Trubridge Inc.

10/09/2024 | Press release | Distributed by Public on 11/09/2024 04:53

Rural Healthcare Goes Beyond Care: Targeting SDOH to Improve Health Outcomes

Social determinants of health (SDOH) have more influence on health than either genetic factors or access to healthcare services, according to the Centers for Disease Control and Prevention (CDC). As a registered nurse with two decades in the field, I've seen the impact social factors have on a patient's health. I've grown up and worked in rural America most of my life and have seen the faces of these statistics first-hand.

The CDC states poverty, which affects one in 10 Americans, is strongly correlated with worse health outcomes and premature death. Poverty is magnified in rural America and affect racial minorities at vastly high rates due to historic, systemic inequities. The US Department of Agriculture (USDA) Economic Research Service reports that rural Black Americans experience poverty rates of nearly 31% compared to rural White Americans with poverty rates of about 13%.

My neighbors, friends, and family are the ones I'm thinking of when I advocate for a brighter healthcare future. As a clinician turned informaticist, I know the value SDOH insights bring to the healthcare experience. My product development work is informed by seven years serving a community hospital. Experience is the best foundation to build new technology solutions and get them into the hands of active clinicians.

The unfortunate truth is, rural Americans are medically underserved and often face heightened challenges across the core areas of SDOH. Here are four insights to consider according to research by the National Institute for Healthcare Management.

Healthcare access and quality: 80% of rural America is medically underserved, only 10% of physicians in the US serve rural areas, and one in six rural Americans ages 19-64 are not covered by health insurance.
Economic stability: Rural communities are notorious for fewer employment opportunities and higher rates of poverty. For example, 36% of rural adults skipped needed healthcare because of cost.
Telecommunications: 17% or 8 million rural Americans do not have access to broadband internet, making telehealth and hospital-at-home services difficult to support.
Fewer community programs: Rural America faces a severe resource gap. While rural communities account for 22% of Americans living in poverty, these areas receive only 8% of total spending in the nonprofit sector. In other words, the nonprofit industry is three times smaller per capita in rural areas than urban ones.

To address these realities, healthcare leaders are tapping into their SDOH data and building healthier communities. This article shares the unique experiences of two critical access hospitals (CAHs) to achieve these goals.

Close transportation gaps to improve care access

While many healthcare providers know SDOH factors comprise a critical area of focus, it can be difficult to prioritize and implement the right strategy for gathering data and caring for the whole patient. Lack of transportation is one example of a SDOH factor that is particularly challenging for rural providers and a significant hindrance to healthcare access.

According to the American Hospital Association (AHA), rural patients travel twice as far to receive healthcare than suburban and urban populations. However, some hospitals are working to relieve this barrier to care. For example, a full-service 25-bed acute care facility located in rural Missouri, recognized this reality when assessing their SDOH data.

The health system implemented mobile clinics in response to SDOH data indicating transportation gaps. The clinics put primary care on wheels and got physicians out and into their communities.

The clinics are self-sufficient - complete with generators, exam rooms, air conditioning, and all the medical equipment needed to perform routine procedures. This mobile option allows patients in the surrounding areas to access quality care closer to home.

Another example of improved healthcare transportation comes from a 25-bed acute care facility located in New Mexico. The hospital offers transportation services to shuttle patients from home to the medical facility and back. This option is yet another way to meet patients where they are and address their needs holistically.

Transportation is not the only health-related social need. There are many more - including financial.

Make care more affordable

Poverty strikes more aggressively in rural communities. Here are two more strategies to consider when addressing the economic needs of rural communities.

Offer affordable medication alternatives. According to Bloomberg, prescription drugs in the US cost, on average, $1,400 per person in 2022. In fact, the same article states that Americans spend more on prescription drugs than any other country in the world. With high costs of medications and pervasive poverty faced by rural populations, it's no surprise that many Americans struggle to pay for prescriptions. However, with visible SDOH information, physicians can take a personalized approach and choose drug regimens that are more affordable. This route supports the patient's overall health by addressing financial needs alongside clinical treatment. Prescribing lower cost medications helps ensure patients stick to care plans and mitigates difficult decisions such as choosing between paying an electric bill or picking up their medications.
Connect with community resources or create them. Rural settings often face community resource gaps such as food pantries. Food insecurity in rural counties is disproportionately high and there are fewer resources to mitigate the problem according to Feeding America, one of the nation's largest food banks. Health systems must seek relationships with existing resources and collaborate to meet the needs of their community.

Working together with communities to identify and apply for grants is another way for healthcare organizations to create their own solutions and meet community needs. SDOH data is an essential tool to identify and address these challenges, work with community partners to expand programs, and quickly connect patients with essential resources.

Questions remain: An alternative perspective on SDOH conversations

Not everyone is on the same page when it comes to the role of healthcare in addressing community needs. A recent Wall Street Journal op-ed titled "Not Everything is Healthcare," by Chris Pope, health policy researcher and Senior Fellow at conservative think tank, the Manhattan Institute, argued against healthcare's decades-long effort to combat social inequities as a form of patient care.

Pope stated, "Giving medical providers the task of solving intractable social problems burdens them with extraneous responsibilities for which they are poorly suited." He continued, "It also impedes the cost-effective delivery of healthcare, which is already far too expensive."

While questions remain about who is best to address SDOH, it is clear there's a need for community support to relieve patients of undue burden. Many scholarly sources indicate treating social drivers of health has positive impacts on patient outcomes; however, high financial burden and persistent challenges in healthcare delivery raise questions for policy makers about which resources are best fit to meet these needs.

Technology and holistic mindset work together to create thriving communities

As poverty, food insecurity, inadequate housing, and complex comorbidities persist, it is essential that rural healthcare leaders have tools and systems in place to address the health of their neighbors. Community and rural facilities need SDOH insights at the point of care to understand their patients' holistic needs and make intentional decisions that support the patients' overall wellbeing.

By gathering and understanding social data, clinicians make more informed decisions that benefit patients' total wellbeing, and in turn, stop medical conditions from snowballing and save public health dollars.