Digital solutions can address social determinants of health
New Maven research published in the American Journal of Obstetrics and Gynecology
Social determinants of health, the non-medical factors that affect people's ability to live, work, and play, account for over 40 percent of health outcomes. But how to best address them has flummoxed health care systems for decades. This shortcoming is particularly evident for pregnant people whose well-being is inextricable from the well-being of their family. A pregnant woman who has faced eviction and lacks access to stable housing, for example, is at greater risk of having a child born premature or of low birth weight.
Dr. Alex Peahl, Maven’s first Visiting Scientist and an Assistant Professor at the University of Michigan, is determined to change this and has quickly become one of the nation’s leading experts on new models of prenatal care. Dr. Peahl led the efforts of our talented research and clinical programming teams to develop a novel social determinants of health tool. We then took a relatively unusual step for a digital health company: we submitted it for peer review and published it as an open access resource in the American Journal of Obstetrics and Gynecology’s Global Reports (Open Access).
Using human-centered design principles, we validated a three-question screen and showed that it is both sensitive and specific in picking up social needs. Our tool performed close to par with the gold standard while being much less burdensome to complete, and is now live in the Maven platform in support of our global membership.
In our research to support the development of this tool, we found that among those with both public and private insurance, 75 percent had at least one material or social support need. Intimate partner violence and social isolation were heartbreakingly prevalent. But encouragingly, digital platforms like Maven are well positioned to identify and assist. The majority felt it was important for their pregnancy care team to be aware of these needs and the majority were comfortable sharing their needs digitally.
This work is a modest but promising step against an enormous public health challenge. It is also an exemplar of an approach to evidence-based design that Maven hopes to lead. Copied below is Maven’s social determinants screen, which we hope others find helpful in practice as well. You can read the team’s paper here.
What my team is reading, considering, and building against
Physicians, like all people, benefit from strong peer-relationships and it turns out that their patients do too. This paper in JAMA Internal Medicine studied whether the strength of physician-peer relationships impacted patient outcomes. The authors found that patients “reported substantially better specialist care” when they were cared for by a specialist who had trained with their primary-care provider. While it’s hard to replicate a care model that is based on with whom a provider has trained, there is an opportunity to be more intentional in how we strengthen peer relationships, particularly in a virtual setting.
Erica Eliason and Maria Steenland are the authors of a research letter in JAMA Health Forum that shows increased insurance coverage for pregnant people in New York following the state’s 2016 decision to add pregnancy as a ‘qualifying event’ for marketplace enrollment. While the ACA has significantly decreased the uninsured rate in the US, the enrollment model consists of a 2-3 month window annually. This potentially leaves a large gap in coverage for folks who become pregnant outside of the window. The success of New York’s first-in-the-nation approach could be a model for other states going forward.
An investigation into the association between the use of palliative care and social work staffing published in JAMA Network Open found increased rates of care when social workers were added to primary care teams at veterans’ hospitals. The findings are an encouraging endorsement of a team-based care model that can make a difference in a variety of settings and populations.