The Social Determinants of Health & Their Effect on Health Outcomes

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HealthWare Systems Blog

The Social Determinants of Health & Their Effect on Health Outcomes

Posted on Friday, August 17, 2018

The social determinants of health are increasingly on the radar of health professionals and health systems.  The National Academy of Medicine (formerly the Institute of Medicine) even recommends this information be included in patients’ medical records.

Hospitals can utilize screening tools to collect patient data concerning the social determinants of health.  While a provider may not be able to resolve all social issues faced by a patient, identifying them can help inform healthcare decisions.  (Providers should also have a list of resources that attend to social needs available to provide the patient when asked.)

When health systems consider the social determinants of health when caring for their patients, all parties benefit.  Patients have better health outcomes, communities improve, and health systems become advocates for their patients (improving patient satisfaction) while saving money.  The social determinants of health not only impact the health of patients, but also the health of a hospital’s revenue cycle.

 

Social factors that influence patients’ health & healthcare decisions include:

Employment – A good job can provide a patient and his/her whole family with health benefits and insurance.  Unemployment negatively affects physical and mental health.

Income – A steady paycheck allows a patient to pay for many of the other factors in this list, such as adequate housing, nutrition, and transportation, as well as healthcare costs.  (Financial assistance screening tools can help patients find out if they qualify for charitable programs to help offset the cost of care, and enable hospitals to facilitate the application process for their patients.)

Housing – Poor living conditions increase the risk of infectious disease, injury, chronic illness, pest and mold problems, and indoor air pollution.  And each year, 1.48 million Americans have no home at all.  (Here are some examples of how hospitals can help meet patient housing needs.)

Violence – The area in which patients live also can affect their exposure to violence or abuse.  Victims or witnesses to acts of violence may experience mental, physical, and/or economic consequences that affect their overall health.

Nutrition – A lack of consistent access to healthy food can negatively impact health outcomes and increase the risk of many adverse health conditions.  Over 12.7 percent of U.S. households were affected by food insecurity in 2015.  (Read our previous blog for more information on how to reduce patient malnutrition.)

Transportation – Access to reliable transportation can govern a patient’s access to medical care.  Approximately 3.6 million Americans miss or postpone medical care due to transportation issues.  (Check out these ideas for addressing patient transportation needs.)

Social Support – As reported by NPR, in a recent nationwide survey conducted by Cigna “nearly 50 percent of respondents” said “that they feel alone or left out always or sometimes.”  Two in five respondents “felt like ‘they lack companionship,’ that their ‘relationships aren’t meaningful’ and that they ‘are isolated from others.’”  Patients who feel unsupported are more vulnerable to poor health outcomes.  (Read how physician empathy can generate better health outcomes.)

Language/Culture – Culture influences our beliefs about health and healthcare.  A patient’s ability to communicate with health professionals may be impeded by language barriers.

Education – According to the CDC, people with higher levels of education are more likely to choose healthy behaviors and refrain from unhealthy ones.  People with lower levels of education are more likely to be obese and more likely to smoke.

Health Literacy – People with lower education levels are also more likely to have inadequate health literacy skills.  People who are limited in health literacy have higher rates of hospitalization and emergency room use and they use preventive care less.  (Read our blogs on reducing patient uncertainty and addressing health insurance confusion for ways to help improve your patients’ health literacy.)

Patient Engagement – A patient must have health literacy skills in order to be actively engaged in his/her healthcare.  Better engaged patients tend to see better health outcomes.  (Promoting health observances, using social media in healthcare, and educating patients about preparing for a doctor’s appointment are a few methods for improving patient engagement.)

Sex/Gender – Many health conditions affect men and women differently and certain treatments may be more or less effective depending on the sex of the patient.  Plus, men are less likely than women to see a doctor for a specific health concern, preventive healthcare, or a standard annual exam.  (Consider these tips for improving male patient engagement.)

 

The social determinants of health are key to improving health outcomes and the revenue cycle.

The social determinants of health are key to improving health outcomes and the revenue cycle.

 

It’s not difficult to imagine how the above factors might influence one another.  The social determinants of health are interconnected and work together to impact a person’s health and healthcare decisions.

Patients whose social needs are unfulfilled are more likely to utilize healthcare resources at a higher cost (including the Emergency Department), be readmitted, miss appointments, and have poor health outcomes.

Hospitals that address the social determinants of health can create better health outcomes, reduce hospital readmission rates, and improve patient engagement while lowering no-show rates and enhancing revenue cycle management.


By Stephanie Salmich

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How Can Hospitals Address Patient Housing Needs?

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HealthWare Systems Blog

How Can Hospitals Address Patient Housing Needs?

Posted on Wednesday, August 8, 2018

Hospitals can significantly improve the health of patients suffering from housing instability by actively addressing patient housing needs.  A patient’s living situation, conditions, and location affect many aspects of health.  Poor housing quality increases the risk of infectious disease, injury, chronic illness, pest and mold problems, and indoor air pollution.  Neighborhood conditions are related to rates of violence, crime, noise, and opportunities for physical activity.

Improving patient housing situations can result in better health outcomes and quality of life for patients and their families.  Plus, there are financial incentives for addressing patient housing needs.  According to the American Hospital Association’s Social Determinants of Health Series:

“The economic benefits for hospitals can be significant, since homeless or unstably housed individuals are more likely to be uninsured, be hospitalized more frequently, have longer lengths of stay in the hospital, be readmitted within 30 days and use more high-cost services. Reducing homelessness and other forms of housing instability—through case management, supportive housing (supportive services combined with housing), housing subsidies or neighborhood revitalization—improves health outcomes, connects individuals with primary care and reduces these high levels of utilization. When hospitals and health systems focus their resources on housing supports and case management, the cost savings can offset the expenditures by between $9,000 and $30,000 per person per year.” (p. 8)

Hospitals can significantly improve the health of patients suffering from housing instability by addressing patient housing needs.

Hospitals can significantly improve the health of patients suffering from housing instability by addressing patient housing needs.

 

Here are a few ways hospitals can address patient housing needs:

 

Contribute to neighborhood improvement projects.  Collaborate with your local government and other organizations that hold a shared interest in the state of your community.  Get involved or make monetary donations to make a difference.

Provide home assessments and patient education for vulnerable populations.  For example, the Seattle-King County Healthy Homes Project targeted low-income households with asthmatic children.  The initiative sent a nurse and community health workers to patients’ homes to educate the families about asthma and self-management and to identify and address environmental triggers (with resources like bedding covers, vacuums, and cleaning supplies).  The goal was to improve health outcomes for patients with asthma and to reduce the use of healthcare services such as urgent care.

Set up a home repair referral program.  Don’t stop at simply assessing patients’ homes for health and safety risks; refer them to a local business that can take care of necessary home renovations for them.  Establish partnerships with businesses who will offer their services at a reduced rate to your referrals or find charitable organizations like veterans’ clubs and churches that may have volunteers who could do the work for free.  The One Touch e-referral program has seen success in linking government and nonprofit groups like Habitat for Humanity to create healthier homes.

Bring care to homeless patients via a mobile health center.  Visit shelters, churches, and community centers and offer primary and preventive health services to at-risk patients.  (Take a virtual tour of the Calvert Health System Mobile Health Center.)

Create a transitional arrangement for homeless patients whose conditions require they be discharged from the hospital, but who are not yet well enough to go back to a shelter or live on the street.  St. Joseph Health created a Medical Respite Program consisting of 15 beds set at three different locations to meet this need.  As its website explains, these beds are for homeless patients “who are being discharged from the hospital, and who need the opportunity to rest in a safe, healing environment while accessing medical care and other supportive services post-hospitalization.”

Invest in your own affordable patient housing.  According to its website, Bon Secours Baltimore “has developed and now owns and operates more than 720 apartment units for low- and moderate-income seniors, families and people with disabilities.”  The heath system has committed to “revitalize West Baltimore.”

Compile a list of affordable patient housing options near your facility.  UW Medicine created a list of both short-term and long-term housing options to help patients, as well as their family members and caregivers, find lodging.  Some of their local hotels even offer a discount to patients’ families and a shuttle service to and from the hospital.

 

Many of the above ideas for addressing patient housing needs are suggested by and discussed in further detail in the AHA’s guide, “Housing and the Role of Hospitals.”  This guide also outlines steps hospitals should take when determining which method(s) would best address the patient housing needs in their own communities (p. 10-11).

Ensuring patients go home to safe, clean environments is critical in helping to reduce hospital readmission rates, which is crucial to reimbursement.

Patient housing instability is one of multiple interconnected social factors that affect health outcomes and healthcare costs.  Along with patient housing needs, health systems should attend to other social determinants of health by, for example, addressing patient transportation needs and working to reduce patient malnutrition.


By Stephanie Salmich

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