OCHIN Inc, Portland, Oregon
OCHIN Inc, Portland, Oregon.
Ann Fam Med. 2023 Mar-Apr;21(2):143-150. doi: 10.1370/afm.2953.
To assess the extent that patients' social determinants of health (SDOH) influence safety-net primary care clinicians' decisions at the point of care; examine how that information comes to the clinician's attention; and analyze clinician, patient, and encounter characteristics associated with the use of SDOH data in clinical decision making.
Thirty-eight clinicians working in 21 clinics were prompted to complete 2 short card surveys embedded in the electronic health record (EHR) daily for 3 weeks. Survey data were matched with clinician-, encounter-, and patient-level variables from the EHR. Descriptive statistics and generalized estimating equation models were used to assess relationships between the variables and the clinician reported use of SDOH data to inform care.
Social determinants of health were reported to influence care in 35% of surveyed encounters. The most common sources of information on patients' SDOH were conversations with patients (76%), prior knowledge (64%), and the EHR (46%). Social determinants of health were significantly more likely to influence care among male and non-English-speaking patients, and those with discrete SDOH screening data documented in the EHR.
Electronic health records present an opportunity to support clinicians integrating information about patients' social and economic circumstances into care planning. Study findings suggest that SDOH information from standardized screening documented in the EHR, combined with patient-clinician conversations, may enable social risk-adjusted care. Electronic health record tools and clinic workflows could be used to support both documentation and conversations. Study results also identified factors that may cue clinicians to include SDOH information in point-of-care decision-making. Future research should explore this topic further.
评估患者健康的社会决定因素（SDOH）在医疗保健点对安全网初级保健临床医生决策的影响程度；研究这些信息如何引起临床医生的注意；并分析与在临床决策中使用 SDOH 数据相关的临床医生、患者和就诊特征。
38 名在 21 个诊所工作的临床医生被提示在电子健康记录（EHR）中每天填写 2 份简短的卡片调查，为期 3 周。调查数据与 EHR 中的临床医生、就诊和患者水平变量相匹配。使用描述性统计和广义估计方程模型评估变量之间的关系以及临床医生报告使用 SDOH 数据来提供护理。
SDOH 报告称在 35%的就诊中影响了护理。了解患者 SDOH 的最常见信息来源是与患者的对话（76%）、先前的知识（64%）和 EHR（46%）。在男性和非英语患者以及在 EHR 中有离散 SDOH 筛查数据记录的患者中，SDOH 更有可能影响护理。
电子健康记录为临床医生将患者的社会和经济状况信息纳入护理计划提供了机会。研究结果表明，EHR 中记录的标准化筛查产生的 SDOH 信息，结合患者-临床医生的对话，可能能够实现社会风险调整的护理。电子健康记录工具和诊所工作流程可用于支持文档记录和对话。研究结果还确定了可能提示临床医生在护理点决策中包含 SDOH 信息的因素。未来的研究应进一步探讨这一主题。
