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医生对健康的社会决定因素的记录:两项全国性调查的结果

Physician Documentation of Social Determinants of Health: Results from Two National Surveys.

作者信息

Iott Bradley E, Patel Vaishali, Richwine Chelsea

机构信息

Division of General Internal Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.

Office of the Assistant Secretary for Technology Policy, US Department of Health and Human Services, Washington, D.C, USA.

出版信息

J Gen Intern Med. 2025 Feb;40(3):620-628. doi: 10.1007/s11606-024-09184-w. Epub 2024 Nov 18.

Abstract

OBJECTIVE

We measured physicians' (1) perceived importance of having access to social determinants of health (SDOH) data received from external providers in the electronic health record (EHR); (2) internal SDOH documentation practices in the EHR, including whether physicians document SDOH in a structured format that may facilitate use; and (3) use of EHR SDOH data to identify community resources and make referrals on behalf of patients.

APPROACH

We conducted a secondary analysis of two national physician surveys.

PARTICIPANTS

Respondents from the American Board of Family Medicine Recertification Survey (ABFM, n = 4040), a survey of family physicians fielded 2021-2022, and the National Physician Health IT Survey (NPHIT, n = 3006), a survey of outpatient physicians across specialty areas fielded in 2022.

KEY RESULTS

Under half of physicians felt that SDOH data were very important (ABFM: 44.8%, NPHIT: 30.8%). Although most physicians documented SDOH in the EHR (ABFM: 72%, NPHIT: 63.3%), fewer used structured documentation methods (ABFM: 56.3%, NPHIT: 33.2%). In both surveys, physicians who participated in value-based care initiatives, those for whom > 10% of their patient population was considered vulnerable, and those who felt that their clinic had the resources to address patients' social needs had higher likelihood of documenting SDOH. Sixty-two percent of family physicians reported using SDOH data for identifying resources and making referrals.

CONCLUSIONS

In 2022, most physicians documented SDOH data in their EHR, yet fewer used structured methods, limiting data exchange opportunities to address patients' social needs. Under half of physicians considered access to external SDOH data to be "very" important, suggesting greater reliance on data collected internally and missed opportunities to identify patients who need support. Variation in perceived importance of SDOH data access and SDOH documentation by physician characteristics indicate opportunities to support adoption of structured documentation tools facilitating SDOH data capture and exchange to improve patient-centered care.

摘要

目的

我们衡量了医生的以下几点:(1)对获取电子健康记录(EHR)中来自外部提供者的健康社会决定因素(SDOH)数据的重要性的认知;(2)EHR中的内部SDOH记录实践,包括医生是否以可能便于使用的结构化格式记录SDOH;以及(3)使用EHR中的SDOH数据来识别社区资源并代表患者进行转诊。

方法

我们对两项全国性医生调查进行了二次分析。

参与者

来自美国家庭医学委员会再认证调查(ABFM,n = 4040)的受访者,该调查于2021 - 2022年对家庭医生进行,以及全国医生健康信息技术调查(NPHIT,n = 3006)的受访者,该调查于2022年对各专科领域的门诊医生进行。

主要结果

不到一半的医生认为SDOH数据非常重要(ABFM:44.8%,NPHIT:30.8%)。尽管大多数医生在EHR中记录了SDOH(ABFM:72%,NPHIT:63.3%),但使用结构化记录方法的医生较少(ABFM:56.3%,NPHIT:33.2%)。在两项调查中,参与基于价值的医疗计划的医生、其患者群体中超过10%被视为弱势群体的医生以及那些认为其诊所拥有解决患者社会需求资源的医生记录SDOH的可能性更高。62%的家庭医生报告使用SDOH数据来识别资源并进行转诊。

结论

2022年,大多数医生在其EHR中记录了SDOH数据,但使用结构化方法的医生较少,这限制了满足患者社会需求的数据交换机会。不到一半的医生认为获取外部SDOH数据“非常”重要,这表明更依赖内部收集的数据,并且错失了识别需要支持的患者的机会。医生特征对SDOH数据获取和SDOH记录重要性的认知差异表明,有机会支持采用结构化记录工具,以促进SDOH数据的获取和交换,从而改善以患者为中心的医疗服务。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f764/11861457/0e4835b34bff/11606_2024_9184_Fig1_HTML.jpg

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