Table 4. Algorithm for identifying positive SDH screens.

SOCIAL DETERMINANTS OF HEALTH (SDH) Citations and Copyright Information June 1, 2016

¹Developed by OCHIN’s Clinical Operations Review Committee.

²Adapted from standard education questions to align with patient population of OCHIN membership.

³Slight modification of IOM-recommended financial hardship item (medications added to list of examples) Puterman E, Haritatos J, Adler NE Sidney S, Schwartz JE, Epel ESl. 2013. Indirect effect of financial strain on daily cortisol output through daily negative to positive affect in the coronary artery risk Psychoneuroendocrinology 2013; 38:12. doi:10.1016/j.psyneuen.2013.07.016. Hall, MH., Matthews KA, Kravitz HM, Gold EB, et al. 2009. Race and financial strain are independent correlates of sleep in midlife women: The SWAN Sleep Study. Sleep 32(1):73 82. Follow-up question, “What is it hard to pay for?” was added to get more granularity and enable care team to identify needed interventions. This follow-up question was adapted from a Kaiser Permanente SDH questionnaire, with permission.

^4-5Housing questions from Health Begins Upstream Risk Screening Tool (http://www.healthbegins.org/).

⁶US Department of Agriculture 18-item Household Food Security Survey (HFSS).

⁷Adapted from a Kaiser Permanente SDH questionnaire, with permission.

⁸Exercise Vital Sign – Question 1 & 2. Sallis RE. Developing health care systems to support exercise: exercise as the fifth vital sign. Br J Sports Med. 2011;45:473 4. Epic already has copyright permission.

^9-11Third National Health and Nutrition Examination Survey (NHANES III). Epic already has copyright permission to use this question. Scoring is based on the Berkman-Syme Social Network Index (SNI). Pantell M, Rehkopf D, Jutte D, Syme SL, Balmes J, Adler N. Social isolation: A predictor of mortality comparable to traditional clinical risk factors. American Journal of Public Health 2013; 103(11):2056 62. Item 10c was created as a parallel to items 10a and 10b to capture social connection via newer electronic modes that weren’t available when Berkman-Syme SNI was created. Frequency categories for 10-11 slightly modified from original. Kaiser is also using this approach in their screening tool. Epic already has copyright permission to use this question.

¹²Modified from item in PROMIS Item Bank v. 1.0 – Emotional Distress - Anger - Short Form 1 – and AARP overall loneliness item from AARP survey about loneliness in older adults; Original PROMIS item written in 1st person; loneliness added to reduce literacy level.

¹³Your Current Life Situation Questionnaire, Kaiser Permanente.

¹⁴1998 Adult Prevention Module of the National Health Interview Survey.