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Top Improvement Strategies for Social Determinants of Health Programs: Part One

social determinants of health programs
The Voice of the Healthcare Business

Using multi-level evaluation approaches for communities, health systems, and payers. 

A two-part blog series on using evaluation data to assess social determinants of health program effectiveness.

As organizations begin assessing the impact of newly launched Social Determinants of Health programs (SDOH) or developing innovative strategies to improve longstanding initiatives, a comprehensive evaluation plan will play an important role towards demonstrating a return on investment (ROI). Healthcare leaders who are reviewing SDOH initiatives should consider the role that multi-level evaluation plans play in assessing the individual, operational, outcome, and organizational impact of programs.

A strong evaluation plan should answer how well the initiatives met the needs of the intended population, initial goal of the program, and drive targeted improvement strategies. Let’s talk through how your organization can proactively use evaluation data, patient social needs screening data, and participants experiences in multiple settings such as community, healthcare systems, and payer settings for SDOH initiatives. A comprehensive evaluation plan can measure the impact and determine where to make improvements to support long term ROI goals.  

These perspectives were also shared in a recent Executives for Health Innovation (eHI) panel webinar, “Using Evaluation Data to Drive Social Determinants of Health Program Improvement Strategies”

What Are Some SDOH Evaluation Use Cases?  

Among Community-Based Organizations, SDOH intervention evaluation methods, such as participant-reported survey data, qualitative data methods (e.g., focus groups, photovoice, interviews), and participant narratives play a large role. Let’s talk through some use cases:

social determinants of health programs

Community-based Evaluation Experiences and Patient Reported Surveys

These examples use the stages of change behavior theory to demonstrate whether an intervention has moved a patient from contemplation (people who are intending to start a behavior within the next 6 months) to action (people who have recently changed their behavior) as an example.

social determinants of health programs

Patient Knowledge Approaches

These evaluate information and awareness as well as changes in participants pre- and post – intervention.

social determinants of health programs

Knowledge from Experience

The importance of centering those with lived experiences, capacity building, and empowerment models such as train the trainer or community based participatory research principles in the evaluation process. 

Optimize Social Determinants of Health Programs to Improve Patient Outcomes  

Among hospital systems, case managers, nurse navigators, and quality improvement staff can evaluate effectiveness of SDOH barrier awareness using existing clinical measures like length of stay and referral data. Referral data is not limited to the number of referrals placed but should also include information around how many referrals were made, as well as how many referrals were accepted and acted upon.

social determinants of health programs

Segmenting the data in this way will allow organizations to drill down into specifics around timing of rides, availability of caretakers at home, or other barriers that may not be readily apparent. Using a ride share program to assist with discharge efficiency and reliability is one example. 

Having SDOH insights on an individual upon admission can help optimize the discharge process when transportation barriers are identified early in the patient’s stay. When inpatient units are full and patients are holding in the Emergency Departments, timely discharges are key to hospital efficiency throughput.  Transportation assistance for discharges can make demand planning and bed management less cumbersome.  

In summary, a comprehensive evaluation plan can provide valuable insights on how social determinants of health programs and interventions are meeting the needs of populations and impacting desired outcomes. Check back soon for part two of the blog series where we share challenges that individuals face related to SDOH data as well as sample metrics that organizations could use to design evaluation plans across individual, operational, outcomes, and organizational levels.  

Click here to see the archived panel discussion. And visit our social determinants of health page to find out how you can launch a successful program within your own organization.

The DNA of Healthcare

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