SOCIAL DETERMINANTS OF HEALTH SURVEY IN THE EHR PRAPARE PROTOCOL FOR RESPONDING TO AND ASSESSING PATIENT ASSETS, RISKS, AND EXPERIENCES

HISTORY

PROJECT OVERVIEW/RATIONALE In September 2013, the National Association of Community Health Centers (NACHC), the Association of Asian Pacific Community Health Organizations (AAPCHO), the Oregon Primary Care Association (OPCA), and the Institute for Alternative Futures (IAF) launched a project funded by the Kresge Foundation, Kaiser Community Benefit, and Blue Shield of California Foundation to create, implement, and promote a standardized patient risk assessment protocol that goes beyond medical acuity to identify risk related to the “social determinants of health” (SDH). The goal of this project is to develop and pilot a consensus-driven national standardized patient risk assessment protocol in partnership with health centers and their networks that not only helps health centers better understand and manage their patient populations, but also supports development of a more appropriate payment methodology that sustains SDH-related interventions.

HISTORY

•1 year grant to develop and implement a SDoH survey that can be used Nationally.

•HIT/Care Coordination

•Implementation phase

•3 months data gathering

•Alohacare patients

•Incorporate into the HRA

•Face to face or over the phone

•Test week 7/27 – 7/31

Project Implementation Team

SDoH Survey (PRAPARE) • The WCCHC revised survey is comprised of original survey

questions, input from the PRAPARE meeting in Oregon and WCCHC Care Coordinators.

• Survey is split in several sections • Demographics (auto-filled from check in)

• Personal Characteristics

• Family & Home/Housing

• Healthcare

• Money & Resources

• Medical Conditions

• Social & Emotional Health

• The patient will complete the EMR template survey using a WCCHC tablet or desktop computer in patient mode.

• The order of questions on paper survey may be slightly different from the EMR template survey.

SDoH Survey (PRAPARE)

SDoH Survey (PRAPARE)

SDoH Survey (PRAPARE)

SDoH Survey (PRAPARE)

SDoH Survey (PRAPARE)

SDoH Survey (PRAPARE)

SDoH Survey (PRAPARE)

SDoH Survey (PRAPARE)

SDoH Survey (PRAPARE)

SDoH Survey incorporated into HRA • HRA on paper

• SDoH survey has a template

Updates in EPM

• Complete the paper HRA

• Transfer SDoH info to SDoH template

• 3 areas where you’ll have to update info in EPM

Veteran Status

Updates in EPM Migrant Worker Status

Updates in EPM

Income data