The Importance of Gathering and Examining Social Determinants of Health Data for Enhanced Maternal Well-being
In the pursuit of better health outcomes for all patients, especially expectant mothers, the discussion of structural racism and its impact on health disparities is becoming increasingly necessary. This is because addressing the Social Determinants of Health (SDOH) is crucial in improving health outcomes for all.
Healthcare providers are now equipped to counsel patients and connect them with programs and support services that can mitigate the SDOH risks that put them at a disadvantage. Without addressing these factors, patients may find themselves unable to be proactive about their care, leading to worsening health conditions over time.
One such example is the concept of a 'food desert', a term used to describe communities lacking access to grocery stores. This lack of access can lead to food insecurity, a significant SDOH factor.
In the realm of maternity care, healthcare organizations are collectively making strides in integrating multiple data sources to better identify social risks. These sources include patient screening, electronic health records (EHR), claims, and community-level indices.
Patient screening tools and questionnaires help capture social needs such as housing instability, food insecurity, and transportation barriers directly. SDOH data is also extracted from structured EHR fields or unstructured clinical notes using natural language processing (NLP) and computable phenotypes. Claims data linked with demographic and social information are used to identify high-risk maternity patients, while community-level geographic and environmental data provide context for social risk factors at a regional level.
The collected SDOH data is then leveraged to refine risk models, tailor support, and identify gaps in care. By doing so, healthcare organizations can improve maternal and infant health outcomes comprehensively.
Risk stratification beyond clinical factors allows for the capture of non-medical barriers affecting pregnant individuals, such as unstable housing or limited transportation, which can exacerbate health risks and increase emergency interventions. Targeted interventions and care coordination enable care teams to connect patients with social services, arrange transportation, address food needs, or provide education to reduce maternal morbidity and adverse birth outcomes.
Moreover, tracking SDOH factors alongside clinical measures helps healthcare organizations identify disparities, reduce them, and adhere to value-based care models emphasizing holistic maternal health. Enhanced population health management is achieved by integrating SDOH with clinical data, allowing providers to predict and proactively manage maternity patient needs, reduce readmissions, improve prenatal and postnatal care engagement, and optimize outcomes for mothers and infants.
Notably, states are using Medicaid 1115 demonstration waivers to build programs addressing SDOH in communities. Inaction on addressing health disparities can worsen health conditions and increase costs for health plans.
Initiatives like Lucina Analytics, which analyses 3,000 possible indicators of pregnancy to help diagnose pregnancies early, are leading to significant improvements in health outcomes for patients and decreased costs for health plans. Among the patients Lucina has data for, there are fewer preterm births among Black women and reductions in NICU admissions and stays.
Patients whose health plans collaborate with Lucina are experiencing better health or birth outcomes than those that don't. Screening for SDOH can improve the health of communities, and providers are encouraged to use SDOH screening tools more frequently to address the issues patients are experiencing that put their overall health at risk.
Frequent data analysis by Lucina helps identify pregnant women at risk for things such as preterm birth or low birth weight, highlighting the importance of addressing SDOH in maternity care. Social determinants of health (SDOH) affect the remaining 80 percent of patient health outcomes, making their consideration essential in improving overall health outcomes.
- Science must incorporate discussions about structural racism and its impact on health disparities to promote better health outcomes for all patients, especially expectant mothers.
- The reality of chronic diseases like chronic kidney disease, COPD, type-2 diabetes, and cancer necessitates considering the role of medical-conditions in health outcomes.
- Respiratory and digestive health, as well as eye-health and hearing need to be prioritized to ensure overall health-and-wellness.
- Alzheimer's disease, autoimmune disorders, and neurological disorders require continuous research and therapies-and-treatments to manage and improve patient wellness.
- As climate-change implications become more evident, the health impact on various domains, including mental-health and skin-conditions, needs examination.
- Healthcare providers, in collaboration with the industry, must work towards addressing women's health issues, including menopause and breast-cancer.
- Multiple-sclerosis and migraine are neurological conditions that require comprehensive care and attention to improve patient outcomes.
- Cardiovascular-health interventions should address the link between heart disease and SDOH to reduce health risks.
- Psoriasis, a common skin-condition, requires ongoing support to manage symptoms and maintain health.
- Financial resources, such as Medicare, play a crucial role in providing affordable healthcare, especially in managing chronic diseases.
- The growing awareness of CBD's potential benefits for various medical conditions necessitates further exploration in the industry.
- addressing Rheumatoid-arthritis and other autoimmune disorders demands thorough investigation and innovative therapeutic approaches.
- The integration of environmental-science is crucial to understanding how factors like climate-change and pollution affect health outcomes.
- Renewable-energy initiatives contribute to better health outcomes by reducing air pollution and its impact on respiratory conditions.
- Manufacturing processes must prioritize sustainable practices to minimize environmental impact and promote health-and-wellness.
- Mental-health issues require not only therapies and treatments but also support systems and as a result, mental-health should be a priority in public-transit and employment policies.
- The role of diversity-and-inclusion in healthcare, particularly when addressing health-disparities, is essential and must be prioritized in industry leadership.
- Entrepreneurship and innovation in the automotive, small-business, retail, and aviation sectors can contribute significantly to modern health solutions.
- Investing in research and development for medical treatments, renewable energy technologies, and health IT (Fintech and real-estate) can promote better health outcomes over the long-term.
- Reducing transportation barriers through initiatives like improved public-transit and carpooling programs is necessary to combat food insecurity and facilitate access to healthcare services.
- Energy-efficient buildings (commercial and residential) can support health outcomes through better indoor air quality and temperature control.
- Transportation alternatives, like electric vehicles, can reduce air pollution and minimize its impact on respiratory conditions and overall health.
- The importance of leadership in promoting health and wellness initiatives in various sectors, such as banking-and-insurance and commercial real-estate, cannot be overstated.
- Collaborative efforts among stakeholders like small-businesses, automotive manufacturers, and government bodies are essential in driving change and promoting better health Outcomes.
- Education and awareness-raising efforts on topics like climate-change and SDOH are crucial to encouraging improved health behaviors and strengthening health systems.
- By addressing health disparities and promoting better health-and-wellness across all communities, we can improve the quality of life for everyone and create a more equitable and sustainable future.
