Asking your patients about social determinants of health (SDOH) can be as routine as taking their vital signs.

Guide to advancing health equity

AMA and AAMC Center for Health Justice guide provides physicians, health care workers and others a valuable foundational toolkit for health equity.

Knowing that a patient with diabetes lives in a food desert or that a patient doesn’t have stable housing means you are better equipped to improve their health. The AMA STEPS Forward™ toolkit “Social Determinants of Health: Improve Health Outcomes Beyond the Clinic Walls” outlines eight steps that physician private practices can follow. The toolkit’s tips and resources also apply to practice settings with other types of ownership structures.

Among other things, the toolkit will help you:

  • Identify methods to understand the unique health needs of your community and ways to engage community members to improve overall health.
  • Formulate a plan to help your practice begin addressing social determinants of health.
  • Explain the different tools available to screen patients, including how and when to use these tools, and connect patients with appropriate resources.

Social determinants of health include the conditions in which patients are born, grow, work, live and age, and the wider set of forces and systems that shape the conditions of their daily life, including economic policies, social norms and political systems.

“It’s important to know our patients’ social conditions. Why is that? Because only 15% of health outcomes are conditioned by medical condition or medical interventions. So, 85% of health derives from elsewhere,” internist David Ansell, MD, explains in a video accompanying the toolkit. He is the senior vice president of community health and equity at Rush University Medical Center.

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The AMA STEPS Forward open-access toolkits offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. STEPS Forward is part of the AMA Ed Hub™ an online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, all in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.

Learn more about AMA CME accreditation and check out this great new interactive CME course that details the basics of health equity.

First steps your practice can take

Start by understanding your community’s health needs, engaging key players in your practice and assessing your readiness. It’s helpful to think about one priority patient population you serve and one health-related social need that affects that population. For example, adults with type 2 diabetes and food insecurity, or children with asthma and substandard housing.

The toolkit outlines 10 areas to assess to determine your private practice’s readiness, including workflow integration, quality improvement and financial readiness. Here are some steps to follow from there.

Select and define your plan. Identify a social need in your patient population, choose a health outcome to track and define your target patient population.

Assess SDOH at the patient level. The toolkit includes some common, free screening tools. Start small: a particular age group or those with a specific diagnosis such as asthma, diabetes, chronic pain or obesity.

Link patients to SDOH resources. Give patients with a list of resources such as local food banks or transportation vouchers and—to have an even bigger impact—consider taking a more active role in arranging a resource alongside each patient and follow up to ensure they successfully accessed it. Access a nationwide resource by calling 211 anywhere in the U.S.

Get more details in the toolkit and read about some success stories on SDOH in health care organizations in Dallas, New York City and more.

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“If we are really going to get to health improvement broadly in this country, it is going to be when we marry what we do in the office with work our organizations might be able to do in the communities to improve the conditions under which people live, work and play that actually determine health,” Dr. Ansell says in the video interview.

It takes astute clinical judgement, effective collaboration with colleagues, and innovative problem-solving to succeed in an independent setting that is often fluid, and the AMA offers the resources and support physicians need to both start and sustain success in private practice.

Find out more about the AMA Private Practice Physicians Section, which seeks to preserve the freedom, independence and integrity of private practice.

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