{"id":309,"date":"2017-09-07T00:00:00","date_gmt":"2017-09-07T00:00:00","guid":{"rendered":"https:\/\/eccovia.com\/index.php\/2017\/09\/07\/digesting-the-social-determinants-of-health-one-bite-at-a-time\/"},"modified":"2024-03-14T19:37:32","modified_gmt":"2024-03-14T19:37:32","slug":"digesting-the-social-determinants-of-health-one-bite-at-a-time","status":"publish","type":"post","link":"https:\/\/eccovia.com\/blog\/digesting-the-social-determinants-of-health-one-bite-at-a-time\/","title":{"rendered":"Digesting the Social Determinants of Health One Bite at a Time"},"content":{"rendered":"
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The healthcare landscape is rapidly changing. One key topic that is consistently at the forefront of this transition is how communities can advance population-wide health improvement efforts. Population health, however, is not always well defined and can mean different things to different people. This is particularly true for community population health. The goal of this discussion is to break down community population health into digestible pieces by looking at the role social determinants of health play in high-risk patients in the community<\/a>, identifying these high-risk individuals, and defining innovative models that improve access to care.<\/p>\n

The Social Determinants of Health<\/h3>\n

While the drive for higher quality care and lower overall costs has been ongoing for many years, the impact of social determinants has not been seriously considered until recently. The focus on high-need patients has highlighted the impact of these social factors on care, and what can be done to mitigate their negative effects. As you have worked with high-need patients, it is likely you have encountered some, if not all, of the social determinants we will address.<\/p>\n

The Department of Health and Human Services defines social determinants as social, economic, and physical conditions of an individual\u2019s life and the surrounding environment, such as income, house, and nutritional factors, that impact the health outcomes of individuals. Essentially, they are the factors that influence our health outside the walls of the hospital. Common social determinants include housing, social services, geographical location, and education. If patients have better health and support in these areas, they are less likely to require the medical services provided by doctors and other care providers.<\/p>\n

Due to the considerable number of social determinants, it will be helpful if we understand the broader classifications used to define them. The four primary social determinants of health are:<\/p>\n

Socioeconomic Factors<\/h4>\n

Poverty can limit access to healthy food, safe neighborhoods, and good schools. Poverty can also lead to homelessness. According to the Corporation for Supportive Housing, \u201cAccess to safe, quality, affordable housing\u2014and the supports necessary to maintain that housing\u2014constitute one of the most basic and powerful social determinants of health.\u201d<\/p>\n

Social Supports and Public Good<\/h4>\n

Certain populations need community partners to advocate for their health equity. Some examples include housing departments working with homeless patients, or health care advocates helping single mothers. Fire and police departments are also public safety partners as they can help reduce drugs, crime, and violence which negatively impact neighborhoods.<\/p>\n

Geography<\/h4>\n

Patients in rural areas have limited access to medical facilities and providers. The sheer distance to the nearest facility is often a barrier to care.\u00a0 Technology, such as telehealth, can help bridge this gap, but requires access to broadband technology which is not always available.<\/p>\n

Educational Attainment and School Intervention<\/h4>\n

There is a correlation between quality education and better healthcare outcomes. Patients who have attained higher levels of education have increased capacity to advocate for themselves and engage with providers.<\/p>\n

One of the most thorough analyses on the impact of social factors is the 2017 report by the National Academy of Medicine (NAM) entitled, Effective Care for High-Need Patients. <\/em>It highlights how social determinants are generally more pronounced in this population, but with the adoption of updated treatment plans, social determinants can have the greatest positive impact.<\/p>\n

Identifying High-Risk Patients<\/h3>\n

This high-need patient population is diverse and, consequently, difficult to target. NAM has identified three primary criteria for defining this population: 1) total accrued health care costs, 2) intensity of care utilized for a given period, and 3) functional limitations. These criteria are common across diverse patient populations.<\/p>\n

To better understand these common elements, patient classifications are used to categorize these factors in the research. The NAM study found that a classification focused primarily on medical characteristics is likely to neglect other key social determinants that can significantly impact quality and cost of care. An effective classification for high need patients must provide guidance on how to embed social risk factors, behavioral health factors, and functional limitations. To achieve this, patients first need to be assigned to a clinical segment, with an accompanying assessment of behavioral health and social service needs to determine the specific types of services required.<\/p>\n

As providers conduct these assessments, you will discover key behavioral health factors most likely to affect care delivery decisions. These will include substance abuse, serious mental illness, cognitive decline, and chronic toxic stress. Key social risk factors include low socioeconomic status, social isolation, community deprivation, and housing insecurity. Classifications are designed to align high-need patients with the care models that target their specific needs and include:<\/p>\n