Events

ABSTRACT

Research Objective: Social determinants of health (SDOH) significantly impact health outcomes more than medical care alone, yet their integration into decision-making is inconsistent. Understanding SDOH documentation in electronic health records (EHRs), especially in primary care—the largest healthcare delivery platform—is crucial. This study explores how family physicians document SDOH in EHRs and identifies factors influencing this practice.

Study Design: We conducted a cross-sectional analysis of family physicians completing the 2022 American Board of Family Medicine (ABFM) Continuous Certification Questionnaire (CCQ). The primary outcome was physicians’ self-reported rating on how often they documented screening for social needs by checking a box/button within the EHR, writing it in a note, or entering it as a diagnosis, later dichotomized as yes (often/sometimes) or no (rarely/never). Using 3 separate multivariate logistic regression models, associations between factors and documenting SDOH were assessed while adjusting for physician (age, gender, race/ethnicity, and trained in a Teaching Health Center or Rural Training Track), practice (type, size, participation in value-based payment programs [VBP], SDOH resources, other health professionals at the practice specifically social workers and care coordinators, and collaboration with local government, neighborhood organizations, and transit), and community characteristics (zip code tabulation area [ZCTA]-level social deprivation index [SDI] and rurality).

Population Studied: The 2022 CCQ was completed by 6,000 family physicians seeking to continue their ABFM certification. Because completing the CCQ is mandatory when registering to recertify, it has a 100% response rate. In this study, we analyzed 2,117 family physicians who were randomized to questions that included documentation of SDOH.

Principal Findings: We found that 65% of respondents documented SDOH in notes, with fewer using electronic forms (49%) or diagnosis codes (37%). Across models, factors persistently positively associated with documenting SDOH included employment at a practice participating in VBP, having the resources to address patients’ social needs, collaborating with neighborhood organizations, and located in a more disadvantaged area. For example, family physicians who worked in a practice collaborating with neighborhood organizations had higher odds of documenting SDOH using electronic forms (OR=1.550, 95% CI=1.226 – 1.960), notes (OR=1.439, 95% CI=1.123 – 1.844), or diagnosis codes (OR=1.678, 95% CI=1.326 – 2.125). In addition, family physicians who worked in ZCTAs with the second quartile of SDI (OR=1.157, 95% CI=0.877 – 1.527), the third quartile of SDI (OR=1.433, 95% CI=1.087 – 1.890), and the fourth quartile of SDI (OR=1.491, 95% CI=1.126 – 1.974) were more likely to enter it as a diagnosis, compared with those in ZCTAs with the first quartile of SDI (least disadvantaged).

Conclusions: 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.

Implications for Policy, Delivery or Practice: This study shows that family physicians who work in communities with higher social needs and who have resources or community relationships were more likely to address SDOH than their peers in more advantaged communities and having no resources or community partners. This evidence supports critical payment policies that provide direct payment for SDOH risk assessment, use of area-based social risk factors for payment adjustment, and support to community-based partners.

LEARNING OBJECTIVES

Objective 1: On completion of this session the participants should be able to understand the extent to which family physicians are engaged in documenting SDOH in EHRs.

Objective 2: On completion of this session the participants should be able to identify facilitators and barriers to addressing SDOH in EHRs.