Role of SDOH in the Context of Quality Improvement

The term Social Determinants of Health (SDOH) refers to the social, economic, environmental, and demographic factors that influence health outcomes. These are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”¹ These are also the non-medical factors that could impact a person’s overall health.

SDOH Factors contribute to about 40% of variation in health status among individuals^2. Despite the impact of SDOH on a patient’s health outcomes and costs, providers and payers are not equipped to address the several social determinants including housing, education, food security, and economic stability.

Understanding The Problem

It is important to understand the factors, other than medical, affecting the life of an individual. 
Factors like housing, food security, access to care, etc., are concerns that may affect the health of the population. An approach of SDOH-led quality initiatives lies beyond the four walls of the clinical setting. Data gathering, with screening tools, focus groups, community congregation, etc., is required to gain an understanding of key social factors that impact population health. In the process of data collection, consider factors that are vital to population health, significant for the care giver/provider and health insurers, since these factors might not be related and may belong to different datasets all together.

Thinking Beyond The Walls

New interventions need to be developed for quality improvement activities to tackle issues attributable to SDOH. Also, an intervention that works with one population set may not work for another.  Minimal or no attention to SDOH factors can lead to failure of understanding of the problem for the given population set. Quality improvement programs that directly address SDOH will need to engage representatives from housing, transportation, education, public safety, school, social care, and beyond. Due to the varied spectrum of stakeholders, it might create new challenges for implementation because of separate priorities, funding streams, etc. Nevertheless, it is the only way to address interlocking influences on health. It is to be noted that this approach does not undermine the inclusion and efforts of nurses, caregivers, providers, administrators, etc., in quality improvement activities.

Developing New Measures Of Success

As the healthcare ecosystem moves towards a value-based care delivery order, it has become useful for the payers and providers to have the inclusion of new quality measures, keeping in line with the changing landscape. This also signals the next step in the direction of population health management. Chicago-based Advocate Health Care, an ACO, reduced healthcare costs by $3,800 per patient, by screening all patients at admission for malnutrition risk, resulting in $4.8 million in total savings. Patients with increased risk scores were given an oral nutritional supplement within two days of admission, The ACO also saw hospital readmission rates drop among patients at risk for malnutrition, within six months of launching quality improvement initiatives ³. In another example, healthcare spending fell by 11% when the payer addressed SDOH⁴.

New measures may include  SDOH elements like employment rates, number of dependents, distance to nearest care center, educational qualification, access to clean environment, availability of daily food, etc. (Exhibit 1). With the inclusion of new quality measure and processes, it will help stakeholders to understand and address these SDOH factors in a meaningful manner. This will also define and build new engagement levels that go beyond clinical settings.

Exhibit 1: Measuring SDOH Interventions

Conclusion

To address health outcomes associated with social determinants of health, physicians, payers, policymakers, communities, and individuals need to understand the role these factors play in individual and community health, and focus their efforts in reaching out to the maximum number of people possible. Integration of social determinants into the health care system delivery may help in reducing health disparities, improve quality of care delivered and reduce cost. Social determinants of health is bound to have an impact on health, as it is a critical component that cannot be ignored in the healthcare ecosystem.