SDOH Flashcards
define CODE Status
when is this discussed
Code Status refers to the decision a person makes regarding the level of resuscitation and intubation while in the hospital. Should their heart or lungs stop working, what would they want.
_At time of admission to the hospita_l, we must ask a patient what are their preferences. Their preference becomes and order in the her
ACP discussions prior to the last 30 days of a oncology patient’s life are associated with:
Lower ICU admissions.
Lower invasive treatments, & rates of chemotherapy
- Use of Radiation and chemo at end-of-life can compromise quality and induce suffering.
↓ psychosocial stress for patient and loved ones.
define
Advance Directives (aka Living Wills
Advance directive re written legal instruction regarding your preferences for medical care at end-of-life should you not be able to make the decisions yourself
- The AD will guide medical team and family should you become terminally ill, seriously injured, coma, brain damage
Topics in ADs include:
- Dialysis or Intubation
- Resuscitation (CPR)
- Antibiotics or antiretroviral meds
- Tube Feeding
- Hydration
- Organ and Tissue donation
define Power of Attorney
is a type of AD in which you name a surrogate decision maker.
- AKA Health Care Proxy or Durable Power of Attorney
define MOLST form
Medical or Physician orders for life sustaining treatments
- Consolidates and standardized the important AD information onto a single form
↑ likelihood that a patient’s wishes will be honored throughout the health care system.
Additional inclusions on MOLST
Do not hospitalize
Do not admit to hospital
Pain Management
In United States NO ACP means …??
Do Everything!
- By doing everything, this means patients may undergo CPR, intubation, surgical procedures, ICU admissions.
- ICU admissions and invasive procedures ↓ overall QOL. And prolong suffering.
having no ACP has what effects?
- Negative effects on caregiver’s mental health.
- Reduce QOL is expected when no ACP occurs therefore it is important to determine what is QOL
mental health of caregivers
aggressive care
ICU deaths VS Hospice deaths
At 6-months post-mortem, more aggressive care of loved ones = higher rates of depression.
ICU and Acute care deaths correlated with higher incidence of psychiatric illnesses VS loved one’s died in hospice.
Caregivers had more regrets
Define SDOH
“the conditions in which people are born, grow, live, work and age….
- Shaped by the distribution of money, power, and resources at global, national and local levels”
A single factor does not determine a health outcome; rather, there are a number of physical, social, behavioral, environmental factors to consider.
list exampls of SDOH
- Income
- Education
- Culture
- Race
- Racism and Discrimination
- Neighborhood
- Occupation
How are Healthcare Leaders Addressing SDOH
Accountable Care Act
Moving healthcare from fee for service –> outcome-based compensation
Expanded healthcare access
Paradigm shift toward population health–> leaders are now aware that SDOH have a greater impact on population health.
- Spending towards social services rather than healthcare may improve the overall population health.
define health disparities
•Differences that exist among specific population groups in the United States in the attainment of full health potential that can be measures by differences in incidence, prevalence, mortality, burden of disease and other health conditions”
define
HEALTH DISPARITY VS HEALTH INEQUITY
Disparity- Difference in the presence of disease, health outcomes, or access to health care between populations
Inequity - Unfair, systematic and socially produced injustices that are rooted in social arrangements that disadvantage some groups in the population more than others
define health equity
how is this quantified??
Health equity is when everyone has the opportunity to be as healthy as possible.
- Programs: Successful health equity strategies
- Measurement: Data practices to support the advancement of health equity
- Policy: Laws, regulations, and rules to improve population health
- Infrastructure: Organizational structures and functions that support health equity
SDOH levels of intervention
- Individual
- Interpersonal
- Clinic
- Community
- Research
- Policy
FACTORS THAT IMPACT HEALTH
Quality and Access to care have a ____ impact on overall health
Social and Economic factors have a ____ impact on overall health
FACTORS THAT IMPACT HEALTH
Quality and Access to care have a 20% impact on overall health
_Social and Economic factor_s have a 40-70% impact on overall health
CAD proximal risk fx
define food deserts
An area that has limited access to affordable and nutritious food (23.5 million people live in “food deserts”)
- Live >1 mile from a supermarket in urban or suburban areas and more than 10 miles from a supermarket in rural areas
- lower income, decreased mobility and lack of availability of fresh food
tips for family health hx
Avoid yes / no questions
Don’t expect people to have all the answers
Use follow up questions “why”, “how”
Sensitive issues: some will not want to talk, adoption
upstream vs downstream SDOH
upstream - features of environment that individual has little control over but can influence behaviors, dz outcomes and health outcomes
- living coditions, distribution of wealth
downstream - trick down effects of upstream SDOH that are seen in the clinical setting
3 areas of oppurtinity to address SDOH
- improve measurements
- deepen understanding
- develop actions to mitigate effects of SDOH (improving living conditions, tackle healthcare inequities)
Models of addressing SDOH
WHO Conceptual Framework -
- Structural determinents - SEP that influences intermediary determinents
- _Intermediary Determinent_s - tangible or psychosocial circumstances, behavior/biology & health system
VULNERABLE POPULATIONS CONCEPTUAL MODEL -
addresses a broader community focus to improve understanding of factors affecting individual halth status
- places emphsis on socioeconomic & environmental resources
-
demonstrates importance of:
- personal & social factors
- resources
- bad behaviors inc risk of mortality
SDOH Screening Tools
which are best for individual vs health system programming
The Social Deprivation Index
- calc levels of disadvantages in small areas to examine their association w/ health outocmes and address health disparities
- better for creation of health systems/ programs rather then screening individual
Functional Health Patterns - assesses individual health mgt practices in the context of a pts life in their roles, responsibilites as well as ethnic and cultural values
Accountable Health Communities - simple tool to implement in everday practice
- 10 item assessment to assess unmet needs over 5 domains
- housing instability
- food insecurity
- transportation
- utility
- interpersonal safety
- inform tx plans & make referrals
Functional Health Patterns & Accountable Health Communities = aimed at screening individual pts
Addressing unemployment
1/3 of pts hospitalized w/ HF lose jobs 12 mo later
- interventions that attempt to improve / sustain employment
- flexible back-to-work policy
- behavioral health intervention
- self-management strategies
- interventions that mitigate risk fx for CVD among unemployed
- CBT
- CHW
- education to improve health literacy
program for addressing food insecurity
must integrate assessment of food insecurity!!
Meals on Wheels - elederly & at-risk population of any age
Interventiosn aimed at Addressing enviornmental factors of SODH
Telehealth - DEC mortality in HF pts, & hospital admissions
access to community based sites - healthcare facilities & parks/sidewalks for excercise
interventions to address low health literacy
include educational resources that are:
- easy to read & incorporate images - superior & promote memory retention
- fifth grade or lower reading level
Combo of different interventions
- clear communication
- teach back method
- culturally sensitive videos / info
- easy to read print materal
Reliable websites
- AHA
- AAHF Nurses
- CDC
- HF Society of America
- Agenda for healthcare research & quality
4 important oppurtunities in which clinicians & researchers should focus efforts
- develop better understanding of potential impact of SHOH on HF care
- integrating assessment data / collection related to SDOH for pts w/ HF into routine care
- Implementing interprofessional care teams to maximize pt access to varied prespectives and skill sets to facilitate self-care & navigation through healthcare system
- INC research examining SDOH profile on pts w/ HF & interventions that can be most beneficial in imporving health outcomes
most imperative first step in addressing SDOH
what does this aim to do?
team - based approach
- optimize care planning - more comprehensive understanding of pt experiences
- introduction of new roles can brinf peer support (pt navigators, CHWs)
suggestions for clinicans in clinical practice setting to address SDOH
- adopt SDOH assessment tool as part of routine care
- develop systems that faciliate routine data collection, storage and retrevial of pts SDOH data for individual care planning and population health initiatives
- collab w/ communiy partners to develop / implement programs that will identify pts w/ HF and various SDOH needs
- develop/evaluate interprofessional/collaborative practice models that clearly define roles and use skill sets of all team members
- Use nontraditional roles (pt navigator, CHWs, public health workers)
interventions to address social support
transitional care mgt
- Nurses who specialize in HF
- CHWS/ PT Navigators - Inc med adherence & renew health insurance
