Identifying and addressing social determinants is becoming an essential part of healthcare. Despite their recognized impact on healthcare outcomes, actually identifying these determinants on both a patient- and population-level is difficult and often leaves us with an incomplete picture. Unstable housing is a major risk factor for many Hennepin Healthcare patients; this session will describe our journey to understand, identify and address this determinant with our patients. A novel approach to using population-level data to identify homelessness was our first step in eventually developing a multi-faceted indicator that is clinically meaningful. This approach is applicable to other healthcare organizations looking to take steps in identifying and addressing social determinants of health.
Identify the difficulties in presenting social determinant data to clinicians in a useful way
Use population-level data to identify patients at risk for unstable housing
Design multi-faceted indicators of social determinant risk at other healthcare organizations