May 13, 2016


Wendy: There are many sources of data that can really help us improve personalized and effective delivery of care to patients. Some of that information we capture when a patient comes to the hospital or to a clinic, we capture their blood pressure, their temperature, their vital signs.

But some of that information we really don't pay much attention to, where they live, whether they are educated, whether they have social support at home. If we can integrate that information while we care for patients we can really improve our care

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Wendy: So we have a special guest today with us to talk about this, Dr. Andrew Bazemore. He's a family physician who directs the Robert Graham center for policy studies in DC. Dr. Bazemore could you give us an example of why it's important to understand the social factors that influence our care for patients.

Dr. Bazemore: We know very well that place matters to your health. As a family physician I can tell you that when I have two patients, both with diabetes, same age and by all other means and measurement looking alike that having one who lives in an area of dense poverty and low education and poor social capital as well as food resources, opportunities for exercise versus another living in the complete opposite situation, I can expect that I'm going to have the different ability to help them shape their health outcomes.

However, I don't have that information on a day-to-day basis when I'm working with my patient one-on-one and I don't really have it in a planning setting when I'm working with my office to cover all my patients to look at my panel. We need to have more information not only at the point of care, but in the hands of clinical planners, of hospital enterprisers that allows us to understand the community environment in which each individual patient and whole panels of patients live.

Wendy: How do we capture that data?

Dr. Bazemore: There's some good news and some bad news here. The good news is that the information that I would like to have my hands on, both in the independent, individual encounter, as well as when I'm doing practice wide, panel wide planning, is available in many large population data sets.

The good work of the census and the American Community Survey, of our Center for Disease Control and Prevention, many national data sets that are freely available and downloadable today is in the public domain but not readily available to me the clinician and certainly not integrated with my patient records.

If I had an easy way to access that information in the very narrow windows of time that represent my one-on-one encounters as well as my planning protocols, I would be a much more informed clinician for it and a much more informed planner.

Wendy: As we bring that type of data forward to the primary health care providers, what other types of interventions do they might . . . how will they use that information to help improve their care of their patients?

Dr. Bazemore: That's a great question. I think the first level of intervention is one of knowledge that these providers didn't previously have and I think that can be undersold. A simple awareness of one's service area, of one's community risk factors, of the opportunities for neighborhood level intervention can really inspire a primary care provider to stop thinking about the 15 minute encounter and work within the box that is our practice and really become more of an agent of community health.

But, that's not nearly tangible enough I know for most of our funders and most of those who would drive health care decision making.

What we need to work on is interventions that bring the primary care provider community into direct contact with those who are in the public health and social services community who can help their patients. There is too often a disconnect between the primary care providers awareness that their patient needs help and the actual social services, public health services, educational and welfare services.

Wendy: Can you tell us an example where the information that you found through these social determinants influenced a policy direction?

Dr. Bazemore: Absolutely. I think I'll first speak to how the integration of the social determinants for population data and clinical data influenced planners, influenced those at the community health center level. When we first began testing these ideas in Baltimore with the Baltimore Medical Systems Group, we knew that their leadership would see things in the intersection of these data that we couldn't and sure enough they did.

For example, they had such received a Susan Komen foundation grant intended to improve African American women over 40's utilization of breast preventive health services, namely mammography and clinical breast exam. What they didn't have was an awareness of where the African American women over 40 tended to cluster. More importantly where that same cohort tended to receive or not receive breast health services currently and by simple geographic targeting we were able to streamline their intervention and improve on the uptake and receipt of clinical breast health services among this targeted population.

Wendy: Well, I can see how this type of data is really important to decision making at a policy level, a community level and also an individual patient level. The incentives are not completely aligned now for a health care system to invest in obtaining that type of data and integrating it. In the meantime how might we move towards that?

Dr. Bazemore: The changing payment system will begin to provide financial incentives to integrate but in the meantime your health systems, in particular your innovators, have to take a leap of faith, that being a step ahead in integrating this data will pay dividends in the future.

I think they also have to apply what I have come to understand, raising whole communities and a real desire to do what's best for the health of communities means that this sort of data integration is important now. And because of the declining cost technologically of actually integrating data sources and the increasing availability of those data, there isn't much of a barrier financially or technologically to creating integration today.

So we may lack the push factor if you will, but boy, has it become a lot easier to do so and extremely plausible to bordering on certain that there will be benefit downstream.

You take those two, even if this isn't highest on your list of technology priorities, I think there is a future that makes this the right thing to do and the financially beneficial thing to do that would allow one to want to take that leap of faith.

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