Factors associated with documenting social determinants of health in electronic health records

INTRODUCTION: Social determinants of health (SDOH) significantly impact health outcomes, yet their integration into clinical decision making is inconsistent. We examined how family physicians document SDOH in electronic health records (EHRs) and identified factors influencing this practice. 

METHODS: We performed a cross-sectional analysis of 2,089 family physicians completing the 2022 American Board of Family Medicine Continuous Certification Questionnaire. The outcome was physicians' self-reported SDOH documentation by checking a box within the EHR, writing it in a note, or entering it as a diagnosis. Physician, practice, and community characteristics associated with SDOH documentation were assessed, using logistic regression. 

RESULTS: We found that 61% of family physicians documented SDOH in notes, with fewer using checkboxes (46%) or diagnosis codes (35%). Across models, factors persistently positively associated with documenting SDOH included participating in value-based programs, having more resources for social needs, collaborating with neighborhood organizations, and working in a more disadvantaged area (higher Social Deprivation Index [SDI] score). For example, family physicians who worked in areas with the third quartile of SDI (OR = 1.366, 95% CI = 1.037 - 1.799) and the fourth quartile of SDI (OR = 1.364, 95% CI = 1.032 - 1.804) were more likely to enter SDOH as a diagnosis, compared with those in the least disadvantaged areas. 

DISCUSSION: Socioeconomic aspects of the communities and a practice-level capacity to address SDOH were the biggest predictors of documenting SDOH, rather than the physicians' own characteristics. These findings affirm the necessity of financial incentives and well-resourced care teams to successfully achieve integrated SDOH in primary care practice.