Implementing SDOH Screening Requires Strategic Planning & Road to Impact-The HSB Blog 8/11/23

Our Take:

The integration of digital health tools and provider screening for Social Determinants of Health (SDOH) issues can greatly enhance patient care and our understanding of barriers to care. Digital health tools enable real-time data collection and also help identify SDOH-related issues promptly for intervention. However, implementing SDOH screening requires taking careful privacy measures as well as collaboration with community organizations. This approach fosters patient-centered, equitable healthcare.

Key Takeaways:

While initially 33% of staff and 58% of clinicians surveyed in one study felt that the clinic was “too busy” to deal with SDOH, by the end of the study those numbers had declined to 10% and 21% respectively (FPM)
Despite the fact almost 90% of hospitals and systems surveyed reported screening patients for social needs, only 30% reported having a formal relationship with community-based providers for their target population (Deloitte)
Although parents can see a throughline between child health and some SDOH, they are reticent to discuss some of those topics (Public Agenda & United Hospital Fund)
Of the 49 provider-based SDOH programs that disclosed funding in one survey, hospitals and health systems committed approximately $2.5 billion, with a median investment of $2M/ program and a mean of $31.5M (Health Affairs)

The Problem:

While the integration of digital health tools and the incorporation of Social Determinants of Health (SDOH) into hospital screening processes can offer significant benefits, this does not come without challenges to overcome in order to fully realize the value of this approach. While the benefits of screening for SDOH have been proven and a number of toolkits for screening for SDOH exist including those from the American Academy of Family Physicians, American Academy of Pediatrics, and the National Association of Community Health Centers, clinicians can often find the task overwhelming. For example, as noted in “ The Feasibility of Screening for Social Determinants of Health: Seven Lessons Learned”, “In the authors' pilot study, 58 percent of clinicians began the project thinking they were too busy for social determinants of health (SDOH) screening.”

In addition, integrating SDOH data from digital tools into existing electronic health records (EHR) and workflows can be technically challenging as hospitals often use various systems that may not seamlessly communicate with each other leading to additional data integration and interoperability issues. There is also the challenge of resource allocation and workload of SDOH screening as implementing SDOH screening requires additional resources. This includes personnel to manage data collection, analysis, and interventions as well as professionals and staff that are trained on how to interpret and utilize SDOH data effectively.

The Backdrop:

While for a number of years, there has been a rising recognition of SDOH's impact on health, it is only in the last several years that the focus has been on measuring and managing the most efficient and effective way to provide these resources. In addition, once providers have decided what and how to measure these impacts, it is important to determine how the results of such surveys will be handled. For example, as noted in “Considerations for Social Determinants of Health Screening Design” not only do they “need to consider the tools they’ll use to deploy the screening, which determinants to look at during screening, and how providers will talk about SDOH with patients to ensure it’s a respectful interaction” they will also need to make sure they have thought through which SDOH issues may “have an immediate and tangible solution to fix”, otherwise “it can be frustrating for both patient and provider—and it can damage patient trust—for a social need to arise and [then for patients to] hear there is no way to fix it.”

As a result of this situation, providers have more recently teamed up with corporations, community organizations and others (including health insurance companies) to not only screen for SDOH but also to invest their own funds more directly in addressing the SDOH needs of patients. For example, a 2020 article in Health Affairs found that of the 49 SDOH provider-based SDOH programs that disclosed funding, ”the total funds committed specifically from health systems or hospitals were approximately $2.5 billion, with a median investment per program of $2 million and a mean of $31.5 million”. In addition, the authors also noted the dominant choice among organizations that chose to address a single SDOH was housing. The authors noted that "housing-related programs included strategies such as the direct building of affordable housing, often with a fraction set aside for homeless patients or those with high use of health care; funding for health system employees to purchase local homes to revitalize neighborhoods; and eviction prevention and housing stabilization programs."

While the article went on to point out that “these investments still represent [only a] small fraction of overall spending by health systems, which currently are much more likely to be developing screening and referral programs”, it does indicate that providers consider the potential for significant and ongoing financial investments that might accompany any screening initiatives.

Implications:

Integrating screening for SDOH to improve patient care can be a substantial undertaking and can require a significant commitment of both human and financial resources. However, digital health tools can allow hospitals to gather comprehensive SDOH data, leading to more personalized and patient-centered care plans. This holistic approach can help providers address patients' unique circumstances and needs, which if handled correctly can improve overall satisfaction and engagement.

Real-time data collection and analysis enable hospitals to identify SDOH-related barriers promptly. Early intervention and preventive measures can reduce the progression of health disparities and complications, particularly in children, ultimately leading to better health outcomes and improved quality of life. Moreover, it is important to train and communicate with stakeholders on the impacts on workflow and to ensure their concerns are heard. While, as noted, initially in one study, 33 percent of staff and 58 percent of clinicians felt that the clinic was “too busy” to deal with patients' social needs by the end of the study only 10 percent of staff and 21 percent of clinicians, felt that the clinic was “too busy” to deal with patient's social needs.” When they investigated the large drop in opposition to screening, the authors found simply that “in the end, the work was not overwhelming, as some had feared it would be.”

Similarly, providers should make sure they are thoughtfully and adequately communicating the goals and purposes of such SDOH screening tools with patients. For as noted in “Considerations for Social Determinants of Health Screening Design” SDOH screening can be challenging because patients aren’t always comfortable discussing often sensitive personal information that does not directly pertain to their health (for example: It could be difficult for patients to admit they are housing insecure)”. Researchers from Public Agenda and United Hospital Fund also reported that “although parents can see a throughline between child health and some SDOH, they are reticent to discuss some of those topics. Particularly, parents or guardians were worried about discussing their own mental health, legal issues, or domestic problems, especially if they did not have an established rapport with the pediatrician.”

As hospitals become more deeply involved in their communities by collaborating with local organizations and public health agencies, not only can this engagement contribute to community health improvement and foster trust, it can also have meaningful financial reforms. For example, the Health Affairs article referenced above also noted that, “although a recent study found no association between overall community benefit spending and readmission rates, hospitals in the top quintile of spending that was directed toward the community had significantly lower readmission rates than those in the bottom quintile.”

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