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MEDICAL YEAR
IN REVIEW

low performing schools, and also neighbor-
hoods where segregation and health dispar-
ities exist. In a sense, if providers don't
understand the profound impact of the so-
cial determinants of health, they may be
surprised that loose dogs are somehow re-
lated to poor glucose control.
Primary care providers see the impact
everyday in patients with chronic condi-
tions. Chronic condition self-management
is the key to improved outcomes individu-
ally and at the population level. However, it
is more difficult to effectively self-manage,
whether it's eating healthier, getting more
physical activity, or adhering to medication
when patients are also struggling with food
insecurity, housing insecurity, keeping the
utilities on, or unsafe neighborhoods.
The local health information exchange
(HIE) in Bexar County, HASA, did an eval-
uation in categorizing glucose control in pa-
tients with diabetes by zip codes with
concentrated poverty and concentrated low
educational attainment (high SDOH risk).
They found that the proportion of patients
with poor control (>=9%) was higher in zip
codes that had high SDOH risk. nerable populations." Then review the coordinate community services for those
While providers may be aware of their in- CDC's 500 Cities project at families. CMS has an Accountable Health
dividual patient's struggles, they probably www.cdc.gov/500cities/ that has estimates Communities pilot project to screen for 5
haven't had aggregated patient outcomes down to the census tract level for the largest social determinants and coordinate com-
stratified by factors such as SDOH risk. 500 cities in the US based on the BRFSS. munity services where they are providing
Most of the quality measurement systems This means that only adults are covered but funding to help providers do this extra
either don't address SDOH at all and just there still are many topics: 13 health out- work. Until we work together with com-
have one standard for recognition set of comes, 9 prevention, and 5 unhealthy be- munity-based organizations providing serv-
clinical quality criteria (e.g., MIPS), whether havior topics. Texas has 47 cities available, ices to address the social determinants of
your patients are mainly high income or from Houston to Missouri City. Knowing health, we will not make the desired im-
mainly low income. However, the MIPS which census tracts are in greatest need for provements in population health.
bonus or penalties may adversely impact certain topics will help providers and com-
providers who care for patients with high munities overall meet those needs. Vincent P. Fonseca, MD, MPH, FACPM, is
SDOH risk. While difficult and new, there are some an Associate Professor, Preventive Medicine and
Therefore, it may be useful for providers national efforts to try to connect specific Director, Patient Safety and Quality Improvement,
to review the information available at as- patients and households to specific com- at the University of the Incarnate Word School of
sessment.communitycommons.org/Foot- munity-based social service support. The Osteopathic Medicine. Dr. Fonseca is a member of
print/ to view their area's census tracts with American Academy of Pediatrics has an ef- the Bexar County Medial Society.
high social determinant risk, known as "vul- fort to screen for food insecurity and then

visit us at www.bcms.org 15