Resolution: S-20-27: ADDRESSING SOCIAL DETERMINANTS OF HEALTH THROUGH DATA COLLECTION AND IMPROVED ACCESS TO SOCIAL SERVICES

[Valerie Lile]

1  WHEREAS, equity in health and overall wellbeing is not simply determined by individual choices but
2  based on life chances and the resources provided in the environment they were born into ^1,2; and

3  WHEREAS, consistent structural differences in social opportunities amongst the indigent compared to
4  the affluent is as important to life expectancy and health outcomes as affordable access to medical
5  treatment^1,2; and

6  WHEREAS, the glaring inequality in freedom to live a thriving, healthy life can be balanced through
7  concerted effort to reverse structural drivers including policies, economics, and living conditions to
8  ensure a sustainable standard of health across all socioeconomic and cultural backgrounds^1,2; and

9  WHEREAS, screening tools to measure social determinants of health (SDoH) such as food insecurity,
10  domestic violence, and housing quality currently exist in clinical practice and are recommended by
11  national organizations including the American Academy of Pediatrics, American Academy of Family
12  Physicians, and American College of Obstetrics and Gynecologists^3,4; and

13  WHEREAS, implementation of comprehensive screening with adequate linked cooperation to local
14  community resources was a noted barrier to practical use³; and

15  WHEREAS, universal assessment tools such as the Center for Medicare and Medicaid Services’
16  Accountable Health Communities (AHC) Model show promise. If applied nationally, inadequate
17  funding, lack of hospital cooperation, and the omission of essential social and behavioral measures
18  could limit its success^4,5; and

19  WHEREAS, American Osteopathic Association (AOA) aims to promote public health and accentuate
20  the distinctive philosophy of Osteopathic Medicine to treat the whole-person as affirmed by AOA
21  Policy H406-A/17 and H300-A/18; and

22  WHEREAS, private sector organizations are working with national medical organizations through the
23  Integrated Health Model Initiative (IHMI) to address the issue of SDoH systematically through the
24  process of creating relevant ICD-10 codes related to “critical factors of patient well-being, such as
25  employment, education, food, housing, access to transportation, and many other factors” which will
26  trigger social services referrals⁷; and

27  WHEREAS, ICD-10-CM is an international classification of diseases that plays a fundamental role in
28  health care delivery and payment policy, and it has recently been adapted in the United States to include
29  clinical modification (CM) which expands implications to precise measuring, disease tracking, health
30  care utilization, and quality of patient care including codes “Z00-Z99” for factors influencing health
31  status and contact with health services ⁶; and

32  WHEREAS, the Gravity Project, developed through Health Level Seven® International (HL7®), the
33  American Academy of Family Physicians, and The Social Interventions Research and Evaluation
34  Network (SIREN), aims to improve screening, diagnosis, treatment, and planning by using technology
35  to streamline data collection by defining a coded library of terms related to SDoH and use
36  interoperability of electronic health systems to address individual patient needs more effectively⁸; now,
37  therefore, be it

38  RESOLVED, that the Student Osteopathic Medical Association (SOMA) will support the use of ICD-
39  10-CM codes regarding social determinants of health that mitigate challenges of physician referrals to
40  social and government resources; and be it further

41  RESOLVED, that SOMA advocates that the American Osteopathic Association (AOA) will adopt an
42  official position that supports the use of ICD-10-CM codes regarding social determinants of health that
43  mitigate challenges of physician referrals to social or government resources; and be it further

44  RESOLVED, that SOMA advocates that the AOA will adopt an official position supporting legislation
45  that improves interoperability of electronic health records to reduce overall health care costs by
46  improving communication between members of a care team including social services; and be it further

47  RESOLVED, that SOMA advocates that the AOA will adopt an official position that supports a
48  validated screening tool to identify patients influenced by social determinants of health.

Explanatory Statement

Please note the use of “structural drivers” in line 7 refers to gender norms and values, economic participation, social exclusion, wealth distribution, education, civil rights, governance, public spending priorities, and macroeconomic conditions ¹. Further, note that the phrase “validated screening tool” referenced in line 51 indicates issuing a position of support for the creation of a standardized measurement of social determinants of health in individual patients that can be used across the nation, in any setting, and that has been authenticated to accurately assess patients at risk without any bias or skew towards certain demographics. This tool is indicated to be used at patient intake to identify individuals, such that the proper ICD-10 codes can be documented at the time of the encounter.  Please be advised that the use of the term “support(s)” in the resolved statements is meant to indicate that SOMA and the AOA will use their judgement to promote the utilization of existing ICD-10 codes whether it be issuing a statement of support, lobbying for federal legislation relating to these codes, etc.

Relevant Existing Policies

AOA Policy H406-A/17 and H300-A/18

References

1. Commission on Social Determinants of Health (CSDH), Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. 2008, World Health Organization: Geneva.
2. U.S. Department of Health and Human Services. Healthy People 2020: Social Determinants. Retrieved October 1, 2019, from: https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Social-Determinants
3. Davidson KW, McGinn T. Screening for Social Determinants of Health: The Known and Unknown. JAMA. Published online August 29, 2019. doi:10.1001/jama.2019.10915
4. Thomas-Henkel, Caitlin. Screening for Social Determinants of Health in Populations with Complex Needs: Implementation Considerations. Center for Health Care Strategies, Inc. October 2017, from https://www.chcs.org/media/SDOH-Complex-Care-Screening-Brief-102617.pdf

5. Centers for Medicare and Medicaid Services. Accountable Health Communities Model. Retrieved March 1, 2020, from: https://innovation.cms.gov/initiatives/ahcm

6. Centers for Disease Control and Prevention: National Center for Health Statistics. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Retrieved March 1, 2020, from https://www.cdc.gov/nchs/icd/icd10cm.htm#FY%202020%20release%20of%20ICD-10-CM

7. American Medical Association. (2019, April 2). UNH and the AMA collaborate to address access to better health [Press release]. Retrieved from https://www.ama-assn.org/press-center/press-releases/unh-and-ama-collaborate-address-access-better-health
8. Health Level Seven® International (HL7®). (2019, August 20). New HL7® FHIR® Accelerator Project Aims to Improve Interoperability of Social Determinants of Health Data [Press release]. Retrieved from http://www.hl7.org/documentcenter/public_temp_E229E04C-1C23-BA17-0C76A643D1AFCAB7/pressreleases/HL7_PRESS_20190820.pdf

---

Submitted by:

Alexis O’Connell, OMS II- Alabama College of Osteopathic Medicine
Rebecca Stoll, OMS II – Alabama College of Osteopathic Medicine
Christian von Gizycki, OMS IV, Lake Erie College of Osteopathic Medicine – Bradenton
Amir Khiabani, OMS II – Alabama College of Osteopathic Medicine
Morgan Bivens, OMS II – Alabama College of Osteopathic Medicine
Ejoven Reed, OMS II – Alabama College of Osteopathic Medicine
Benjamin Duong, OMS II – Alabama College of Osteopathic Medicine
Brandon Newell, OMS II – Alabama College of Osteopathic Medicine
Katherine Beyer, OMS II – Alabama College of Osteopathic Medicine

Action Taken:
Date:
Effective Time Period: Ongoing

[Author]

Posts