Providing high-quality patient care and outcomes not only increases healthcare providers’ revenue but ensures the well-being of every patient. However, with 50% of health outcomes driven by factors other than clinical care, understanding the social and structural influences on health outcomes is crucial to providing the highest quality of care.

Social Determinants of Health (SDoH) are the nonmedical factors that influence health outcomes. More specifically, the World Health Organization (WHO) defines them as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

To improve patient outcomes with SDoH in mind, providers must focus on addressing the factors influencing a majority of their target population. This guide will examine factors in each of the five SDoH domains that are critical for improving patient outcomes and optimizing care delivery.

1. Economic stability

Economic stability refers to the financial resources needed to maintain good health and well-being. The key components of economic stability include:

• Employment: An individual’s employment provides their primary source of income as well as benefits that support access to healthcare, including health insurance and paid leave. Employment data is commonly included on new patient registration forms, along with the name of the policyholder if the patient has health insurance. 
• Food insecurity: Without access to reliable and quality food sources, individuals may face malnutrition and chronic diseases like diabetes. Food insecurity is also a risk factor that influences an individual’s healthcare needs and costs — data from nutritional assessments or food assistance program usage can supplement risk adjustment analytics to predict healthcare needs. 
• Poverty: Limited resources restrict an individual’s access to basic needs and healthcare, creating a cycle of economic instability. Patients living in poverty are likely to have lower life expectancy due to limited access to healthcare and healthy living conditions. Utilization of social services, such as Medicaid or welfare programs, and any other data about income levels or housing situations may help identify patients living in poverty.

Providers can identify patients at risk of economic instability and refer them to the appropriate resources to enhance their quality of care. To reach larger populations, providers may promote such resources publicly. For instance, a healthcare website could host links to registration pages for social services or the schedule for a free ride-share program. 

2. Education access and quality

Education is necessary to understand health information and guide healthy behaviors, such as exercising regularly and following a healthy diet. Education also impacts the opportunities, employment, and income available to individuals, meaning it supports other determinants of health. 

As a result, patients with access to educational attainment realize greater health benefits, ultimately influencing their life expectancy. Education access and quality refer to: 

• The availability of educational opportunities: This includes access to education across all age groups, from early childhood development to primary, secondary, higher, and adult education. Factors such as the school’s proximity and affordability influence the accessibility of education.
• The quality of educational opportunities: Quality of education considers the value of a curriculum and other resources available, including textbooks, technology, and extracurricular programs. It can also be measured according to the quality of the educational program or institution, such as graduation rates and standardized test scores. 

Measuring education access and quality can be challenging for healthcare providers. However, leveraging surveys and data from educational institutions can help providers identify potential gaps and offer support where needed.

3. Healthcare access and quality

Healthcare access and quality encompasses the availability, timeliness, and appropriateness of health services. For providers, measuring access and quality provides key insights needed to offer the best care, including timely care coordination and referrals to other providers. Individuals who can access quality health care are more likely to receive early detection and quality treatment. 

However, socioeconomic status and other factors make certain populations vulnerable and unable to access the care they need. Healthcare access and quality can be hindered by:

• Geographic accessibility, meaning the proximity of healthcare facilities and the availability of transportation to reach them
• Timeliness, including appointment availability and the amount of time patients wait to receive care
• Affordability, referring to the availability of health insurance coverage and the ability to cover out-of-pocket costs
• Quality of care, such as the qualifications, experience, and skills of healthcare providers

Understanding this SDoH factor is essential to not only managing ongoing health conditions but also preventing them before they escalate. For example, Arcadia notes that predictive analytics can be used to create treatment plans tailored to individual patient profiles. Providers need the context of a patient’s utilization of quality health services to determine how to help the individual get the right care at the right time.

4. Neighborhood and built environment

The physical characteristics, infrastructure, and social aspects of the places where people live are an individual’s neighborhood and built environment. This environment can impact a person’s mental health, well-being, and likelihood of developing chronic diseases. 

Providers must understand this context to reach various communities with treatment plans tailored to their living arrangements. For example, providers may encourage increased patient portal usage for tips on protecting against respiratory illnesses in areas with heavy air pollution.

The factors that influence an individual’s environment may include:

• Housing quality, referring to the structural safety and affordability of an individual’s living arrangements. A living environment that is both structurally sound and affordable reduces the risk of injury and enables residents to allocate more resources to health-promoting activities, like nutritious food.
• Crime and violence, including the safety of the community and the exposure to violence. For example, high crime rates may lead to chronic anxiety.
• Environmental conditions, such as air and water quality or access to parks and recreational areas. This can influence various health issues, such as respiratory conditions, and the ability to participate in physical exercise. 

With the right healthcare dashboard, providers can gain geographic population insights, allowing them to target at-risk populations and develop targeted interventions. For example, providers might develop community health programs or launch mobile clinics to help address specific health needs in a local area. 

5. Social and community context

An individual’s health and well-being can be greatly influenced by their relationships, social networks, and community environments. These aspects of social interactions play an essential role in shaping health behaviors and overall quality of life.

For example, the support of family members and large friendship networks can help reduce stress and promote mental health. Conversely, experiences of discrimination can lead to chronic stress or mental health issues.

The only way to assess social and community context is to ask individuals directly about their experiences. You may gather this data through surveys, focus groups, or partnerships with other organizations that address relevant factors. 

While the factors listed in this guide offer a solid starting point, there is no standard for measuring SDoHs. As a provider, it’s your responsibility to analyze the unique populations you serve and identify the factors that influence their health needs. As you gather patient data, keep it clean and organized in an intuitive tool that helps you analyze and draw insights from this information. As a result, you’ll be able to identify relevant factors and determine how to best meet patient needs.

About Author:

 

Arjun Gosain (Data Architect)

Arjun Gosain is a Data Architect on the Customer Insights team at Arcadia. He works with Arcadia’s customers to deliver ad-hoc analytics and custom reports. His areas of expertise include care management outcomes, risk stratification, and social determinants of health (SDoH). Prior to Arcadia in 2020, Arjun worked for a health insurance company as a data scientist in population health. In that role, he gained experience in financial reporting, care management, risk stratification, and modeling. A community ride-along helped him find his passion for SDoH. Since then, he’s made it his mission to learn and implement various strategies to address SDoH in healthcare through tools and concepts, such as imp actability models.