ORIGINAL RESEARCH
Jeongyoung Park, PhD; Yalda Jabbarpour, MD; Robert L. Phillips, MD, MSPH; Andrew W. Bazemore, MD, MPH; Nathaniel Hendrix, PharmD, PhD
Corresponding Author: Jeongyoung Park, PhD; Robert Graham Center for Policy Studies in Family Medicine and Primary Care, American Academy of Family Physicians
Email: jpark@aafp.org
DOI: 10.3122/jabfm.2024.240279R1
Keywords: Clinical Decision-Making, Cross-Sectional Studies, Documentation, Electronic Health Records, Family Physicians, Health Equity, Logistic Regression, Outcomes Assessment, Primary Health Care, Social Deprivation, Social Determinants of Health, Socioeconomic Factors, Surveys and Questionnaires
Dates: Submitted: 07-25-2024; Revised: 10-21-2024; Accepted: 11-04-2024
Status: In production for ahead of print.
INTRODUCTION: Social determinants of health (SDOH) significantly impact health outcomes, yet their integration into clinical decision-making is inconsistent. We examined how family physicians document SDOH in electronic health records (EHRs) and identified factors influencing this practice.
METHODS: We performed a cross-sectional analysis of 2,089 family physicians completing the 2022 American Board of Family Medicine Continuous Certification Questionnaire. The outcome was physicians’ self-reported SDOH documentation by checking a box within the EHR, writing it in a note, or entering it as a diagnosis. Physician, practice, and community characteristics associated with SDOH documentation were assessed, using logistic regression.
RESULTS: We found that 61% of family physicians documented SDOH in notes, with fewer using checkboxes (46%) or diagnosis codes (35%). Across models, factors persistently positively associated with documenting SDOH included participating in value-based programs, having more resources for social needs, collaborating with neighborhood organizations, and working in a more disadvantaged area (higher Social Deprivation Index [SDI] score). For example, family physicians who worked in areas with the third quartile of SDI (OR=1.366, 95% CI=1.037 - 1.799) and the fourth quartile of SDI (OR=1.364, 95% CI=1.032 - 1.804) were more likely to enter SDOH as a diagnosis, compared with those in the least disadvantaged areas.
DISCUSSION: Socioeconomic aspects of the communities and a practice-level capacity to address SDOH were the biggest predictors of documenting SDOH, rather than the physicians’ own characteristics. These findings affirm the necessity of financial incentives and well-resourced care teams in order to successfully achieve integrated SDOH in primary care practice.