How to improve screening for social determinants of health

Kevin B. O'Reilly , Senior News Editor

What’s the news: A recently published survey finds that about one in four hospitals and one in six physician practices screen their patients for social conditions that affect health, such as food access, housing stability, utility and transportation needs, and interpersonal violence. 

Fostering healthier communities

This episode of AMA Doc Talk explores how physicians can better serve their patients by thinking beyond the walls of the exam room.  

Results of the cross-sectional survey of 2,300-plus physician practices and nearly 800 hospitals were published in JAMA Network Open, and they highlight barriers to discovering the factors outside the exam room or hospital wall that can affect health or interfere with patients’ engagement in their clinical care. 

Why it matters for patients and physicians: Unmet social needs have a significant impact on a person’s health, affect patients’ access to care and hinder their ability to adhere to treatment plans. 

The AMA recognizes the importance of addressing social conditions that affect health, and a recently announced collaboration between the AMA and UnitedHealthcare will work to standardize data collection on SDOH to help address individuals’ unique needs. 

The two organizations are supporting the creation of 23 new ICD-10 codes related to social determinants. ICD-10 codes are typically used to record diagnosis, symptoms and procedures. Social factors that the new codes would capture include: 

  • Access to nutritious food. 
  • Adequate and safe housing. 
  • Available transportation. 
  • Financial ability to pay for medications. 
  • Financial ability to pay for utilities. 
  • Caregiver needs. 

“We are clear that 80% of what creates health happens outside of the doctor’s office, therefore it is critical that physicians know and can be responsive to the full context of patients’ lives to ensure optimal health outcomes,” Aletha Maybank, MD, MPH, the AMA’s chief health equity officer, said in an interview. 

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How health care organizations can best support communities they serve

What’s next: The AMA has adopted forward-looking policy along several dimensions of health’s social determinants to address the implications for tomorrow’s doctors, payment and health information technology. 

In medical education, the AMA supports:  

  • Efforts designed to integrate training in social determinants of health and cultural competence across the undergraduate medical school curriculum to assure that graduating medical students are well prepared to provide their patients safe, high quality and patient-centered care.  
  • Faculty development, particularly clinical faculty development, by medical schools to assure that faculty provide medical students' appropriate learning experiences to assure their cultural competence and knowledge of social determinants of health.  
  • Medical schools in their efforts to evaluate the effectiveness of their social determinants of health and cultural competence teaching of medical students, for example by the AMA serving as a convener of a consortium of interested medical schools to develop Objective Standardized Clinical Exams for use in evaluating medical students' cultural competence.  

The AMA also supports payment reform policy proposals that encourage screening for social service needs and referral to community support systems.  

And the AMA is urging EHR vendors to adopt SDOH templates that are created with input from the Association, medical specialty societies and others with expertise in social determinants of health metrics and development.