While healthcare practitioners are not equipped to appropriately address patients’ social situations, understanding a little about the various factors and challenges they face in their daily lives can open the door to more positive patient interactions and outcomes.
And since such factors play a greater-than-expected role in patients’ health outcomes, considering these appropriately titled “social determinants of health” has become increasingly critical in your ability as rehab therapists to help patients achieve their functional and wellness goals.
Payers know this. And as they strive to adopt reimbursement models tied to value-based care, they see the ability to assess and address social determinants of health (SDOH) as a key competency for success.1
So, it behooves you as physical therapists, occupational therapists and speech-language pathologists to understand the basics around SDOH – what they are, how they affect patients, how to track the data, and what may be expected of you in the future.
What Are Social Determinants of Health (SDOH)?
Social determinants of health are defined as “the conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.”2
These conditions can be broken down into five categories:
Economic Stability: Do your rehab therapy patients have steady employment? Are there factors in their lives (i.e., disabilities, injuries, lack of resources such as child care, etc.) keeping them from earning or holding a steady job?
Education Access and Quality: Do patients and their families have access to good, quality education? How has the stress of poverty affected development? Are children experiencing forms of social discrimination that may affect school performance?
Health Care Access and Quality: Do patients have – or have access to – health insurance? Do they have primary care providers? Can they afford preventative care? Necessary treatments and medication?
Neighborhood and Built Environment: Do patients live in violent neighborhoods? Do they have access to clean air and drinking water? Are safe sidewalks, parks and/or trails part of their neighborhoods?
Social and Community Context: Do people you see at your rehab therapy clinic have strong family support, social circles and/or community support? Do they feel safe at home, free of discrimination, and able to afford what they need to promote optimal well-being?
How Do These Social Determinants Affect Patient Health?
Whereas medical care accounts for around 20% of the health outcomes for a specific population3, research shows that social determinants of health account for up to 80%.3
In other words, where someone is born, lives, grows, learns, works and ages can have up to four times the impact on health outcomes as what health professionals can offer the typical patient independent of such factors.
How can this be?
Consider the role transportation and work/childcare flexibility can have in patients’ ability to make appointments and complete a plan of care. Or, how a patient who lives near a community center and paved walking paths may benefit from advice differently than one who lives in an isolated rural setting or a busy urban city center.
Social determinants of health simply acknowledge that there are a lot of factors at play when considering patient health and their ability to comply with their plans of care.
And, while much of it simply can’t be controlled by practitioners, understanding these factors can enable rehab therapists to do their jobs better while achieving higher patient outcomes.
Put SDOH Data to Good Use in Rehab Therapy
As stated earlier, payers that have or are in the process of adopting reimbursement models around value-based care have taken particular interest in social determinants of health.
This includes the Centers for Medicare and Medicaid Services (CMS), which has emphasized the collection of SDOH data via ICD-10 Z codes to help determine a baseline of its impact on population health.
The goal: to develop policies and systems that work toward healthcare equity.4
Rehab therapists who collect SDOH data, however, can make use of this information in the more immediate future. That is, insights gained through collecting this data can help drive the creation of more appropriate and achievable care plans for individual rehab therapy patients.
You can also help patients identify community resources that may provide them with services appropriate for their situations and challenges.
The patient doesn’t have great work flexibility? Schedule evening, weekend or lunch-hour appointments. He or she doesn’t have access to safe walking routes or a gym? Consider altering home exercise programs to accommodate this.
Your patient is elderly and doesn’t have a reliable support system? Connect him or her with local senior service agencies and vow to check in with them more often.
How To Collect Social Determinants of Health Data
Collecting meaningful SDOH data from our patients, and doing so in a consistent and meaningful way, will require some finesse.
The first step is to simply be open with patients, making them aware of why this information is essential in optimizing their health outcomes. Let them how this information is useful not just for you as a practitioner, but for them to achieve the goals they’re setting out to accomplish.
In gathering relevant data, consider reviewing the ICD-10 Z55 to Z65 codes to see what types of SDOH information CMS is focusing on. But, don’t limit yourself to that.
Plenty of standardized measures exist for practitioners who wish to include social determinants of health as part of their initial evaluation process. These tools help you determine the information you need to seek as well as help you record and track this information for your patients.
To learn more about these tools, and for a more in-depth view of how social determinants of health may affect you and your rehab therapy patients, watch our recent (and free) webinar titled, “Leveraging Social Determinants of Health Data to Advance Patient Outcomes.”
Leveraging Social Determinants of Health Data to Advance Patient Outcomes
Learn the basics of social determinants of health, the relationship between SDOH and patient outcomes, and how to best capture these variables
1 Primary Care: Clinics in Office Practice, “Assessing and Addressing Social Determinants of Health,” Oct. 3, 2019
2 US Department of Health and Human Services, Healthy People 2030: Social Determinants of Health, Sept. 30, 2022
3 CareJourney, “Social Determinants of Health: The Unaddressed Variable Accounting for 80% of Health Outcomes,” Sept. 18, 2020
4 The World Health Organization, Social Determinants of Health, September 30, 2022