In my conversation with Dr. Greg Johnson, Chief Physician Executive of Unity Point Health and former CEO of Hospital Medicine for Sound Physicians, we touched upon health equity, and he quoted a maxim that I took to heart: "There is no quality without health equity."
A healthcare system needs to make sure that all citizens have equal access to the care when it is needed. Sadly, this has not been the case in our country, and this has been so for decades. In 2003, the National Academy of Medicine issued a report entitled, "Unequal Treatment," which confronted racial and ethnic disparities in access to healthcare. A follow up report was issued in May 2024, "Ending Unequal Treatment," and it began by saying that not much has been done in the more than two decades since the original report. It then goes on to issue further recommendations to help address the continued health inequity that plagues our system today.
While this is a large, global problem, all of us in healthcare has a role to play to address health inequity. And it starts by screening for social determinants of health during multidisciplinary rounds (MDRs).
What are MDRs?
Multidisciplinary rounds is a gathering of members of the healthcare team to discuss all aspects of a patient's care in the hospital. We have MDRs every single day in all of our ICUs across the country at Sound Critical Care. In fact, it is one of our
Yet, MDRs should not only occur in the ICU. They need to occur on every medical unit in the hospital. They are led by the physician, and it includes nursing, physical and occupational therapy, respiratory therapy, case management, and other specialties as available. The group then reviews the care for the patient each and every day in a comprehensive manner, outlining the plan of care and - most importantly - next phases of care once the hospital stay is completed.
In order to help improve healthcare disparities, Dr. Johnson noted that MDRs not only need to address the medical care, but they should also screen for social determinants of health.
Core Aspects of Social Determinants of Health. I have always seen icons about social determinants of health (SDH) in various electronic health records, but I asked Dr. Johnson what are SDH? He mentioned five core aspects:
-
Housing insecurity
-
Food insecurity
-
Transportation insecurity
-
Utility insecurity
-
Interpersonal safety insecurity
These five core areas have great impacts on healthcare, especially in relation to readmission to the hospital. For example, we can set up as many follow up appointments with a patient's primary care physician as we want, but if they have no reliable way to get to the appointment, the follow up will not happen. Similarly, if a patient needs home oxygen therapy, but has unreliable electricity in the home, a portable oxygen concentrator will be of no use. Thus, it is very important that we start to screen for these SDH, and if any number of insecurities are present, we must address them as much as possible. And the screening should start during MDRs.
Redesigning MDRs
First, if there are no MDRs in your hospital, they need to be started. It is the absolute best way to ensure that all patients are receiving all the care they need. MDRs are not very difficult to do, and they do not take very much time out of the day. And the return on the investment of that time is enormous.
If your hospital already has MDRs, then it should start screening for social determinants of health. There are a number of screening tools, including one by the Centers for Medicare an Medicaid Services. They can be easily made as online surveys, and many health systems already have the tools built into the electronic medical record. The sooner we address social determinants of health, the sooner we can begin - one patient at a time - to end the unequal treatment that continues to plague our healthcare system in America.
