Vanderbilt University Medical Center has received a three-year, $1.6 million federal grant to incorporate social drivers of health into adult primary care with the aim of improving outcomes for patients with multiple chronic conditions.
Social drivers of health include economic status, food, housing, access to health care, education level, health literacy and discrimination. They are responsible for 50-60% of health outcomes and underlie health disparities in chronic diseases. Clinical care provides an opportunity to address many social needs, which can substantially improve health equity.
Despite the urgings of the National Academies of Sciences, Engineering, and Medicine and other professional societies, health care organizations have traditionally not screened or acted on social drivers of health in a systematic way. New regulations from The Joint Commission add urgency to the need to study and establish best practices.
The grant from the National Institute on Minority Health and Health Disparities, part of the National Institutes of Health, will support the establishment of a multi-level initiative to address social drivers of health in clinical practice.
The project is co-led by Sunil Kripalani, MD, MSc, professor of Medicine, and Lyndsay Nelson, PhD, research assistant professor of Medicine. Kripalani directs VUMC’s Center for Health Services Research and the Center for Clinical Quality and Implementation Research (CCQIR).
“We will gather input from stakeholders, including primary care physicians, patients, and community organizations, to inform the design of the initiative, including a social drivers of health assessment that patients will complete prior to their clinic appointment,” Kripalani said.
“This research will generate valuable insight into the effects of social risk-informed care on clinical practice, community resource referral, and patient outcomes,” added Nelson, assistant director of the CCQIR.
While the implementation of the assessment will take place as a system change across VUMC adult primary care practices, the grant’s evaluation activities will center on patients with Type 2 diabetes and a comorbid condition such as high blood pressure or high cholesterol.
Clinical staff will receive training on how to discuss social drivers of health with their patients, and clinical decision support will provide them with recommended actions and links to health system and community resources.
Outreach will be provided to patients who report social risk factors to help them connect with appropriate resources that can provide support and assistance. The researchers will coordinate their work with the collection of data on social drivers of health that is part of VUMC’s Racial Equity Plan.
To determine the impact of the initiative, the researchers will examine the number of patients screened, prevalence of social risk factors identified, use of referrals and other recommended resources, and effect on clinical outcomes such as blood pressure, hemoglobin A1c and low-density lipoprotein cholesterol over 12 months.
“We will also survey a subgroup of patients to examine trends in self-reported psychosocial and behavioral measures,” Nelson said.
The initiative is part of the Southeast Collaborative for Innovative and Equitable Solutions to Chronic Disease Disparities, funded in September 2021 with a separate $12.4 million grant from the National Institute on Minority Health and Health Disparities.
The four principal investigators of the collaborative grant, which includes VUMC, Meharry Medical College and the University of Miami Miller School of Medicine, are:
- Consuelo Wilkins, MD, MSCI, Senior Vice President and senior associate dean for Health Equity and Inclusive Excellence, and professor of Medicine at VUMC.
- Nancy Cox, MD, Mary Phillips Edmonds Gray Professor of Medicine at VUMC, and director of the Vanderbilt Genetics Institute.
- Stephania Miller-Hughes PhD, MS, MSCI, professor of Surgery at Meharry Medical College.
- Roy Weiss, MD, PhD, chair of medicine at the University of Miami Miller School of Medicine.
The collaborative is funded by NIH grant number 5P50MD017347, and the initiative to incorporate social drivers of health into primary care by grant number 3P50MD017347-03S3.