State Health Equity Toolkit | DNPAO
Trends in Unmet Need for Physician and Preventive Services in the United States, 1998-2017
Has unmet need for physician services shifted for US adults between 1998 and 2017? Using data from US adults aged 18 to 64 years in 1998 (n = 117 392) and in 2017 (n = 282 378) who responded to the Centers for Disease Control and Prevention Behavioral Risk Factors Surveillance System, this study found that from 1998 to 2017 the inability to see a physician because of cost increased 2.7 percentage points owing to worsening access to care among the insured. In contrast, the proportion of chronically ill adults receiving checkups did not change; results for receiving guideline-recommended preventive services were mixed.
Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2
If standardized social and behavioral data can be incorporated into patient electronic health records (EHRs), those data can provide crucial information about factors that influence health and the effectiveness of treatment. With this goal in mind, a committee was convened to conduct a two-phase study – first to identify social and behavioral domains that most strongly determine health, and then to evaluate the measures of those domains that can be used in EHRs.
Rethinking the Social History
Heidi L. Behforouz, Paul K. Drain, and Joseph J. Rhatigan, N Engl J Med (2014)
Doctors don’t pay enough attention to their patients’ ability to pay for medications, access to transportation, available time, and competing priorities. Physicians cannot afford to ignore these social factors in assessments and treatment plans “if we hope to improve outcomes, reduce costs, and improve patient satisfaction,” the authors assert. “Patients know clinicians cannot alleviate their poverty, but empathy and concern shown by a clinician who explicitly addresses it constitute powerful medicine.”
Addressing Patients’ Social Needs: An Emerging Business Case for Provider Investment
Deborah Bachrach, Helen Pfister, Kier Wallis, and Mindy Lipson, Manatt Health Solutions. The Commonwealth Fund (2014)
The Affordable Care Act and other changes in the health care landscape are leading medical providers to more directly confront the social determinants of health. New payment models, for example, will increasingly hold providers financially accountable for patient health and the costs of treatment. “These models—including capitated, global, and bundled payments, shared savings arrangements, and penalties for hospital readmissions—give providers economic incentives to incorporate social interventions into their approach to care,” the authors say.
Medical schools neglect social determinants of health
We know a lot about the ways in which inequality destroys health. Why aren’t we doing more to fix it? Jonathan Metz, Ph.D., explains that training in biology alone leaves doctors unprepared for understanding how social circumstances shape people’s health. Metz, a psychiatrist who happens to have master’s in poetry and doctorate in American studies, directs Vanderbilt University’s Center for Medicine, Health, and Society. You can read further in an unusually lucid sociology paper he co-authored with Helena Hansen of New York University.
Addressing the Social Determinants of Health Within the Patient-Centered Medical Home: Lessons From Pediatrics
Arvin Garg, M.D., M.P.H.; Brian Jack, M.D.; Barry Zuckerman, M.D.; Journal of the American Medical Association (2013)
A pediatrician asserts that medical practices that adopt the patient-centered medical home model are more capable of addressing the social determinants of health.
The Social Determinants of Health and Pandemic H1N1 2009 Influenza Severity
Elizabeth C. Lowcock, Laura C. Rosella, Julie Foisy, Allison McGeer and Natasha Crowcroft; American Journal of Public Health (2012)
Clinical risk factors for severe pandemic H1N1 2009 illness explain only a small portion of the associations observed between socioeconomic status and hospitalization. This suggests that the means by which the social determinants of health affect pandemic H1N1 2009 outcomes extend beyond influencing these recognized risk factors. The authors conclude that “a social determinants approach to promoting public health is an essential component of pandemic planning” and preventing flu-related hospitalizations and deaths.