By Ashley Kroll, JD, MPH
Social determinants of health (SDH) are environmental and social aspects of patients’ lives that are increasingly recognized as important to clinical care and health. A national movement is now urging health care providers to identify patients’ SDH and act on their SDH-related needs. This is especially important in Community Health Centers (CHCs), whose patients are often low-income and experience more social hardship than the general population. However, little is currently known about how to help CHCs collect patients’ SDH information and act on the information they gather.
ASCEND is a five-year study that builds on a pilot study called ASSESS & DO (both were funded by NIDDK and led by Principal Investigator Rachel Gold, PhD, MPH). In ASSESS & DO, a suite of electronic health record (EHR) tools were designed, with stakeholder input, to help CHCs collect information on patients’ SDH. Now that these tools are available to hundreds of CHCs, the study team will evaluate how CHCs are using these tools, and identify the factors that lead to success in SDH collection.
The ASCEND study has three main goals. The first is to understand how the SDH tools developed in ASSESS & DO are being used, by looking at EHR data from the CHCs with access to the tools. Some of these CHCs have used these tools extensively, others not at all. The study will describe the characteristics of high- and low-use clinics. Additionally, the study team will interview representatives from eight to 10 high-use clinics, to understand the factors that helped these clinics use the tools. This will provide insight into the motivations for tool use, barriers encountered by the clinics, and how collected SDH data are being used by CHC providers and teams.
The study’s second goal is to conduct a randomized trial to test how to help CHCs implement SDH data collection and action. Thirty CHCs will be randomized into smaller groups, called wedges. The study team will focus on one wedge at a time, with each wedge receiving intensive implementation support for six months. This support, called the “SDH Action Plan,” will include tailored technical assistance and training materials that are designed to help CHCs collect and act on patients’ SDH information. Specifically, the SDH Action Plan will consist of general support, including an all-staff training orienting CHC staff to the Action Plan, SDH data collection and action, and the basics of data-driven improvement, as well as training materials for new staff and CHC leadership. The SDH Action Plan will also include support for incorporating SDH data collection into clinic workflows and written guides to collecting and acting on SDH data, and decision support that can help care teams determine how to respond to patient SDH needs. In addition to this general support, the study team will provide clinics with individualized support, including bi-weekly interactive webinars, monthly one-on-one check-in calls with clinic managers to identify and work through barriers, and ongoing email communication.
The study’s third goal is to evaluate the effectiveness of the SDH Action Plan. The study will assess whether the SDH Action Plan improves collection of patients’ SDH information in CHC workflows, the integration of patients’ SDH information into diabetes risk management care, and clinical measures associated with effective diabetes care.
CHC providers need automated tools that allow them to collect their patients’ SDH information easily and effectively, in a way that helps them improve patient care and thus health outcomes. ASCEND is a timely investigation that will provide guidance to CHCs as they seek to incorporate SDH collection tools into their everyday practice.