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Social Determinants of Health and Clinical Documentation Improvement

By Susan Chapman, MA, MFA, PGYT

Social determinants of health (SDoH) are individuals’ living conditions that can include socioeconomic status, housing, food security, education, access to health care, and support systems and their impact on health outcomes.1 By ensuring that health care documentation accurately reflects a patient's medical and social histories, clinical documentation improvement (CDI) professionals can play essential roles in addressing SDoH.

The Impact of SDoH on Health Outcomes
SDoH can significantly affect health outcomes in a variety of ways. Low-income individuals and families with limited access to health care, for example, are more likely to experience poor health outcomes such as chronic disease and mental health disorders.2 Additionally, social isolation and lack of social support have been linked to poor health outcomes, including increased risk of depression, cardiovascular disease, and premature death.3

Addressing SDOH in CDI
CDI professionals can help ensure that documentation accurately reflects the patient's social history as a way to affect health outcomes. For instance, documentation ideally should include information on a patient's housing situation, access to transportation, and social-support network. This information can enable health care providers to better understand a patient's health and develop a more effective treatment plan.

However, gathering that information can be challenging. According to a 2021 article in For The Record, professionals must take care when asking patients about sensitive topics such as housing and personal safety within their families. One expert, Jennifer Mueller, MBA, RHIA, FACHE, FAHIMA, and vice president and privacy officer for the Wisconsin Hospital Association, noted that patients are more likely to respond accurately through private questionnaires rather than interviews.4

Kim Conner, BSN, CCDS-O, a CDI educational specialist, adds that if the patients are to be interviewed, “It’s important to determine who’s going to ask the questions. Is it the physicians, the social worker, or the case manager? It’s a team effort with CDI right in the middle of it because it’s all about documentation,” she says. Conner notes that CDI professionals should look for clues in the documentation that then prompt them to ask physicians questions to help them capture crucial SDoH data.

Conner recommends forming committees to begin addressing the issue. “It’s a matter of getting stakeholders to the table to say how we should handle this situation. They need to be asking, ‘How are we going to streamline this process and be able to capture all of this information?’ That initial step will be important, and then we have to determine how to start working these things out with coding departments,” she says.

Working closely with social workers and other community professionals is another avenue for CDI professionals to address SDoH. Those community professionals can provide valuable information on patients’ social situations and help connect them with vital resources to satisfy social needs. Through these important collaborations, CDI professionals can help ensure that documentation accurately reflects patients’ full circumstances and the interventions recommended to help them.

Conner notes that CDI’s role in SDoH is an area she’s very passionate about. CDI professionals, like Conner, can play vital roles in improving health care policies and practices. Such work can include advocacy for social policies that will enhance health care access and social services or helping implement appropriate screening tools to identify patients who may be at risk for poor health outcomes due to social factors.

“Social determinants of health is a vital issue right now,” Conner says. “There are statistics from 2022 that show 80% of all health problems are related to social determinants of health. There is a big push for hospitals to create sustainable programs. It’s not enough for them to be collecting the data. They have to report that they’re accurately capturing the information from a quality standpoint, accurately representing their patient population, and also demonstrating what they are doing with the information they gather. By next year, that will become mandatory.”

Because addressing SDoH is critical to improving patient outcomes and overall population health,5 CDI professionals can help improve health care quality and promote better health outcomes for all patients. “We need to do better. We need to be able to support the health care initiatives that are moving forward, which is all about quality of care vs quantity and cost,” Conner says. “We also need to know how we are keeping people well at home even with chronic disease problems and that those factors are all contributors to promoting that wellness.”

— Susan Chapman, MA, MFA, PGYT, is a Los Angeles-based freelance writer and editor.

References
1. Social determinants of health. US Department of Health and Human Services website. https://health.gov/healthypeople/priority-areas/social-determinants-health

2. Havranek EP, Mujahid MS, Barr DA, et al. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132(9):873-898.

3. Xia N, Li H. Loneliness, social isolation, and cardiovascular health. Antioxid Redox Signal. 2018;28(9):837-851.

4. Chapman S. Making sense of social determinants of health. For The Record. 2021;23(6):14-17.

5. Johnson E. How SDoH improves patient outcomes for community care organizations. Arcadia website. https://arcadia.io/resources/sdoh-for-community-care-orgs. Published August 11, 2022.