A driving force for health equity

JAMA Invited Commentary and National Academies Report Feature OCHIN Lead Research Scientist, Dr. Rachel Gold.

Two recent publications, in JAMA Network Open and a National Academies report, highlight OCHIN’s leadership and learnings related to collecting and using information on patients’ social determinants of health (SDH).

OCHIN was a pioneer in adding SDH screening tools into the EHR, leading to the creation of the largest existing repository of EHR-embedded, patient-reported SDH screening results, with more than 300,000 SDH screens captured as of September 2019. In addition, OCHIN is a national leader on research on best practices for the implementation of SDH screening, having receive two of the first NIH-funded studies in this field.

Evidence increasingly demonstrates that screening patients for SDH can be important for treatment and care planning, as SDH can negatively influence patient outcomes and contribute to total costs of care. Screening patients for SDH can also provide direction for investment and advocacy in clinic settings and communities.

In comments invited by JAMA, Dr. Rachel Gold, OCHIN’s Lead Research Scientist, highlights the fundamental challenges of implementing the practice-level changes involved in screening patients for SDH factors. She states that primary care providers, especially safety-net providers, need both financial and implementation support to successfully adopt systematic documentation of patients’ social risks, expounding on findings from Fraze et al, [1] which indicate that clinics are more apt to collect SDH data if financially incentivized to do so. Gold further explains how critical it is to use evidence-based implementation approaches, like those identified through research conducted of OCHIN, to avoid unintended consequences among healthcare providers – and policymakers – seeking to support the implementation of screening. 

In these comments, Dr. Gold writes that, “Disseminating and sustaining social risk screening will require a deep understanding of how best to structure financial and other incentives to optimally support social risk screening; high-quality research is needed to help design reimbursement models that reliably influence adoption.”[2]

A National Academy of Medicine report on social care integration released today, of which Dr. Gold is a co-author, includes a comprehensive summary of potential challenges associated with implementing SDH screening and referral activities. The report includes lessons learned through research conducted at OCHIN member safety net clinics who have implemented SDH screening. Dr. Gold describes possible strategies to address implementation challenges in clinic settings including addressing and developing staff buy-in, community partnerships, appropriate technology, and effective payment structures to support adoption of SDH screening. 

Rachel Gold, PhD, MPH is Lead Research Scientist at OCHIN and holds a joint appointment as a Senior Investigator at Kaiser Permanente’s Center for Health Research. She is a lead or co-author on more than 90 peer-reviewed publications and is a leading voice in understanding how to implement the collection of social determinants of health data collection in primary care settings

[1] Fraze TK, Brewster AL, Lewis VA, Beidler LB, Murray GF, Colla CH. Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals. JAMA Netw Open. Published online September 18, 20192(9):e1911514. doi:10.1001/jamanetworkopen.2019.11514

[2] Gold R, Gottlieb L. National Data on Social Risk Screening Underscore the Need for Implementation Research. JAMA Netw Open. Published online September 18, 20192(9):e1911513. doi:10.1001/jamanetworkopen.2019.11513