Infectious Disease

“Raw data” on social determinants of health could help with patient referrals

November 24, 2021

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Source:
Healio interview

Disclosure:
Vest is a co-founder and shareholder of Uppstroms LLC.

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A machine learning model using the most basic of raw data can help clinicians identify patients in need of a social worker referral and predict their risk of hospitalization.

“There is so much data out there on social determinants of health, but the challenge is to turn it into something that healthcare providers can use,” said Joshua R. Vest, PhD, MPH, Regenstrief research scientist and professor at Indiana University, Richard M. Fairbanks School of Public Health, it says in a press release.

Vest and colleagues tested various algorithms on data from more than 200,000 patient encounters within the Eskenazi Health safety net in Indiana, according to a press release. They found that the most accurate predictive model uses raw data on housing, income, and education. Vest said the algorithm – which they called “Uppstroms” – provides a practical way for health professionals to use social determinants of health data.

“Raw data is a viable solution to building a recommendation model,” he said in the press release. “More complex models may need to be developed in the future, but this can be a good starting point for health systems to take advantage of social determinants of health, especially systems that may be less resourceful.”

In an interview with Healio Primary Care, Vest shared more details about Uppstroms.

Healio Primary Care: How did you create and test Uppstroms?

Vest: Uppstroms is Swedish for upstream. This word reflects our reflections on how to deal with social risks and social needs, which are the real drivers of a person’s health and wellbeing, before they become challenges.

When my colleagues and I came to Indiana University and the Regenstrief Institute a few years ago, we sat down with the providers of our clinical partners and their management and asked, “How can we help? What can we help you with? [more] and be more effective in the care? ”

From these discussions a strong desire arose to address patient social risk factors such as homelessness, housing, food insecurity and such financial challenges.

However, it was very difficult to identify patients before these challenges arose, and as their visits increase health care utilization, clinicians have always felt that they are reactive and not proactively addressing the problem.

Healio Primary Care: What data is there to support the use of Uppstroms?

Vest: We looked at over 100 pieces of data and ran several rigorous evaluations of each other to make sure we identified the right elements. Then when we introduced it in a study, we saw an increase in referrals to social workers, and that is exactly what we wanted to do when this risk stratification model was released. We also saw cost savings from reductions in hospital stays.

Healio Primary Care: A previous study suggests that pediatric and family medicine providers “lack comfort screening and social determinants of health”. How does your tool alleviate some of the inconvenience providers may experience addressing these determinants?

Vest: We took the approach of referring people to the appropriate providers. We said, “Let’s automate the process and use whatever information we have access to so we can identify people without the extra burden on doctors.” That was the driving force behind the development of Uppstroms. In most health systems and organizations, it is not a doctor who intervenes to address someone’s housing problems or unsafe living environment. It will be a social worker or a case manager.

Healio Primary Care: Do you think patients would be open to discussing sensitive information such as income and education? How can doctors initiate this conversation?

Vest: Some patients feel comfortable having these conversations. Other patients, especially those who have received poor treatment and have experienced systematic prejudice in the health system, are less likely to have these conversations.

The doctor may say to a patient, “I want you to have a conversation with our social worker” or “We want you to have a conversation with our social worker or nutritionist as they are the ones best equipped to deal with Talk to you about other non-medical topics. These are the people who are specially trained to have these conversations. ”

Healio Primary Care: What else could Uppstroms possibly be used for besides referrals to social work and hospital stay prognoses?

Vest: There are many ways to improve patient wellbeing and health by taking social factors into account. The field is continuously expanding.

When we started working on Uppstroms, most of our clinical partner’s staff were using in-house services. However, the use of the model to connect patients with community-based organizations has increased. We are now interested in expanding our modeling to understand how we can effectively inform and risk stratify recommendations to community-based organizations.

Healio Primary Care: How Can Doctors Not Affiliated With Regenstrief Access Uppstroms? Is it compatible with existing electronic health record systems?

Vest: We would be happy to have more partners. We designed Uppstroms to be completely vendor neutral so that it can be implemented widely. It is a model that requires access and use of a lot of data and an understanding of the priorities, workflows and data collection processes of health organizations so that we can stratify their populations accurately. People can visit uppstroms.com to see our research and to contact us regarding possible partnerships.

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