One of the objectives of the Integrated Health Model (IHMI) is to support the representation of Function, State, Goals, and Outcomes in the context of health. IHMI is defining Functional Status, Health-related State, Patient Goals and Social Determinants of Health to ensure consistent capture of relevant health information.
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A request has been sent to connect to this user.Hoping to start a dialog on social determinants of health. Collecting (and using) information on our patients' Race, Ethnicity and Language is the first step in helping to understand and address health disparities in our practices and communities. How can these data be used by physicians, hospitals and care systems? A first step is to look at routine quality and performance measures to see where disparities exist and where to prioritize efforts.
While Race, Ethnicity and Language are important, we should also consider Economic Status, Age, and Education Level. We often find that these factors also play a significant role in causing such disparities.
I couldn't agree more!
William and Minda, I too couldn't agree more with your assessments. The question I pose is what do we mean by routine quality measures? Is it that information like race, age and ethnicity, economic status are low hanging fruit that are easy to capture? Or that there are quality measures that currently exist to capture these data elements. Regardless of the answer, I do believe that will some of this data is currently collected, it is not collected in a uniform way for comparison. Also, I think we need to combine other administrative data eg zip code, to get data to draw conclusions regarding SDH.
Marjorie, I think a small first step that many providers and systems could do is to collect race, ethnicity and language on their patients; and then look at the routine quality metrics that they are already submitting to Medicare, Medicaid and private health plans. In this way, a practice could learn if there are any groups within the practice that aren't doing as well. That would be a good place to prioritize improvement efforts.
Functional status is a great way to follow our patients through their trials and tribulations otherwise known as life. I believe an important distinction must be made, that is how the functional status is followed. Is it a vague number quantifying the overall functional status? Or is it an evolving and continuously changing observation of a patient capacities and limitations. By utilizing standardized tools ie. Lawton or the Katz (Independent Activities of Daily living), which have a quantitative score we can quickly notice when there is a change in the patients functional status.
But I believe the devil is in the details , and using a Qualitative/Quantitative flow sheet to track improvements/decline in specific domains from year to year is especially important. An automated flow sheet that highlights major changes from previous measurements, makes functional status (IADL) less of a number to casually follow and more of a cross sectional analysis of our patient health status.
We have found that functional status reflected by ADL's have significant prognostic significance for patients undergoing surgical care. Additionally, there is growing support to perform PreHabilitation for patients whose functional status is poor prior to a major operation. Therefore we advocate a rapid capture of these variables prior to operation.
Great observation; using standardized and validated instruments not only to assess patient reported outcomes but to follow patients is key. How to get the information into the EHR and then be accessible to us in a format that is useful when we need it without extra burden? How to share that information between primary care, specialists and care coordinators? I'm hoping IHMI can be part of that solution.
Our web-based system to assess knee/hip arthritis pain and function will automatically score PROs/function, trend over time, and integrate the effect of medical, emotional, and musculoskeletal co-morbidities. The system is built to serve as an API for electronic health records to serve individual patient care decisions.
This is a great JAMA article: Collecting and Applying Data on Social Determinants of Health in Health Care Settings. jamanetwork.com/journals/jamai...