We are currently in the process of updating this chapter and we appreciate your patience whilst this is being completed. The overwhelming influence on health service needs is the age structure of the population. This is recognised in the UK, where NHS resources are allocated on the basis of age-weighted capitation. The ages which entail the highest levels of health care involvement are:
Percentages of health centers screening for core domains.
In a new window Figure 2. Health center data collection survey results. Previous Section Next Section Discussion This study is, to our knowledge, the first of its kind to investigate systematically how SDH screening is incorporated into routine clinical practice at sites likely to provide care to predominantly disadvantaged patient populations.
Our assessment of current SDH screening practices across Michigan demonstrates that HCs across the state are routinely implementing SDH screening into clinical care across many domains, and that there is broad de facto consensus regarding core domains, despite regional differences in the populations served and the services available.
Further, the 15 core domains we empirically identified are largely aligned with recommended screening guidelines established by multiple national and expert bodies. Future work should focus on understanding how and why screening processes differ between HCs, and what, if any, relationship the variation in screening administration has to local populations or resource availability.
Among the 15 core domains identified, not all were routinely included in screening. The lack of universal screening for health-related behaviors was surprising, given the existence of evidence-based instruments to screen specifically for alcohol and tobacco use, 3132 as well as expert panel recommendations to screen for these issues in a clinical setting.
Further work to understand how HCs, providers, and other members of the care team define and screen for SDH will be important in generating consensus for SDH screening instruments. Moreover, clarity in common approaches to screening for SDH can facilitate the efforts of public health officials and policymakers who wish to advance SDH principles and practices.
While increasing evidence suggests that screening for SDH uncovers previously unidentified needs and increases referrals to social services, 3334 evidence is still lacking to link screening for SDH with improvements in health outcomes.
Concerns exist that screening for social issues that cannot be addressed may cause unintended harm in the doctor-patient relationship. Yet, as SDH increasingly move under the umbrella of health and health care, it will be important to ensure screening practices are methodologically sound and evidence-based.
The identification of core domains already in use in HCs across a large and diverse state is an important first step toward a goal of a unified approach to SDH screening for large-scale implementation.
Before this study, 3 state-initiated concurrent projects were being implemented to better understand and address issues related to SDH in Michigan. Both in Michigan and nationally, consistent measures are greatly needed to monitor SDH across a national population of differing communities, values, and resources.
Core domains will allow for trackable metrics across communities to monitor individual SDH, population health, community needs, available ancillary services, and allocation of resources. Identifying core domains will allow policymakers and community stakeholders to determine whether new programs are having their intended health impacts.
Without consistent measures across communities, the ability to monitor the influence of SDH on health outcomes, health care utilization, and costs will be limited.
In addition, uniform core measures allow for increasing leverage of SDH data in the current landscape of changing payment reforms. Limitations Our study had several limitations. First, our data were collected at the HC organization level. Each HC organization is responsible for managing and overseeing multiple delivery sites.
While the HC organization has specific knowledge of overall policy and procedures across sites, the use and incorporation of screening documents in the workflow may vary at each individual delivery site, and we were unable to capture this variation. Second, likely some variation existed in HC organizations' interpretation of what constituted an SDH screening document.
The number of screening documents submitted varied across HCs, as did the nature of the submitted documents. Some HCs submitted a large number of medically related screening forms in addition to SDH screening forms, whereas others submitted only documents related to an ongoing demonstration project in the state that uses an evidence-based questionnaire.
While this may limit the generalizability of our findings across all types of medical practices, HCs serve the highest proportion of low-income patients at risk for unmet social needs. Our data were gathered in one Midwestern state.Issuu is a digital publishing platform that makes it simple to publish magazines, catalogs, newspapers, books, and more online.
Easily share your publications and get them in front of Issuu’s. The report examines the demographic, health and socioeconomic trends accompanying the growth of the aging population.
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