Browsing by Subject "social determinants of health"

Now showing 1 - 7 of 7
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    Anemia as a Marker of Social Determinants of Health: Then and Now
    (Elsevier, 2022-10) Sherwin, Nomi K.; Ott, Mary A.
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    Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review
    (JMIR Public Health and Surveillance, 2019) Golembiewski, Elizabeth; Allen, Katie S.; Blackmon, Amber M.; Hinrichs, Rachel J.; Vest, Joshua R.
    Background: Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective: This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods: We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results: A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions: A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.
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    The Heart of Maternal Mortality: Postpartum Cardiomyopathy and Its Upstream Determinants of Health
    (2020) Campbell, Meredith; Lee, Deborah; Marks, Claire; Palma, Samantha; Yang, Caroline
    CASE: A 25-year-old obese African American female presented with dyspnea 6 weeks after a full-term vaginal delivery complicated by pre-eclampsia. Further work up showed LV enlargement without hypertrophy and globally decreased contractility consistent with postpartum cardiomyopathy as well as endocarditis with vegetations on the aortic and tricuspid valves. In the setting of poor patient compliance, patient progressed to worsening systolic heart failure as LVEF dropped from 45% to 25% within a year. Despite further management including valve replacement, ICD placement and a continuous milrinone treatment, LVEF continued to decline, with the lowest value at 12%. During one of her recurrent acute respiratory failures, the patient and team made the difficult decision to transition to palliative care, where she expired. BACKGROUND: Postpartum cardiomyopathy (PPCM) is a life-threatening disease that arises between the last month of pregnancy and four months after delivery, where patients present with dyspnea, dizziness, or lower extremity edema. Although it is rare with an incidence of 1 case per 2187 live births, it has a high mortality rate in the US ranging from 6% to 10%, mostly in the first 30 days. DISCUSSION: Multiple recent studies have demonstrated the significance of early diagnosis of PPCM and its strong association with more favorable outcomes, including greater LVEF recovery and lower rates of morbidity and mortality. This evidence suggests the need for pre-discharge screening, in order to diagnose patients earlier and give them the greatest opportunity for a full recovery. Additionally, patient noncompliance, largely influenced by socioeconomic status and medical literacy of the patient, is another crucial factor that affects the prognosis of PPCM. Effective strategies to increase compliance include educating the patient, using an inter-professional healthcare team, and working with the psychological and socioeconomic barriers to compliance.
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    Medical Racism and Black Health Activism in Indianapolis and Beyond: Learning Modules for Health Professionals
    (2024) Nelson, Elizabeth
    This set of modules, designed for health care professionals, focuses on the history of health disparities in the United States, with a special focus on Indianapolis. Health disparities between different racial and ethnic groups have been documented since the 1800s. Anti-Black racism has played a central role in the making of modern medicine in the US; Dr. Martin Luther King Jr., considered discrimination in medicine to be the most “shocking and inhuman” form of racism. Civil Rights activists and Black health care professionals have led efforts to minimize health disparities, in Indianapolis and beyond, over many decades. But there is more work to be done. As we build toward a more equitable future, we would be wise to inform ourselves of this past.
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    A Profile in Population Health Management: The Sandra Eskenazi Center for Brain Care Innovation
    (2019) Boustani, Malaz; Yourman, Lindsey; Holden, Richard J.; Pang, Peter S.; Solid, Craig A.; Medicine, School of Medicine
    This article describes how key aspects of the Sandra Eskenazi Center for Brain Care Innovation's (SECBCI) care model can inform other entities on the development of new models of population health management, through a framework that emphasizes social, behavioral, and environmental determinants of health, as well as biomedical aspects. The SECBCI is a collaboration with Eskenazi Health and community-based organizations such as the Central Indiana Council on Aging Area Agency on Aging and the Greater Indianapolis Chapter of the Alzheimer's Association in Central Indiana.
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    Sociopolitical values and social institutions: Studying work and health equity through the lens of political economy
    (Elsevier, 2021-06) Fujishiro, Kaori; Ahonen, Emily Q.; Gimeno Ruiz de Porras, David; Chen, I-Chen; Benavides, Fernando G.; Social and Behavioral Sciences, School of Public Health
    Work contributes to health and health inequity in complex ways. The traditional exposure-disease framework used in occupational health research is not equipped to address societal contexts in which work is embedded. The political economy approach to public health directly examines macro-level societal contexts, but the attention to work in this literature is mostly on unemployment. As a result, we have limited understanding of work as a social determinant of health and health inequity. To fill this gap, we propose a conceptual framework that facilitates research on work, health, and health equity in institutional contexts. As an illustration of different social institutions creating different work-related health, we present characteristics of work and health in the United States and the European Union using the 2015 Working Conditions Surveys data. The results also highlight limitations of the traditional exposure-disease approach used in occupational health research. Applying the proposed framework, we discuss how work and health could be investigated from a broader perspective that involves multiple social institutions and the sociopolitical values that underpin them. Such investigations would inform policy interventions that are congruent with existing social institutions and thus have the potential for being adopted and effective. Further, we clarify the role of research in generating knowledge that would contribute to institutional change in support of population health and health equity.
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    Using structured and unstructured data to identify patients’ need for services that address the social determinants of health
    (Elsevier, 2017-10) Vest, Joshua R.; Grannis, Shaun J.; Haut, Dawn P.; Halverson, Paul; Menachemi, Nir; Health Policy and Management, School of Public Health
    Introduction Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH. Methods A cross-sectional study described patients in need of SDH services offered by a safety-net hospital’s federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources. Results More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex. Discussion The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data.