The social determinants of health (SDOH) represent factors that impact the health and effectiveness/compliance of a treatment plan for a patient. The SDOH include such factors as economic stability, education, home and community context, access to healthcare, neighborhood and built environment, and personal behavior. The purpose of this study is to determine the extent of collection and integration of SDOH into clinical practice, and the usefulness of this information in medical decision making. Following a thorough literature review, an online survey was deployed to physicians and administrators around the country, with the aim of answering the following questions: 1) Do provider practices collect information on a patient's social determinants of health? 2) If yes, how is that information being used, if at all? 3) If not, what is preventing them from doing so? 4) Do the answers to questions 1-3 differ based on the type of payment model (Fee-for-Service or Capitation) to which the practice is subject? The results of the study suggest that fee-for-service payment environments present less incentive to use a patient's SDOH in medical decision making.

As 2020 unfolded, a new headline began taking over front pages: “COVID-19”. In the months that followed, waves of fear, sorrow, isolation, and grief gripped the population in the viruses’ wake. We have all heard it, we have all felt it, indeed because we were all there. Trailing a few months behind those initial headlines, more followed that only served to breed misinformation and ludicrous theories. Even with study after study, quality, scientific data about this new virus could not come fast enough. There was somehow both too much information and also not enough. We were scrambling to process the abundance of raw numbers into some semblance of an explanation. After those first few months of the pandemic, patterns in the research are beginning to emerge. These horrific patterns tell much more than just the pathology of COVID-19. As the number of sick, surviving, and deceased patients began to accumulate, it became clear that some populations were left devastated, while others seemed unscathed. The reasons for these patterns were present long before the COVID-19 Pandemic. Disparities in health care were highlighted by the pandemic – not caused by it. The roots of these disparities lie in the five Social Determinants of Health (SDOH): (1) economic stability, (2) neighborhood and built environment, (3) education, (4) social and community context, and (5) health and health care. Minority populations, namely Black Americans, Hispanic Americans, Native Americans, and Pacific Islanders consistently have higher diagnosis rates and poorer patient outcomes compared to their White American and Asian American counterparts. This is partly because minority populations tend to have jobs that pay lower, increase exposure risk, and provide little healthcare. When unemployment increased in the wake of the pandemic, minorities were the first to lose their jobs and their health insurance. In addition, these populations tend to live in densely populated neighborhoods, where social isolation is harder. Higher poverty rates encourage work DISPROPORTIONATE EFFECTS OF COVID-19 ON MINORITY POPULATIONS 3 rather than education, often perpetuating the cycle. The recent racial history and current aggressions towards minority people might produce a social attitude against healthcare Health care itself can be expensive, hard to find, and/or tied to employment, leading to poorly controlled comorbidities, which exacerbate poor patient outcomes in the case of COVID-19 infection. The healthcare delivery system plays little part in the SDOH, instead, public policy must be called to reform in order to fix these issues.

The reactionary nature of the current healthcare delivery system in the United States has led to increased healthcare spending from acute exacerbations of chronic disease and unnecessary hospitalizations. Those who suffer from chronic diseases are particularly at risk. The dynamics of health care must include grappling with the complexities of where and how people live and attempt to manage their health and disease. Team-based care may offer a solution due to its interdisciplinary focus on proactive, preventative care delivered in outpatient primary care.

Studies examining the effects of team-based care have shown improvement in; HbA1c, blood pressure, lipids, healthcare team morale, patient satisfaction rates, quality of care, and patient empowerment. In an effort to improve type 2 diabetes health outcomes and patient satisfaction a team based care project was implemented. The setting was an outpatient primary care clinic where the patients are known to have limited social resources. The healthcare team was comprised of a DNP Student, Master of Social Work Student, Clinical Pharmacist, and Primary Care Physician, who discussed patient specifics during informal meetings and referral processes.

Adult patients whose HbA1c level was greater than 6.5% were eligible to participate, 183 were identified and invited. Fourteen (14) agreed to participate and seven (7) completed the initial screening with a mean HbA1c of 9.7%. Significant social needs were identified using the Health Leads Questionnaire. The diabetes and social needs were addressed by members of the team who met individually with patients monthly over the course of three months. Of those who completed the initial evaluation only two (2) returned for a follow-up and had a repeat HbA1c. Both participants had important improvements in their A1C with a decrease of 2.3%, and 3.4%. The others were lost to follow up for unknown reasons. Despite the small numbers of participants this project suggests that patients can benefit when an interdisciplinary team addresses their needs and this could improve health outcomes.