The Role of Social Determinants of Health (SDOH) in Pre-Operative Patient Assessment - A Framework for Comprehensive Patient Optimization


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Background – Comprehensive pre-operative patient evaluations are critical to providing high value, patient-centered surgical care. These evaluations systemically address risk assessment and identify areas for risk modification. Historically, pre-operative optimization has focused on medically oriented contributing factors. Social determinants of health (SDOH)- health related behaviors, socioeconomic factors, and environmental factors- contribute broadly to healthy outcomes. Widespread integration of SDOH assessment in the perioperative evaluation provides an opportunity to improve outcomes for patients undergoing both elective and emergency surgical procedures.

Purpose – To understand the barriers to widespread integration of SDOH assessment in the pre-operative assessment of surgical patients.

Methods – An online cross-sectional survey was conducted to assess provider knowledge, beliefs, and barriers to the assessment of social determinants of health in pre-operative patient optimization.

Results – 50% of providers were somewhat familiar with social determinants of health as a concept. Only 33% of participants were aware of the impact of SDOH assessment on reimbursement, while 66% were not aware of the recent coding changes. 58% do record at least one social determinant in their pre-operative consult note. Access to transportation to care, followed by health literacy/educational level and addiction to tobacco or illicit medications were identified to have the greatest perceived impact on outcomes. Time to collect data and lack of resources to address problems identified were the most common barriers, 83% and 67% respectively. In order to increase the impact of SDOH assessment, the survey identified need for additional resources to address the needs identified (75%), additional knowledge about social determinants (58%), and additional reimbursement (58%).

Conclusions - SDOH has a significant impact on the improvement of surgical outcomes and the reduction of disparities. Additional education and policy advocacy are needed to fully actualize prehabilitation and post-operative care coordination.



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