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Six steps to improving equity in health outcomes


Understanding a patient's life circumstances is key to improving their health. Here's a guide for how to start.

Every physician knows the care they deliver to patients has its limitations. While examining and treating a patient do play a huge role in maintaining their health, lifestyle factors are undoubtedly more than half of the equation.

Where a patient lives, where they work, and what they do in their free time are immensely important, and understanding these social factors is key for physicians looking to improve the overall wellness of their patients.

For example, does a patient have reliable transportation? Do they live in a safe neighborhood? Do they have reliable access to food? These factors, known as social determinants of health (SDoH), can dramatically affect health outcomes. However, addressing the potential inequities in SDoH remains challenging.

Typically, providers spend only a few minutes with each patient, and most of that time is spent looking at a medical record or examining symptoms. This doesn’t give them much insight into patients' lives to see what is happening – after all, a physician is not a family member or a social worker.

Nevertheless, it’s still vital to understand who a patient is outside the clinic, and to address social and lifestyle factors that can negatively impact their health. With this in mind, we spoke with experts in the field to compile a list of steps that doctors and other care

providers can realistically take to affect the overall picture of health equity.

1. When face-to-face, ask questions.

The medical industry has collected plenty of data over the years, but much of it is underutilized, unusable in its current format, or simply inaccurate. Further, a patient is more than just data. Sometimes, you have to look beyond the electronic health record and ask a patient about themselves to get a full picture of who they are.

The social determinants that impact health can often be very personal and uncomfortable, and patients may not always want to talk about them. But you have to try.

All clinical staff should be trained to ask questions and gather information on a patient’s life in a sensitive, non-judgmental way. The way questions are phrased, and the tone of voice used when posing questions are important factors in collecting useful, unbiased SDoH information helps to paint an accurate picture of a patient’s life, so any potential inequities and challenges can be addressed.

2. Be aware of your biases.

We are all human, and as such, we all frame the world based on our past experiences, upbringing, culture, and more. Everything from initial data collection to patient interactions to a prescribed treatment plan and follow-up is fraught with bias. That alone does not make a person a good or bad clinician.

Being aware that those biases exist and willing to make changes to address them is a huge step forward in addressing inequities in health care. That said, the work in confronting bias has to be an ongoing initiative to keep clinicians mindful of how they act and what they say.

3. Trust takes time, but it’s important.

The only way to understand SDoH and their resulting inequities is by talking to patients to get a sense of their background, perspective on life, and what resources they may or may not have. Unfortunately, not all patients feel safe in a medical environment. It takes courage for people to open up and be vulnerable about their challenges.

Medical providers who can build a solid relationship with patients over time by being open and honest, approaching care without judgment, and listening with empathy will get more accurate information. Ultimately, this foundation of trust is vital in reaching better outcomes for everyone. As more health care moves into the home, we will likely see deeper and stronger trust develop between patient and provider.

4. Know your community and provide education.

Inequities in health care affect everyone. Whole communities are impacted when an infectious disease spreads, stress and anxiety damage the environment in schools, the workplace, and the social fabric of the community. Labor hours are lost due to medical disabilities, and health care costs rise.

Education can help providers, patients, and the community understand health inequity. However, there is no one-size-fits-all course that will address the problems facing each region. Community leaders and health care providers can come together to talk about the unique background and challenges within their locales.

5. Leverage helpful technology.

Software solutions can be incredible tools for gathering and tracking data, but some technology creates more work for providers without adding value. The onus is on developers to understand the problems facing the medical industry and the way clinicians work day-to-day and then solve those problems in a way that helps.

When software and medical providers have real conversations and create partnerships, technology can be utilized to get the right information to the right person when and where they need it. Data––both the initial collection and the application––has to be part of the standard workflow so that it is a usable tool.

6. Build new care models as you gather SDoH data.

Amid the COVID-19 pandemic, Denver Health used the data they already had, combined with new information clinicians gathered from the community, to shift their care policies.

As just one example, data revealed that up to 25% of their patients self-identified as food insecure. As a result, they began an initiative to partner with a local organization called “Fill the Void” to provide food assistance resources to patients.

Digging deep into available data on patients is as important as gathering new information. The Denver Health case study is just one example of how organizations can move forward once they have the trust of their patients, smart technology solutions, and input from the community.

Health inequities will not be addressed overnight, nor will solutions come from individual cases or a single organization. It takes community input, policy innovations, and sufficient resources to address complicated social factors that negatively impact health. But by taking some basic steps, providers can begin to understand some of these concerns and address them to improve the health of their patients immediately.

Therasa Bell is co-founder, president, and chief technology officer at Kno2. Peter Schoch is senior vice president of population health, Advent Health System and president of the Florida Hospital Physicians Network

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