SdoH: Hospitals Grappling to Integrate Key Assessments

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Original story posted on: March 4, 2020

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    The Social Determinants of Health: Case Management's Next Frontier

List of factors for front-line professionals to consider keeps evolving. 

Everyone wants to know how to assess the social determinants of health (SDoH). The healthcare industry is working hard to integrate in the moment, creating assessments using the five main SDoH domains:

  • Economic stability
  • Education
  • Health and healthcare
  • Neighborhood and built environment
  • Social and community context


Most analytic platforms integrate key components of established tools, such as PRAPARE or the American Hospital Association Screening tool. Others cull resource platforms to promote identification and referral of at-risk patients and populations. However, this task becomes more complex when the list of factors for front-line professionals to consider keeps evolving, creating wider gaps in resource provision and negatively impacting health and wellness.

Several recent studies point to important considerations for anyone focused on reining in the SDoH. First was a study out of Virginia Commonwealth University, which showed that 30-50 percent of early childhood wellness visits are missed by children. The greatest percentage of these missed visits is among children whose parents are poor, uninsured, and identify as African-American. Among the related implications:

  • Vaccine administration
  • Early detection of illness
  • Monitoring of growth and development


Immigration status and language literacy are additional factors contributing to attendance challenges.

The second study, out of Boston Medical Center, cites how patients who experience trouble paying utility bills are often missed in screening and assessment processes; this is a factor that impacts safe discharge planning and easily contributes to readmissions.

The newest generation of SDoH screening tools could benefit from incorporating questions on the ability of patients to pay electricity, gas, and cellular bills, as well as if any of these services was recently turned off. Most U.S. states have laws that prohibit utility companies from ending services for low-income families if a medical letter can be provided that confirms a household member has a severe chronic health condition. A total of 2,973 patients at Boston Medical Center received such a letter over the last decade. Two-thirds were black, and three-fourths were insured through federal programs.

While the newest generations of electronic health records (EHRs) and analytics tools prioritize at-risk populations, guide assessments, and even identify key resource needs, there’s a catch. The products can’t advocate for patients to be accepted by those resources, provide necessary medical documentation, or automatically adjust for every nuance identified by the industry as vital for inclusion as social needs. Technology has many merits, but they can’t replace a healthcare professional’s awareness, critical thinking, and fierce patient advocacy.

We asked our Monitor Mondays listeners: How often do patient utility challenges impact their discharge or readmission? The survey results were astounding, and speak volumes to the untapped opportunity to address support, with utilities as a factor for attention.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the State of the Social Determinants weekly on Monitor Mondays, 10-10:30 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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