How to Better Address Social Determinants of Health (SDOH)

As the healthcare field further recognizes the critical role that socioeconomic factors play in patients' well-being, it’s important that providers and healthcare institutions adopt a holistic approach that addresses SDOH.  

DataGen’s Mandi Diamond, senior practice transformation advisor, breaks down the key reasons for understanding and measuring SDOH and provides additional healthcare delivery insights. Read on for expert medical practice consulting advice.  

Understanding social determinants of health  

In recent years, healthcare practices have been held accountable for collecting SDOH data. This metric includes race, ethnicity, language, socioeconomic barriers and even personal circumstances, like family structure and sexual orientation/gender identity. 

The more practices expand their data collection efforts, the easier it is to understand patients' backgrounds. This allows practices, specialists and community resources to build stronger, more trusting relationships based on respect and integrity. This is an empathetic approach and desire to “see” a patient's life while fostering a more honest and trusting interaction. 

Now that we have a basic overview of SDOH data and how it helps, let's dig deeper. 

The importance of diversity data  

Providers have experienced some pushback from patients when trying to collect basic demographic data, such as race and ethnicity. However, not collecting data or making care assumptions can lead to missed opportunities. 

The term "people connection" means: to make meaningful care connections and interventions. This includes acknowledging how individuals identify themselves. Prioritizing patient needs enhances the overall patient experience and outcomes. 

To create an inclusive healthcare environment, practices should ask:  

• Do we have the right structures in place to meet our patients' needs?  

• Are our services and providers diverse enough to reflect the communities we serve?  

• Do our materials and communication methods resonate with our patients’ cultures, races and ethnicities?  

• Are we linked to community resources that can help bridge gaps in care?  

• Does our team possess the cultural competency necessary to effectively serve our patients?  
  
  

Tips for navigating SDOH data collection 

SDOH data aims to identify daily living conditions and can be used to reduce health disparities. Before we jump into some metric collection methods, let's first talk about the importance of screening for the National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) model. 

The need for screening: NCQA PCMH model  

At its core, the PCMH model encourages providers to collect patient data through screening methods. There are many SDOH screening tools available for providers to consider, such as conversations and in-take surveys.  

Conversations provide a more informal but effective means to gather patient information. Whereas in-take surveys make it easier to document and score answers. Both methods at their core ask patients key questions to better understand their care needs. 

Regardless of the screening method chosen by providers, they must find ways to weave these tools into their daily practice, ensuring that SDOH data collection is taking place. This will make it easier to gain or maintain NCQA PCMH recognition.  

It will also help providers get a head start on building relationships with community organizations and specialists. This way, providers can best identify and connect patients to resources that support their health and well-being. 

How to handle SDOH conversations  

Many healthcare professionals find discussions about SDOH challenging. However, here are some strategies to make these conversations more seamless:  

1. Empower patients through self-intake: Offering self-service intake forms, whether digital or paper, puts patients in control of their information. This reduces pressure and enables patients to choose whether to provide specific details.  

2. Address patient pushback calmly: If patients express discomfort, having calm, offline conversations can help clarify the purpose behind collecting these data. Framing questions around the idea of serving the patient's best interests can foster understanding.  

3. Educate patients on data collection: Share information about why these data are being collected and how it will be used to improve their care. Transparency can alleviate fears and encourage participation.  

4. Tailored treatment plans: Each patient is treated as an individual. Self-management strategies for chronic and preventive care are guided by the entire patient's portrait, not just their medical needs. 
   
   

By implementing these strategies, healthcare providers can create a more inclusive environment, enhancing the overall patient experience and ultimately leading to improved health outcomes.  

Case study: Empathetic approach example 

In this example, patient A has had a difficult time in the past with providers who used the wrong pronouns. This made it hard for them to tell their provider about their struggles with anxiety and depression. By not using pronouns, the patient: 

• felt invisible and uncomfortable; 

• struggled to know if their provider "accepted them" as they are, which led to more stress; 

• didn't feel the provider would have resources to support their needs; and 

• didn't feel a part of a nurturing and compassionate environment. 
  
  

However, their new provider (Dr. Joyce) knows their preferred pronouns and uses them when appropriate. Patient A feels more comfortable with Dr. Joyce and can discuss their mental health. Dr. Joyce can now refer Patient A to the right specialist who meets their needs. 

By using an empathetic approach and SDOH data, providers can: 

• identify potential gaps in support and resources; 

• foster more honest and trusting patient-provider interactions; 

• meet care goals by adopting industry-approved practices; and 

• implement a way to use data collection to positively impact treatment plans and outcomes. 
  
  

Put patient needs first: Contact DataGen 

At DataGen, we believe addressing SDOH is essential to creating a holistic approach to healthcare. By understanding our patients’ backgrounds and building respectful, trusting relationships, we can better support their unique needs. While there may be challenges in gathering this information, the benefits far outweigh the obstacles. Together, we can pave the way for a healthier future for all.  

Explore our Medical Practice Consulting solution to learn how we work with providers to confidently deliver high-quality care. Learn how we help practices achieve and sustain models of patient-focused, equitable care like PCMH and Health Equity Accreditation. Then, read our blog on how to advance equitable care through NCQA and learn how to sustain the medical home care model.  

Want to improve outcomes today? Contact us to discover how we can take the guesswork out of practice transformation.