Nurses Role in Addressing Social Determinants of Health

The American Academy of Medicine's Future of Nursing 2020-2030 Technical Panel rounded up many ongoing trends and insights for nurse managers and leaders recently.

Among the panel were Robyn Begley, DNP, R.N, and Priya Bathija, both executives from the American Hospital Association. They continued the important conversation of Medicaid's, hospitals', and other healthcare providers' attention on social determinants of health and their impact on value-based payment models.

Value-based models are an important ongoing trend you should be aware of if you aren't already. Providers are using value-based models to measure patient experiences and outcomes and compare them to the cost of care provided. In other words, what does the patient get, for what they pay?

And we don't see this trend stopping.

Between 2012 - 2017, the number of hospitals using alternative payment methods like value-based payment models nearly doubled to 2,000.

The problem is, hospitals and other care providers still don't have a clear determination of what value really is… yet.

Healthcare providers are taking initiatives to improve the value they are providing by understanding what social determinants of health they should screen for, and how to record successful initiatives to back up the validity of value-based payment models.

In order to do that, hospitals are looking to registered nurses.

Registered nurses play a vital role in screening for social determinants of health for a few reasons: 1) they are trained to consider care beyond the discharge paradigm, they consider the patient's family during care, and 3) they have developed extensive touchpoints with a patient's schools, communities, ambulatory, outpatient and inpatient settings.

But First, What Are Social Determinants?

Social determinants of health are an assessment of the social needs and conditions affecting a patient's everyday life.

Socioeconomic status, education, neighborhood, and physical environment, employment, and social support networks, as well as access to health care all factor into value-based payment models and ultimately, how care is delivered and when.

According to the AHA's 2018 Population Health, Equity and Diversity in Health Care Survey, 77% of hospitals are already screening some or all patients for social needs, of which health behaviors (85%), transportation (71%), and food (63%) rank as most reported.

In addition, 91% of hospitals surveyed have partnered with one or more community organizers to help understand the social needs of their communities served.

But there is still a need for more research on social determinants of health and registered nurses are uniquely qualified and positioned to screen for them.

Here's why.

Nurses Move Beyond the Discharge Paradigm

Since the beginning of your education and every day on the unit floor, you are taught to assess the totality of the patient.

It is no longer adequate to focus only on the patient's clinical needs. Rather, focusing on a holistic approach allows you to be aware of the impact social needs have on a patient's health and well-being, and whether those social needs will cause difficulties post-care or even readmission.

This is extremely important considering 19.6% of nearly 12 million Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days, and 34.0% were rehospitalized within 90 days.

Identifying social determinants of health at the first stages of admission will help hospitals and other care settings project the proper care (and education) their patients need, as well as better coordinate their care as they transition home or to outpatient care services.

We only expect this trend to continue as we see more registered nurses transition into care and case management.

Nurses Consider More Than the Patient

If you've ever turned on a recent episode of Grey's Anatomy or Chicago Med, you'd know that sometimes the biggest players affecting a patient's health has nothing to do with the patient at all.

Patients can have parents, siblings, and families that care for them during admission… and they too are considered as social determinants of health.

Recognizing, recording, and addressing challenges with families while providing care is needed to adequately assess the totality of the patient's care and the potential cost the care provider may incur.

Developing relationships with family members by providing emotional support, communicating an understanding of the care being provided and why, consulting on care options, and training can not only help alleviate some of these challenges but also help identify a patient's social needs in the process.

Nurses Develop Many Touchpoints Within Other Settings

Just as observing and interacting with family expands your knowledge of a patient's social determinants of health, establishing communications with touchpoints outside of the inpatient setting is also critical in fully understanding the complete lifecycle of a patient's care.

• EMTs and ambulance units may be able to communicate social needs noticed during their ride that would otherwise be unknown.
• Communities members may provide a deeper understanding of a patient's personal issues, lifestyle, and home environment.
• School nurses and outpatient settings may need to continue care delivery and evaluations of the patient's recovery.

All of these touchpoints factor into the ability for a patient to return to full health and collecting these data points adjust how and when care is provided.

Conclusion

The role of nurses in evaluating social determinants of health is essential to the future success of value-based payment models.

Nurses are uniquely qualified to recognize, record, and address social needs as they coordinate care and develop relationships with relevant support networks, including families, communities, schools, ambulatory, outpatient and inpatient care settings.

But most importantly, nurses understand that a patient's care and ability to return to full health extends well beyond the inpatient setting. Adapting care to address a patient's social determinants of health will not only prove better results for the patient but also better cost of care too.

Are you doing all you can to address a patient's social determinants of health?

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Written by: American Nurses Association \ California Staff - advancing the nursing profession by creating nurse pioneers and advocating for modern policies and legislation.