard from the experiences of others, will get you answers, but they could be useless.
Beyond the interpersonal issues, what questions do you ask? There are already many required questions for various quality programs. How do you prioritize? There are many SDOH variables and no organization can address them all.
At IHM, we think about the sources of SDOH data in three categories:
We’ve already discussed the option of acquiring data directly from patient surveys.
EHR data can be a good source of SDOH data but the information is often buried in free text notes and not easily accessible for evaluating individual patients or a patient population.
Government data can provide broad insights into SDOH both by census tract linked to patient address and by catchment area. This data is not easy to work with, but IHM has made it accessible and understandable to our member hospitals, including the IHM SDOH Index, a single index derived from multiple SDOH variables to facilitate analytics.
Our premise is that starting with government data at both a patient and a community level enables hospitals to target priority areas and then gather additional information by focused patient surveys. Community data will also inform hospital community needs assessments and prioritize community initiatives.
What are your personal or organizational experiences with social determinants of health data collection? I’d be glad to hear your thoughts and experiences.
Anita Karcz MD MBA
Chief Medical Officer and Co-Founder
References
‘The Health Leads Screening Toolkit’. Health Leads, https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/.
Center for Medicare and Medicaid Innovation. The Accountable Health Communities Health-Related Social Needs Screening Tool. Center for Medicare and Medicaid Innovation, https://innovation.cms.gov/files/worksheets/ahcm-screeningtool.pdf.
‘Homepage’. PRAPARE, https://prapare.org/.