Hospitals struggle with social determinants

Proactive, holistic patient care is becoming increasingly important to healthcare providers as the industry continues its march to value-based care. Healthcare organizations of all types, including acute care hospitals, now have greater incentives to address issues that fall outside the traditional scope of clinical care, including the social determinants of health (SDOH).

Due the COVID-19 pandemic and its subsequent economic fallout, the emphasis on identifying socioeconomic needs—and actively helping individuals solve for these issues—has become even more pressing.

Unfortunately, the nation’s healthcare infrastructure is still poorly equipped to address SDOH challenges at scale.

Health systems are still struggling to consistently screen patients for non-clinical needs, such as food and housing insecurity, loneliness, health literacy and transportation access, and collect that data in a standardized format suitable for analytics.

And even when such data is available, organizations are finding it challenging to connect people in need with community-based resources to access necessary services, finds a new research letter published in JAMA Health Forum in October.

Smaller and more remote hospitals, including critical access hospitals (CAH), rural hospitals and safety-net hospitals (SNH), are among those facing the most difficulties, found researchers at the Harvard T.H. Chan School of Public Health after reviewing data from an American Hospital Association (AHA) survey conducted in 2020.

A targeted supplement to the survey collected information on three domains: screening for SDOH concerns, the existence of interventions to address SDOH issues, and whether or not hospitals had community partnerships in place to address SDOH needs.

The data revealed that CAH, SNH and rural hospitals were keeping pace with larger teaching hospitals and for-profit institutions on screening patients for SDOH needs, which is positive news. The article did not specify whether these data collection efforts were paper-based or digital.

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However, despite the known socioeconomic and health disparities facing patients of these facilities, the smaller organizations were somewhat less likely to have SDOH-focused programming in place and significantly less likely to have established community partnerships.

The study authors suggested the shortfall may be due to resource and workforce constraints, a perceived shortage of available community-based organizations to partner with, and lack of financial incentives to engage in this type of non-clinical work.

Because the survey took place at the start of the devastating COVID-19 pandemic, these factors may have been heightened even further as hospitals fought to keep their heads above water while managing a huge influx of critically ill patients.

With the slow return to a more stable healthcare environment, however, comes the opportunity for small and rural hospitals to reengage with their communities and launch innovative partnerships.

Partnering to impact social determinants of health

Investing in building ties to the community can increase resilience ahead of future crises by increasing health literacy among patients, establishing mutually beneficial relationships with local resources, and fostering trust among historically disadvantaged populations.

Hospitals serving rural and vulnerable communities should consider reaching out to key stakeholders in the community, including schools, faith-based groups, local government and law enforcement, and charitable organizations focused on important issues such as senior care, violence prevention, food security and youth development.

While developing these partnerships, hospitals should focus on how to share critical data across disparate systems.  Providing digital referrals—and closing the loop on whether those referrals were completed with EHR integration—is crucial for ensuring easier access to services and integrating non-clinical care into the patient’s overall care plan.

This is still a relatively new area of health IT development, and smaller, resource-constrained hospitals may wish to focus first on establishing basic ties with the right community partners, even if they are analog. But planning ahead for a digitally enabled SDOH ecosystem will position hospitals for future success as the industry further develops its SDOH capabilities.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.