Department of Medicine, Harvard Medical School, Boston, Massachusetts.
OpenNotes, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
JAMA Netw Open. 2024 Oct 1;7(10):e2444376. doi: 10.1001/jamanetworkopen.2024.44376.
Social determinant of health (SDOH) data are essential to individualized care and reducing health disparities. However, there is little standardization in the way that SDOH data are collected, and barriers to increasing the collection of such data exist at both the patient and clinician levels.
To evaluate clinician, patient, and care partner perspectives on the barriers to and facilitators of patients sharing SDOH information with their clinicians.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study included clinicians, patients, and care partners across the United States. Focus groups were conducted between September 2022 and February 2023 to understand the experience of collecting, documenting, and exchanging SDOH data.
Rapid assessment procedures were used to analyze focus group transcripts, creating summaries, codes, and themes mapped directly to the project research questions.
A total of 235 individuals participated, including 109 (46.4%) clinicians (60 [55.0%] male; 25 [22.9%] Asian, 2 [1.8%] Black, and 74 [67.9%] White) and 126 (53.6%) patients and care partners (45 [35.7%] male; 1 [0.8%] Asian, 48 [38.1%] Black, and 64 [50.8%] White). Clinicians and patients agreed that SDOH data are important for clinicians to know. Both clinicians and patients wanted a structured, standardized way to collect SDOH data in the future, accompanied by time for more in-depth discussion during the visit. However, they highlighted numerous issues that impact collecting these data, including beliefs about how the information will be used, the clinician-patient relationship, having enough of the right staff, time needed to collect SDOH information, and technology used to collect the data (eg, usability, standardization).
This qualitative study of the experience of collecting, documenting, and exchanging SDOH data underscores the ongoing barriers to widespread adoption of uniform approaches to SDOH data documentation as well as factors that may help lower those barriers, such as trusting patient-clinician relationships, greater transparency in how the data will be used, and targeted resources. A multifaceted approach to addressing the concerns raised by clinicians, patients, and care partners is required to ensure that such data can be captured in a way that improves care and allows for progress toward an equitable health care system.
社会决定健康因素（SDOH）数据对于个性化护理和减少健康差距至关重要。然而，SDOH 数据的收集方式几乎没有标准化，并且在患者和临床医生层面都存在增加此类数据收集的障碍。
评估临床医生、患者和护理伙伴对患者与临床医生分享 SDOH 信息的障碍和促进因素的看法。
设计、地点和参与者：这是一项在美国开展的定性研究，包括临床医生、患者和护理伙伴。2022 年 9 月至 2023 年 2 月期间进行了焦点小组，以了解收集、记录和交换 SDOH 数据的经验。
快速评估程序用于分析焦点小组的转录本，创建直接针对项目研究问题的摘要、代码和主题。
共有 235 人参与，包括 109 名（46.4%）临床医生（60 名[55.0%]为男性；25 名[22.9%]为亚洲人，2 名[1.8%]为黑人，74 名[67.9%]为白人）和 126 名（53.6%）患者和护理伙伴（45 名[35.7%]为男性；1 名[0.8%]为亚洲人，48 名[38.1%]为黑人，64 名[50.8%]为白人）。临床医生和患者都认为 SDOH 数据对临床医生了解患者很重要。临床医生和患者都希望将来有一种结构化、标准化的方式来收集 SDOH 数据，并在就诊期间有更多时间进行更深入的讨论。然而，他们强调了许多影响收集这些数据的问题，包括对信息将如何使用的看法、医患关系、拥有足够的合适人员、收集 SDOH 信息所需的时间以及用于收集数据的技术（例如，可用性、标准化）。
这项关于收集、记录和交换 SDOH 数据经验的定性研究强调了在广泛采用统一的 SDOH 数据记录方法方面持续存在的障碍，以及可能有助于降低这些障碍的因素，例如信任的医患关系、更大透明度的信息使用方式，以及有针对性的资源。需要采取多方面的方法来解决临床医生、患者和护理伙伴提出的问题，以确保以改善护理和推进公平医疗保健系统的方式能够捕获这些数据。
