Measure Components	The CDU uses a standard process/protocol for addressing SDoH in clinical settings for patients with HBP, including:
	• Utilization of a standardized tool, such as the Accountable Health Communities Screening Tool,177 to screen health-related social needs in clinical settings.
	• Integration of social and behavioral domains (Table A) into EHRs to monitor efforts to address SDoH.
	• Documentation of patient assessments of SDoH and referrals to social services in medical records.
	• Integration of clinical staff members (eg, social workers, case managers, registered dietitians) to link patients with appropriate community resources.
	• Training of volunteers within the CDU to access a database of resources to address SDoH and provide follow-up until a resolution of unmet social needs is achieved.
	• Identification of community health workers to conduct home social assessments to connect socially deprived patients with community resources.
	• Creation of partnerships with community organizations that provide healthy food and assist with enrollment in federal nutrition assistance programs.
	• Creation of partnerships with pharmacies to provide access to home delivery options for obtaining medication to manage HBP
Rationale
Socioeconomic inequalities are strong determinants of ASCVD risk internationally.178,179 Therefore, it is important to tailor advice to a patient’s socioeconomic and educational status, as well as cultural, work, and home environments.180 The CMS has developed a tool to assess 5 domains of non-health-related measures that impact health outcomes: housing instability, food insecurity, transportation difficulties, utility assistance needs, and interpersonal safety.177 ASCVD prevention could benefit from such screening. ASCVD risk begins early in life, with heightened susceptibility tied to low socioeconomic status.181 Examples of upstream SDoH that affect adherence and ASCVD health outcomes include comorbid mental illness, low health literacy, exposure to adversity (eg, home/community violence, trauma exposures, safety concerns), financial strain, inadequate housing conditions, food insecurity (eg, access to affordable and nutritious food), and inadequate social support.182 Systems of care should evaluate SDoH that affect care delivery for the primary prevention of ASCVD (eg, transportation barriers, the availability of health services).
Important considerations related to socioeconomic disadvantage are not captured by existing ASCVD risk equations.183 Addressing unmet social needs improves management of BP and lipids,184 highlighting the importance of dietary counseling and encouraging physical activity.185 More time may be required to address ASCVD prevention when working with adults of low health literacy or disadvantaged educational backgrounds. Differential cardiovascular outcomes persist by important sociodemographic characteristics, including but not limited to age, gender, and race/ethnicity.186–189 Failure to address the impact of SDoH impedes efficacy of proven prevention recommendations. Standardized use of EHRs that include social and behavioral domains could improve care for patients with HBP. Table A outlines social and behavioral domains that may be integrated into EHRs to address SDoH.190
Clinical Recommendations
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease14
Recommendations for Addressing Social Determinants of Health (SDoH) (Section 2.1, 2019 Prevention Guideline)
1. Social determinants of health should inform optimal implementation of treatment recommendations for the prevention of ASCVD.178–181,185,189,191 (Class 1, Level of Evidence: B-NR)