PUBLIC POLICY SESSION 1: USING QUALITY IMPROVEMENT AND INTEGRATING MENTAL HEALTH CARE TO IMPROVE SOCIAL DETERMINANTS OF HEALTH

2019 ◽  
Vol 27 (3) ◽  
pp. S223
Author(s):  
Adrienne Mims
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Public Policy ◽  
Quality Improvement ◽  
Mental Health Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health

scholarly journals Social determinants of health in mental health care and research: a case for greater inclusion

2019 ◽  
Vol 26 (8-9) ◽  
pp. 895-899 ◽  
Author(s):  
Joseph J Deferio ◽  
Scott Breitinger ◽  
Dhruv Khullar ◽  
Amit Sheth ◽  
Jyotishman Pathak
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Social Determinants Of Health ◽  
Language Processing ◽  
Social Determinants ◽  
Ad Hoc ◽  
Extraction Methods ◽  
Determinants Of Health ◽  
Independent Risk Factors

Abstract Social determinants of health (SDOH) are known to influence mental health outcomes, which are independent risk factors for poor health status and physical illness. Currently, however, existing SDOH data collection methods are ad hoc and inadequate, and SDOH data are not systematically included in clinical research or used to inform patient care. Social contextual data are rarely captured prospectively in a structured and comprehensive manner, leaving large knowledge gaps. Extraction methods are now being developed to facilitate the collection, standardization, and integration of SDOH data into electronic health records. If successful, these efforts may have implications for health equity, such as reducing disparities in access and outcomes. Broader use of surveys, natural language processing, and machine learning methods to harness SDOH may help researchers and clinical teams reduce barriers to mental health care.

scholarly journals Establishing Optimal Mental Health Care for Common Mental Disorders in Primary Health Care

2017 ◽  
Vol 6 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Lauren Kennedy
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Adequate Treatment ◽  
Primary Health ◽  
The Social

Various definitions of health and mental health exist, however there is a generally persistent inclusion and acknowledgement of the importance of holistic elements such as environment and relationships. Integration of the physical, social, and mental aspects of an individual, through the social determinants of health is an important component in establishing the effective delivery of optimal mental health care. With increasing numbers of collaborative care teams, and mental health promotion strategies, primary health care is increasingly building its capacity to help respond to these holistic mental health care needs, with increased and more purposeful attention to the social determinants of health. Despite these steps in the right direction, a gap continues to exist in the delivery of mental health care and many people continue to struggle in accessing adequate treatment. In order to determine how best to proceed, it is important to understand what mental health is, what mental health care in primary health care looks like, what the existing challenges to the delivery of mental health care in primary health care are, and what other models have been successful in integrating the social determinants of health and mental health into the primary health care system.

scholarly journals Comorbidities Associated With Social Determinants of Health in Latinx Patients Receiving Mental Health Care at a Community Clinic in South Florida

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 157-157
Author(s):  
Sabrina Martinez ◽  
Margaret Gutierrez ◽  
Jezabel Maisonet ◽  
Juan Ayala ◽  
Aydeivis Jean Pierre ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
South Florida ◽  
Determinants Of Health ◽  
Annual Income ◽  
Depression And Anxiety ◽  
Community Clinic

Abstract Objectives Mental and physical health conditions are intrinsically linked. Depression and anxiety may co-exist with an array of chronic diseases and conditions. Social Determinants of Health (SDOH) may have a powerful impact on health and may contribute to chronic disease disparities in underrepresented and underserved communities. The objective of this study was to examine the comorbidities found in patients seeking mental health care and their relationships to SDOH. Methods A needs assessments was completed using a random sample of 100 de-identified medical records of individuals seeking mental health care at Caridad Center in Boynton Beach, Fl. Demographics, diagnoses, laboratory tests results and the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) questionnaire data were abstracted. Statistical analyses included descriptive statistics, Spearman's correlations, Mann-Whitney U, and chi-square. Results The patients’ mean age was 51.9 ± 11.9 years and 79.4% were female. About 64% were below 100% of the federal poverty level and 52% were unemployed. About 43% were diagnosed with depression, 38% with anxiety and 17% with both depression and anxiety. In addition, 33% had 2 or more other diagnosed comorbidities and 11% had 3 or more comorbidities. Annual income was negatively correlated with the number of CVD risk factors (r = −0.283, P = 0.008). Median annual income was lower for those with hypertension compared to those without hypertension ($14,472 (IQR = $7200-$19,260) vs. $19,200 (IQR = 14,400–28,800), P < 0.001). Higher rates of unemployment in those diagnosed with diabetes were found compared to those without diabetes (67.6% vs. 56.6%, P = 0.035). Three or more social contacts per week was associated with lower median hemoglobin A1C levels (5.9 mmol/mol (IQR = 5.6–7.7) vs. 6.9 mmol/mol (IQR = 6–10.4) P = 0.05) compared to less contacts. Conclusions SDOH were associated with comorbid conditions in this Latinx sample who are sought mental health care at a community clinic in South Florida. Minority populations such as Latinx may suffer a greater burden of disease and health complications. Assessing SDH may be an important marker for identifying and intervening within the most vulnerable members of the population afflicted by multiple comorbidities. Funding Sources FIU RCMI/NIMHD.

600 Social Determinants and Their Impact on Burn Surgery Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Luis H Quiroga ◽  
Tomer Lagziel ◽  
Mohammed Asif ◽  
Raymond Fang ◽  
Grace F Rozycki ◽  
...  
Keyword(s):  
Mental Health ◽  
Diabetes Mellitus ◽  
Social Determinants Of Health ◽  
Population Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Hospital Charges ◽  
Burn Patients ◽  
Increased Risk ◽  
History Of

Abstract Introduction To our knowledge, no studies have been conducted assessing the social determinants of health and the impact on the outcomes for burn patients. Such studies are needed considering burn injuries are associated with high costs, severe psychological impact, and a high burden placed on the healthcare systems. The burden is hypothesized to be aggravated by the increasing amount of diabetes and obesity seen in the general population which put patients at increased risk for developing chronic wounds. Studies have shown that several socioeconomic status (SES) factors are associated with increased risk of burns, but none have documented the outcomes of burn patients based on their social determinants of health. In our study, we will be comparing patients in the burn ICU (BICU) to patients in the surgical ICU (SICU). The purpose of this comparison is to evaluate whether the same social determinants of health have similar influences in both groups. Methods We performed a retrospective analysis of population group data from patients admitted to the BICU and SICU from January 1, 2016, to November 18, 2019. The primary outcomes were length-of-stay (LOS), mortality, 30-day-readmission, and hospital charges. Pearson’s chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups. Results We analyzed a total of 487 burn and 510 surgical patients. When comparing BICU and SICU patients, we observed significantly higher mean hospital charges and LOS in burn patients with a history of mental health (mean difference: $42,756.04, p=0.013 and 7.12 days, p=0.0085), ESRD ($57,8124.7, p=0.0047 and 78.62 days, p=0.0104), sepsis ($168,825.19, p=< 0.001 and 20.68 days, p=0.0043), and VTE ($63,9924.1, p=< 0.001 and 72.9 days, p=0.002). Also, higher mortality was observed in burn patients with ESRD, STEMI, sepsis, VTE, and diabetes mellitus. Burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus also had greater 30-day-readmissions rates. Conclusions This study sheds new knowledge on the considerable variability that exists between the different population health groups in terms of outcomes for each cohort of critically ill patients. It demonstrates the impacts of population health group on outcomes. These population groups and social determinants have different effects on BICU versus SICU patients and this study provides supporting evidence for the need to identify and develop new strategies to decrease overspending in healthcare. Further research to develop relevant and timely interventions that can improve these outcomes.

scholarly journals Impact of COVID-19 on social determinants of health for adults with cystic fibrosis

2021 ◽  
Vol 15 ◽  
pp. 175346662110374
Author(s):  
Dana Albon ◽  
Heather Bruschwein ◽  
Morgan Soper ◽  
Rhonda List ◽  
Deirdre Jennings ◽  
...  
Keyword(s):  
Health Care ◽  
Cystic Fibrosis ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Issues ◽  
Determinants Of Health ◽  
Care Utilization ◽  
Health Questionnaire ◽  
Improvement Project ◽  
The Impact

Introduction: Outcomes in cystic fibrosis are influenced by multiple factors, including social determinants of health. Low socioeconomic status has been shown to be associated with lung function decline, increased exacerbation rates, increased health care utilization, and decreased survival in cystic fibrosis. The COVID-19 pandemic disrupted the US economy, placing people with cystic fibrosis at risk for negative impacts due to changes in social determinants of health. Methods: To characterize the impact of COVID-19-related changes in social determinants of health in the adult cystic fibrosis population, a social determinants of health questionnaire was designed and distributed to patients as part of a quality improvement project. Results: Of 132 patients contacted, 76 (57.6%) responses were received. Of these responses, 22 (28.9%) answered yes to at least one question that indicated an undesired change in social determinants of health. Patients with stable employment prior to COVID-19 were more likely to endorse undesired change in all domains of the questionnaire, and the undesired changes were most likely to be related to employment, insurance security, and access to medications. Patients receiving disability were more likely to report hardship related to utilities and food security compared with patients previously employed or unemployed. Of patients endorsing risk of socioeconomic hardship, 21 (95.5%) were contacted by a social worker and provided resources. Conclusion: Utilizing a social determinants of health questionnaire to screen for social instability in the context of COVID-19 is feasible and beneficial for patients with cystic fibrosis. Identifying social issues early during the pandemic and implementing processes to provide resources may help patients with cystic fibrosis mitigate social hardship and maintain access to health care and medications.

scholarly journals Pushing poverty off limits: quality improvement and the architecture of healthcare values

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Polly Mitchell ◽  
Alan Cribb ◽  
Vikki Entwistle ◽  
Guddi Singh
Keyword(s):  
Quality Improvement ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Deprivation ◽  
Ethical Dilemmas ◽  
Determinants Of Health ◽  
Ethical Challenges ◽  
The Social ◽  
Significant Burden ◽  
Health Related

Abstract Background Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI). Discussion Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. Conclusions We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.

Sign in / Sign up

Export Citation Format

Share Document