UCSF

Purpose

To assess the extent that patients' social determinants of health (SDOH) influence safety-net primary care clinicians' decisions at the point of care; examine how that information comes to the clinician's attention; and analyze clinician, patient, and encounter characteristics associated with the use of SDOH data in clinical decision making.

Methods

Thirty-eight clinicians working in 21 clinics were prompted to complete 2 short card surveys embedded in the electronic health record (EHR) daily for 3 weeks. Survey data were matched with clinician-, encounter-, and patient-level variables from the EHR. Descriptive statistics and generalized estimating equation models were used to assess relationships between the variables and the clinician reported use of SDOH data to inform care.

Results

Social determinants of health were reported to influence care in 35% of surveyed encounters. The most common sources of information on patients' SDOH were conversations with patients (76%), prior knowledge (64%), and the EHR (46%). Social determinants of health were significantly more likely to influence care among male and non-English-speaking patients, and those with discrete SDOH screening data documented in the EHR.

Conclusions

Electronic health records present an opportunity to support clinicians integrating information about patients' social and economic circumstances into care planning. Study findings suggest that SDOH information from standardized screening documented in the EHR, combined with patient-clinician conversations, may enable social risk-adjusted care. Electronic health record tools and clinic workflows could be used to support both documentation and conversations. Study results also identified factors that may cue clinicians to include SDOH information in point-of-care decision-making. Future research should explore this topic further.