There is a constant theme for every talk I have given in the last 6 months. The fundamental structure includes a discussion of social determinants of health. A recent article in NEJM was a worthwhile rabbit hole and reminded me specifically of diseases prevalent in the elderly. BECOMING A PHYSICIAN Rethinking the Social History connects dots presented by higher rates of illness in the USA compared to other countries but I would speculate that it has, at least in part, to involve living conditions, education, and quality of life—the social determinants of health.
Topics for expanded social history
Behforouz and colleagues revised social history topics to improve health outcomes. Six general categories capture data regarding individual characteristics, life circumstances, emotional health, perceptions of health care, health-related behaviors, and access to and utilization of health care.
The connection between social determinants and health status continue to be characterized and included in the evolving healthcare debate. Research questions that untangle parallel pathways in chronic disease and diseases of aging have identified risk that may reveal preventitive strategies in diseases as complex as Alzheimer's disease and dementias in general.
In my role as a Right Care Action Week Captain, I am specifically focused on the role of expanded social history and acquiring the ability to contextualize illness within the social environments where it occurs.
Stay tuned for insights from the Protecting Overdiagnosis conference at the National Insititutes of Health next week.
Erika H. Newton, MD, MPH, and colleagues published a study in JAMA Internal Medicine this month that probed the extent to which outpatient and emergency department clinical performance measures assessed underuse as compared to overuse. In an interview with MedicalResearch.com, Dr. Newton underscores the growing concern that if performance measures are too narrowly focused on underuse, this will lead to excessive unnecessary care. And yet process measures overwhelmingly target underuse. Examining 16 major national collections of performance measures, the authors found that out of a total of 521 outpatient measures, more than 90 percent assessed underuse, while only seven percent assessed overuse. And the overuse measures in this seven percent were not widely employed— almost half included none at all. To solve this issue, the authors recommend that clinicians both consider the evidence, but also engage with the system to help reshape policies and begin to address the “’more is better’ culture in medicine.” Stephen Martin, MD, and Jerome Hoffman, MD, advise in a USA Today piece that patients can also play a role in recognizing and avoiding unnecessary care.--LOWN INSTITUTE
Thoughtful discussions about content development and outcomes analytics that apply the principles and frameworks of health policy and economics to persistent and perplexing health and health care problems