Perspectives in primary care: A conceptual framework and path for integrating social determinants of health into primary care practice

The United States falls behind other industrialized nations on most health indicators and remains plagued by stark health disparities. Efforts to understand the factors underlying these persistent inequalities and other shortcomings highlight the role of social determinants of health (SDH). There is mounting evidence to suggest that SDH influence health outcomes more than medical care. Even so, attempts to address SDH in medical care settings have been limited and, for the most part, ineffective. Serious efforts to reduce health disparities and improve population health will require innovative solutions for systematically addressing SDH in all primary care settings. While developing a research agenda to help inform and evaluate efforts to address SDH in health care settings, we created a framework that outlines the integration of SDH into primary care practice, with specific ideas for how SDH information might prompt action. The first step is collecting and organizing the data in a systematic way. Once we make progress toward routine collection of SDH data, the second step is making the data available and useful in ways that enhance care (the right data, at the right time, in the right place). There is likely another important step needed to maximize the potential usefulness of integrating SDH into primary care, however. This third step involves the development of automated systems that harness SDH data to prompt action. The nation needs a bold, forward-thinking research agenda to study and produce the evidence for how SDH data can and should be incorporated into primary care. As we move forward with efforts to address SDH, we must simultaneously investigate which social determinants are most influential on health outcomes, how to present SDH data in the EHR to maximize its utility, where in clinic workflows and in what format the data should be made available, and how care teams can best use such data.