Key obstacle to reducing health disparities: measurement

One of President Biden’s top priorities is reducing health disparities. In fact, President Biden created a Health Equity Task Force to address the issue; the Centers for Medicare and Medicaid Services (CMS) have created their own Framework for Health Equity 2022–2032. The 5 priories in this CMS Framework are:

Expand the collection, reporting, and analysis of standardized dataAssess causes of disparities within CMS programs, and address inequities in policies and Ooperations to close gapsBuild capacity of health care organizations and the workforce to reduce health and health care disparitiesAdvance language access, health literacy, and the provision of culturally tailored services Increase all forms of accessibility to health care services and coverage

With respect to (1), a key question is how well is information information on social determinants of health collected currently.

According to a recent paper by Kepper et al. (2022), the answer is not very well. The authors examine electronic health record (EHR) data for patients with hemoglobin A1c > 5.6 and qualitative interviews with health care providers and stakeholders to identify social needs by social determinants of health (SDOH). The authors also examine how often Z-codes related to SDOH are currently being recorded in EHR data. Using this approach, the authors find that:

Z-codes were not frequently used in the EHR (<1% of patients), and there was an overall lack of congruence between quantitative and qualitative results related to the prevalence of social needs. Providers faced barriers at multiple levels (e.g., individual-level: discomfort discussing social needs; organizational-level: limited time, competing priorities) for documenting SDOH and identified strategies to improve documentation.

In short, not only is the information on SDOH in EHR limited today, but there are significant barriers to improving data quality in the future.