Using geographic information systems and geospatial data to identify and address social determinants of health in clinical practice and training
Training primary care providers to use geospatial data and geographic information systems (GIS) with the potential to improve patient outcomes both at a local level and a national level as graduates disperse to diverse practice locations. This study examines best practices and effective models of integrating geospatial data and GIS into clinical care and provider training.
Project Summary
Delivery of medical care in clinical settings contributes to an estimated 10-20% of health outcomes; the remaining 80-90% of health outcomes are attributed to social determinants of health (SDH) (1). When considering this fact in the context of the Health Impact Pyramid, those seeking to create the greatest positive impact on health must develop interventions that impact the conditions in which people are born, grow, live, work, and age (2). Similarly, when recognizing the trend towards more Accountable Care Organizations, which increase payments for care in socially complex patients, health systems’ interest in identifying SDH is likely to increase (3).
EHR & SDH
The Electronic Health Record (EHR) has substantial potential as a tool that can identify and address social determinants of health. A key limitation is that although several core measures related to SDH are routinely collected (i.e., race/ethnicity, tobacco use, or alcohol use), there are neither comprehensive nor standardized methods for gathering SDH (4). When granular, patient-level SDH data are lacking, readily available patient-level geospatial data can guide health systems to identify the likely SDH affecting their patient populations. Another critical link that EHRs can fill is linking patients with local resources to address SDH, using Geographic Information System (GIS) technology. Thus, the combination of geospatial data and GIS technology can provide clinicians and health systems with a potent method for identifying and addressing SDH.
To date, little has been published regarding effective use of geospatial data or GIS. There has been at least one pilot project examining use of geospatial data and GIS to provide tailored SDH “prescriptions,” to patients (5), though others are likely experimenting with its implementation. Identifying and disseminating exemplary practices, such as those related to selecting GIS technologies and optimal training for clinicians and staff, can provide valuable guidance to those in earlier stages of implementation.
Additional benefits of disseminating effective, scalable methods of addressing SDH relate to training primary care providers. Clinicians in training generally report not screening or addressing SDH in clinical encounters (6). Providing local, accessible resources for addressing SDH can help enhance skills and self-efficacy in identifying SDH. Furthermore, learners can deepen panel management skills. Rather than relying on individual clinical visits, learners can better practice methods of addressing health in populations of patients and address barriers to health outside of the clinical encounter. Ultimately, training primary care providers in the consistent use of geospatial data and GIS systems has the potential to improve patient outcomes both at a local level, as well as a national level as graduates disperse to diverse practice locations.
Supporting Literature:
- Hood CM, Gennuso KP, Swain GR, Catlin BB. County Health Rankings: Relationships Between Determinant Factors and Health Outcomes. Am J Prev Med. 2016;50(2):129-135.
- Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health. 2010;100(4):590-595.
- Taylor L, Hyatt A, Sandel M. Defining the Health Care System’s Role in Addressing Social Determinants and Population Health. Health Affairs Blog 2016.
- Cantor MN, Thorpe L. Integrating Data On Social Determinants Of Health Into Electronic Health Records. Health Aff (Millwood). 2018;37(4):585-590.
- Lindau ST, Makelarski J, Abramsohn E, et al. CommunityRx: A Population Health Improvement Innovation That Connects Clinics To Communities. Health Aff (Millwood). 2016;35(11):2020-2029.
- Pettignano R, Bliss L, McLaren S, Caley S. Interprofessional Medical-Legal Education of Medical Students: Assessing the Benefits for Addressing Social Determinants of Health. Acad Med. 2017;92(9):1254-1258.