Leveraging Health and Community Data: Insights into Social Determinants of Health

Abstract

The field of health informatics is rapidly evolving to encompass data from outside health care systems. Much of the external data is at the community level and is analyzed in conjunction with patient-level data to identify potential living circumstances that adversely affect patients’ health. These circumstances, or social determinants of health, are often the key to resolving chronic health problems and preventable use of health care facilities. The effective resolution of these problems frequently requires a partnership between health professionals and others, such as attorneys, social workers, or civil agencies. The exponential growth of data that are available presents challenges in management, secure storage, and translation into actionable knowledge that facilitates gained insights in a timely manner, and recruitment and retention of skilled personnel.

Appendix: Answers to Review Questions

• 1. As a health services researcher, you are interested in a pattern you observed in population health data that indicate a higher-than normal prevalence of pancreatic cancer in the lower Ohio River Valley in the U.S. You want to explore potential factors associated with this cancer, including the characteristics of the people who developed this cancer and any environmental exposures people with this cancer may have experienced. Identify at least two sources of data you might find available in the cloud where you can explore data you need.

  There are many resources for information; here are some examples.

Resource	Type of data
Cancer registries	Detailed information about cancer patients, distribution of cancer cases by gender, race/ethnicity, age, and other demographic factors, what prevention efforts work best, who is most likely to get cancer. Cancer registries analyze data and share with groups working to fight cancer.
National Vital Statistics database (CDC)	Captures all deaths from all causes across every state in the nation. These data help track the characteristics of those dying in the United States, help determine life expectancy, and allow comparisons of death trends with other countries
Death certificates	Details vary from state to state, but often include: • Full name, • Address, • Birth date and birthplace, • father’s name and birthplace, • mother’s name and birthplace, • If a veteran, the discharge or claim number, • Education, • Marital status and name of surviving spouse, if any, • Date, place, and time of death, and, • Cause of death.
Labor statistics	Types and prevalence of employers and industries in the areas, products manufactured, services provided.
Environmental Protection Agency	Toxic discharges from industry, agriculture, or other sources in the area where the patient lived
Interviews with patients and families	Qualitative data regarding where the patient’s place of employment, lifestyle, smoker or non-smoker, other relatives with cancer and what type of cancer, possible exposures to toxins

• 2. Identify three challenges health care providers experience that are related to collecting relevant data on patients’ SDOH. Suggest one potential response to each challenge.

  There are many challenges and these are a few examples:

Challenge	Response
Lack of standards for defining social determinants of health	Work within your organization and across organizations to be part of developing standards; be consistent within your own organization; provide input to national organizations working to define standards
Inadequate healthcare-based solutions for the core problems such as access to care, poverty and food insecurity	Develop partnerships with partners who can provide solutions, such as social work agencies and medical-legal partnerships
Reluctance of some providers to bring up sensitive topics such as abuse with patients	Educate providers—include opportunities to practice in with classmates before taking the skills to patients; allow clients to self-report via paper or electronic survey; ensure privacy during face-to-face conversations

• 3. You are a social worker helping a family that is struggling to obtain disability payments and health coverage for the husband, who was injured on his job as a construction worker. He has applied for disability and workmen’s compensation and been denied. The family is very frustrated with the “run around” he has gotten from the Social Security and Workmen’s Compensation offices and is suffering financially. Identify at least one external resource the health care provider could engage to help the family resolve this problem.

  The most useful resource to address denial of benefits is legal assistance through a medical-legal partnership. If an MLP is not available, the local Legal Aid Society is another option.