Telehospital Medicine and the Social Determinants of Health

Quality health care is essential to health, but health outcomes are driven by a range of other factors, including the patient’s genetic makeup, health behaviors, social, economic, and environmental factors.?While researchers are divided on the relative importance of each of these factors to health, there is a consensus that addressing the social determinants of health is important for improving health outcomes and reducing health disparities.

The social determinants of health are the conditions in which people are born, grow, live, work and age. They include factors such as socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, in addition to access to health care.??

There have been a variety of initiatives, both inside and outside the health care sector, to address the social determinants of health. Outside of the health care sector, policies and practices can be implemented that promote health and health equity.??A good example is improving urban transport in ways that make it easier for urban residents to get to a doctor’s office, drug store, clinic or hospital, or significantly reduce air pollution by decreasing vehicle congestion.

Within the health care sector, the Federal, state, and local governments and health care providers and plans have made extensive efforts to address the social determinants of health. These efforts include expanding health insurance coverage under the Affordable Care Act (ACA), new funding and demonstration projects provided through the ACA, and an increasing shift across the entire health system toward value- or outcome-based payments and “whole person” care.?

Most physicians, and hospitalists in particular, acknowledge that the social determinants of health can influence care outcomes.??However, some may feel that trying to address factors such as homelessness, food insecurity, or lack of ready access to transportation or pharmacy services either impractical, or just “not part of the doctor’s job.”

It will be increasingly difficult to maintain such a hands-off attitude as the US health care system continues to transition towards a value-based health care model and evidence grows that social factors are important contributors to costly outcomes, such as avoidable hospital readmissions or emergency room visits.

Hospitalists are well-positioned to try to figure out how the psychosocial context of their patients’ lives contributes to their health care needs.???What are the circumstances that led to the hospitalization in the first place???What will happen to the patient after they are discharged?

Despite not being in the same room with their patient, the growing number of telehospitalists have a similar obligation to try to understand how the conditions of the patient’s life contributed to their requiring hospitalization, and influence the choice of treatment strategy.??Telehospitalists’ training emphasizes providing them the online and personal skills needed to establish a personal rapport with the patient and any family members who are in the room with the patient.??

Such a rapport is vital to understanding the social factors influencing the patient’s hospitalization and treatment.???It is another way in which the distinction between in-house hospitalists and telehospitalists is becoming increasingly blurred.