By Jennifer Larson, contributor Oct 08, 2019
When you see
a patient in the hospital or an exam room, you’re only getting a small glimpse
into their lives. You can’t see where they live, the conditions of their environment,
the food they eat or many of the other factors that play into their health and
care we receive plays an important role, health outcomes may often be driven by
the conditions in which we live, learn, work, and play,” wrote Cara V. James,
PhD, director of the Office of Minority Health for the Centers for Medicare &
Medicaid Services (CMS) in a blog
post earlier this year.
a small minority of physician practices and hospitals are screening for all of
a person’s key social needs, according to a new
study for JAMA Network Open. The researchers noted that there
is a lot of room for improvement.
new opportunities to provide excellent care as a locum tenens.
of health: What are clinicians missing?
the World Health Organization and the U.S. Department of Health and Human
Service’s Healthy People 2020 initiative,
there are five
factors that contribute to a person’s health:
- Biology and genetics
- Individual behavior
- Physical environment
- Social environment
- Health services, including access to care
nurses and other medical staff fill out medical history forms every day that
provide answers to the first two items on this list, and but far fewer are
getting a complete picture of a patient’s environment, their access to important
services and their ability to follow treatment plans.
CMS: The five key social needs
How is a
clinician expected to know all the relevant information about a patient’s home
life, and their social and physical needs?
take a cue from a screening tool developed by the CMS Center for Medicare and
Medicaid Innovation (CMMI). The CMMI includes five key
domains in the Health-Related
Social Needs (HRSN) Screening Tool that it created for the
Accountable Health Communities (AHC):
- Housing instability
- Food insecurity
- Transportation problems
- Utility help needs
- Interpersonal safety
Less than 1 in 4 are asking the right
asked hospitals and physician practices if they were screening for these five social
needs in the new JAMA Network Open study, which was led by Taressa K.
Fraze, PhD, with the Dartmouth Institute for Health Policy and Clinical
Only 24.4 percent of the hospitals and 15.6 percent of physical practices surveyed
were screening for all five of those factors. In fact, 33.3 percent of
practices and 8 percent of hospitals reported that they didn’t do any screening
for social needs at all.
participants noted that challenges arise when it comes to screening for social needs.
Common obstacles include a lack of time, a lack of capacity for addressing any
problems that are uncovered during screening, and a lack of financial resources
to help patients solve those needs.
really hard to do, and hospitals and practices are under a ton of pressure to
do so many things during any clinical encounter,” noted Laura Beidler, MPH, research
project coordinator at the Dartmouth Institute for Health Policy and Clinical
Practice and a co-author of the new JAMA study.
expanding array of resources and programs
gathering this vital information? A growing number of programs are taking up
the cause—raising awareness of the importance of social determinants of health
to populations, and looking for ways to address them.
for Disease Control and Prevention (CDC) has at least eight
programs, many of which work together with community partners across
a range of sectors. The American Academy of Pediatrics (AAP) offers resources
on social determinants of health. And the American Academy of Family Physicians
(AAFP) launched The
EveryONE Project in 2018 as a resource to help family physicians
better address social determinants of health for the patients in their
practices, and in their communities.
institutions are also creating new screening methods or programs in an effort
to improve patient outcomes.
Boston Medical Center recently published the results of an observational
study in which a team of researchers gave a one-page screening tool to
patients in primary care settings. The responses were entered into the
patients’ electronic health record (EHR), and helped identify social needs like
housing or food that might have otherwise gone undetected. The medical center
is now using the tool, called THRIVE, with all patients in their ambulatory
primary care centers.
Identifying vulnerable populations
should also be aware of especially vulnerable populations.
research letter, published September 30, 2019 in JAMA Internal Medicine, Medicare
enrollees under age 65 reported significantly more food insecurity than Medicare
enrollees over age 65. Many of the first
group are especially vulnerable due to factors such as long-term disabilities
that qualified them for early Medicare enrollment, and many are also enrolled
in Medicaid, noted researcher Jeanne Madden, PhD, associate professor in the Department
of Pharmacy and Health Systems Sciences at Northeastern University.
it’s important for physicians to know more about their patients than just about
their physical state,” said Madden, adding that life circumstances like food
insecurity can play a very important role in a patient’s treatment and overall
a formal screening tool, clinicians and their staff can still gather important information
from patients, just by asking a few questions along the lines of the CMS five
key domains. They can then use that information to help shape an individual
care plan that has greater chance of success.
those conversations could be really helpful for a lot of those patients,” said
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