Social Determinants of Health

This data element captures the combined income of the patient and the family members he/she lives with.

Submitted By: Raymonde Uy / National Association of Community Health Centers (NACHC)
Data Element Information
Use Case Description(s)
Use Case Description	Income is a well-documented factor related to health outcomes. For example, it is associated with lower life expectancy. Financial resource strain that results from insufficient income has been shown to lead to stress, depressed mood, self-rated poor health, smoking, and other substance abuse behaviors. Income is a significant determinant of health, impacting one’s ability not only to receive care but also from accessing the care they need
Estimated number of stakeholders capturing, accessing using or exchanging	All federally qualified health centers (FQHCs) gather data about income. This encompasses, in 2019, 29 million patients at 1400+ FQHCs with more than 13000 health care delivery sites. The evaluation of social determinants of health, however, should be considered a required component of a patient-centered, value-based approach to care and therefore should be potentially relevant for any patient or care setting.
Healthcare Aims	Improving patient experience of care (quality and/or satisfaction) Improving the health of populations Reducing the cost of care Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s)	ICD-10: Z59.5 Extreme poverty (100% FPL or below) Z59.6 Low income (200% FPL or below) Z59.7 Insufficient social insurance and welfare support Z72.4 Inappropriate diet and eating habits SNOMED-CT: 365553008 - Finding of household income (finding) 365556000 - Finding of pattern of income (finding) 365552003 - Finding of income details (finding) LOINC: 93025-5 - Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]
Additional Specifications	http://build.fhir.org/ig/HL7/sdoh-cc/ http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/ https://confluence.hl7.org/display/GRAV/Implementation+Guide
Current Use	Extensively used in production environments
Supporting Artifacts	Community Health Centers, Health Center Controlled Networks and Primary Care Associations routinely capture these data elements in different electronic health record systems
Number of organizations/individuals with which this data element has been electronically exchanged	5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts	Commercial vendors including Aunt Bertha, UNITEUS and NowPow consume PRAPARE data and use it to link individual patients to social interventions.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code)	None
Restrictions on Use (e.g. licensing, user fees)	The PRAPARE tool has very minimal licensing and user fees.
Privacy and Security Concerns	None
Estimate of Overall Burden	Low burden, especially for healthcare institutions that routinely cater to the target demographic and geographic catchment area.