Why it’s important to document your patients’ social determinants of health

Electronic health records (EHRs) contain a patient’s vital health information. While this includes their medical history, including any testing, diagnoses and treatments, research suggests there is also a benefit of documenting their social determinants of health (SDOH). 

What are social determinants of health?

The Office of Disease Prevention and Health Promotion explains t social determinants of health are the environments people spend their time in during their course of life that “affect a wide range of health, functioning and quality-of-life outcomes and risks.” The following are the five SDOH domains: 

1. Economic stability: Whether the person has steady employment or lives in poverty.
2. Education access and quality: Namely whether children and teens have access to high-quality education.
3. Healthcare access and quality: If the person has access to care needed and the quality of that care.
4. Neighborhood and built environment: Whether these environments are both safe and healthy.
5. Social and community context: Whether they feel supported by their family, friends and community.

SDOH and musculoskeletal health

Research published in the journal Arthritis Care and Research in June 2023 reports certain social determinants of health are linked with an increased risk of musculoskeletal disease. This was supported by the finding that, of the 558 individuals included in this study, 45% had one or more SDOH-related needs documented within the notes of their EHRs.  

The following are the SDOH needs recorded most frequently: 

• Financial insecurity (31%) 
• Transportation needs (19%) 
• Food insecurity (17%) 

This research also revealed that black individuals were over two times more likely to have an SDOH need in their health records than white individuals. SDOH needs were also more likely to appear in the records of individuals with Medicaid or Medicare coverage than those who were commercially insured. 

Importance of SDOH documentation

Documenting patients’ economic, educational and social situations can help practitioners better recognize those at greater risk of musculoskeletal issues. Or, as stated in a 2019 article in the Journal of Orthopaedic and Sports Physical Therapy, “If you aren’t measuring them [social determinants of health], you aren’t seeing the big picture.” 

In this article, researchers from Duke University and the University of Mississippi Medical Center contend a person’s SDOH factors may be more influential in their musculoskeletal treatment and recovery than the interventions supplied by health professionals. Thus, taking these factors into account can help practitioners provide a higher level of care. 

This type of care begins with adding patients’ SDOH information to their EHRs. By making this data accessible to healthcare providers, these professionals are in a position to not only discuss how these factors may be affecting a patient’s health and recovery but also identify patients who may benefit from resources that can help address their needs. 

Addressing patients’ SDOH needs

In one article directed toward healthcare professionals, suggestions provided for addressing patient SDOH factors include: 

• Documenting patient language preference and providing interpreters, if necessary 
• Providing extended office hours to better accommodate patient schedules 
• Creating a culturally safe and welcoming healthcare environment 
• Reaching out to and/or partnering with local schools and community groups 

It’s also beneficial to learn the resources available to address SDOH-related needs. The Agency for Healthcare Research and Quality provides several links to SDOH resources and materials. Some link to the latest research while others link to tools providers can use to address SDOH within their practices. 

In November 2023, the Domestic Policy Council Office of Science and Technology Policy also published “The U.S. Playbook to Address Social Determinants of Health” which outlines actions being taken on a national level to address these factors. This provides insight into what can be expected in the future to ultimately improve Americans’ health. 

Final thoughts

Asking your patients about their social determinants of health can enhance your understanding of the challenges they face and how those challenges may affect their health. Identifying, then addressing these factors can make a huge difference in your patients’ healthcare outcomes.