Family Physicians Debate Social Determinants of Health

HealthLandscape has long recognized the value of Social Determinants of Health - the idea that socioeconomic and demographic characteristics play significant roles in influencing health outcomes. This idea has been gaining traction over the past few years, with organizations such as the Centers for Disease Control and Prevention releasing new guidelines on Health Outcomes and Determinants.

In their March/April 2016 issue, the Annals of Family Medicine ran three pieces discussing the integration of social determinants of health into primary care practice.

Alongside our colleagues at OHSU and OCHIN, Dr. Andrew Bazemore and Jené Grandmont represented the HealthLandscape team in the authorship of the main editorial article, "Perspectives in Primary Care: A Conceptual Framework and Path for Integrating Social Determinants of Health Into Primary Care Practice." This editorial discusses the importance of incorporating social determinants of health into the process of care. The article addresses the idea of standardizing the SDoH to be collected at the point of care, in line with the 11 domains recommended by the National Academy of Medicine in their 2014 report "Capturing Social and Behavioral Domains and Measures in Electronic Health Records." Further, the piece begins to explore an integration framework, considering how SDoH might best be used for practice and research.

The follow-up point/counterpoint section features two physicians debating the benefits of placing social determinants of health onto a primary care physician's already overloaded plate. While both writers recognize the value of incorporating patient and community data, opinions differ on what the physician's role in that process should be and how effectively a physician can use that information to help their patients.

It will be interesting to see where these conversations take us in the world of health care delivery, and we're excited to be a part of it.

Want more information about social determinants of health? Visit our Population Health Mapper to explore community characteristics and health outcomes in your area or check out the HealthLandscape Community Vitals API, a powerful tool that allows researchers and others to append extracts of the HealthLandscape community data pool to their de-identified clinical records in order to study the impact of social and behavioral factors on health outcomes.

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What Counts? Data Forum Focuses on Innovations in Population Health

How do we move from data to action? I’m excited to be joined by a series of speakers this Thursday (October 29th) at Data! Fostering Health Innovation in Kentucky and Ohio in Erlanger, KY, where we will be exploring this question and presenting recent innovations in improving population health.

As part of a panel focusing on the validity and use of data to address social determinants, I’ll be presenting HealthLandscape’s most recent work on Community Vital Signs, an approach for incorporating community indicators into electronic health records.  Also joining me on the panel are Katie Bachmeyer from Starfire, and Dr. Robert Kahn from Cincinnati’s Children’s Hospital.

Keynote speakers for the conference include Niall Brennan, the Chief Data Officer of the Centers for Medicare and Medicaid Services, and Naomi Cytron, Senior Research Associate in the Community Development Department for the Federal Reserve Bank of San Francisco.

 

Michael Topmiller
Health GIS Research Specialist 
HealthLandscape 

 

Looking Inward, Looking Outward

Looking Inward: How we measure and use Vital Signs

'Hæmostaticks' and the History of Blood Pressure

In the early years of the 18th century, Stephen Hall began experiments involving horses, brass pipes, and eight foot lengths of glass tubing, that allowed him to measure the force exerted by the horse’s heart with each beat.  These somewhat gruesome experiments would lead to what we know today as the measurement of blood pressure.  Several hundred years of experimentation with various invasive and non-invasive measures and machines ultimately led us to the modern Sphygmomanometer, which provides accurate measures of blood pressure without the inconvenience of spurting blood and the accompanying mess.

Blood pressure is a common Physical Vital Sign, measured routinely in physicians’ offices, hospitals, and even in patient homes for routine blood pressure monitoring.  The standard Sphygmomanometer, with glass tubing and mercury, is quickly being replaced with digital devices that quickly provide accurate measurement.  We understand how a person’s age, weight, body temperature, and even body positioning impact blood pressure.

Just as important as accurate measurement, this information is actionable.  

Blood pressure is a common and critical measure of a person’s physical health and we’ve developed detailed goals and treatment plans that include include both pharmacological and nonpharmacological approaches.  We know when a person is prehypertensive, we know when to expect elevated results (after trauma or while smoking), we know how much medication to give at certain levels of hypertension, and when it can be reasonably controlled with diet and exercise.

It has been 300 years in the making, but we’ve gotten very good at using this important Physical Vital Sign.

Looking Outward: How can we measure and use Community Vital Signs?

We’re now on the cusp of a new direction in healthcare, by looking outward at the community where an individual lives, works, plays, and travels.

We know that poverty is an important community vital sign that impacts a person's health, but we have much to learn.  Are we measuring poverty correctly?  Should we focus on individual/household poverty, or poverty level of their community?  What IS community?  Is community their immediate neighborhood, their city, their county?  When we measure poverty, do we really want to know availability of economic resources, better measured by wealth?  Is economic capital more or less important than social capital -- the intangible, usable social networks a family can take advantage of?  What about walkability?  Residential segregation?  More comprehensive summary measures in the Social Deprivation Index developed by researchers at Australian National University and the Robert Graham Center?

We’ve learned a lot in recent decades, but we have along way to go, before we can match the success of Stephen Hale and his original 'Hæmostaticks' research.

Where do we go from here?

This is not meant to be at all discouraging.  This is an incredibly exciting time to be doing research on social determinants of health, or what we refer to as Community Vital Signs.  We’re collaborating with organisations like the Robert Graham Center and OCHIN to tackle this field of study, by creating innovative tools like the HealthLandscape Geoenrichment API, which can be used to geocode and enrich patient records to include a host of Community Vital Signs

We’re also developing web-based applications that present the Community Vital Signs data in clinical environments to help healthcare providers integrate the social and medical needs of patients, to improve community and patient care.

Mark Carrozza

Director

HealthLandscape

Related Reading:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1543468/pdf/procrsmed00089-0065.pdf

http://blog.withings.com/2014/05/21/the-history-of-blood-pressure/

http://www.ncbi.nlm.nih.gov/pubmed/26174867

http://www.aafp.org/news/practice-professional-issues/20150831vitalsigns.html