- Swimming "upstream" to tackle the social determinants of health
- Quality improvement interventions typically focus on how to improve the care delivered within healthcare organisations or by health systems. Rarely do efforts venture beyond the walls of clinics and hospitals to target the social determinants of health. Berkowitz et al remind us that swimming "upstream" is essential if we want to improve health outcomes for vulnerable or disadvantaged patients.The authors conducted a cross-sectional study of a Health Leads intervention in two urban adult primary care practices. Social needs were identified and then addressed by advocates based in the practices. They found that 15% of patients seen had an unmet resource need, most commonly food insecurity or a health resource need such as difficulty obtaining health insurance or affording medications. Patients with unmet resource needs were less healthy, had more "no-show" appointments, more emergency department visits and were less likely to meet care targets.
Tara Kiran, Andrew D Pinto
BMJ Qual Saf 2016; 25: 138-140. doi: 10.1136/bmjqs-2015-005008
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