Teaching Modules

Introduction

The emergency department (ED) is historically where one thinks of sick/unstable patients with myocardial infarction patients, those who present with gunshot wounds, or crashing septic patients. Although designed for medical emergencies, EDs have become a common place where patients seek help for various problems. EDs thus care for patients who present not only for heart attacks and strokes, but also for a variety of social ills, such as homelessness, poverty, and hunger. In doing so, the ED has become the safety net for those who lack access to other resources for their care.

Every ED screens patients for life-threatening illnesses, no matter the chief complaint. However, EDs and emergency providers are often left frustrated, as they may be unable to address the root cause of the patient’s visit. This is not surprising, given that experts estimate that only 20% of a patient’s health is shaped by medical care, whereas social and economic factors account for 50% of health outcomes, highlighting the importance of concurrent medical and social interventions to advance patient health outcomes. Social determinants of health thus impede healthcare by simultaneously creating barriers to healthcare access and resulting in non-adherence to medical interventions. Furthermore, left unaddressed, social determinants drive up both healthcare cost and utilization. Even for those with access to healthcare, competing social needs impede the ability of the individual to adhere to treatment plans. Social determinants thus place a strain on the physician-patient relationship.

Few emergency departments take a population health approach to patient health by screening for and addressing social determinants. In part, this is because traditional medical education focuses on the biological aspects of disease while ignoring social determinants, resulting in healthcare providers and a healthcare system that are unprepared to ask about and address social determinants, such as housing and food. Previous studies have shown that providers are unable to address these social issues because of: 1) lack of time, 2) lack of understanding of the importance of these issues, 3) discomfort exploring these issues, 4) lack of knowledge of available community resources, and 5) failure to understand the relevance of these issues. Thus, when social issues surface, healthcare providers depend on social workers to attend to patients’ needs without fully understanding or championing engagement. Although some residencies have recognized this shortcoming and have implemented various programs to teach about the social determinants, there is no standard curriculum.

These modules were created as a way for interested individuals who care for patients affected by issues such as homeless and hunger, but who are not experts in the social determinants of health, learn about the social determinants of health. These individuals can then use these modules to teach other members of the healthcare team, including, but not limited to, students, residents, nurses, advanced practice providers, social workers, case managers, pharmacists, and attending physicians about different social determinants of health.

Collectively, these modules serve as a primer to the social determinants of health that affect our patients. Each module, however, intended to stand alone on the social determinants it covers, can be used to teach during rounds or in small groups focused on introductory concepts and clinical “pearls” rather than an exhaustive review. It is our hope that using these modules will allow providers to recognize, discuss, and address the social determinants of health to improve the patient experience, patient outcomes, and clinician experience, and promote health equity while decreasing costs.

We welcome feedback and suggestions for improvement and would love to hear about your experience (s) using the modules, and thoughts on additional topics to cover.

Sincerely,

Breena Taira, Dennis Hsieh & Adedamola Ogunniyi
Editors, IDHEAL Case Modules
Section of International and Domestic Health Equity (IDHEAL)
Department of Emergency Medicine
University of California, Los Angeles

Objectives

Every healthcare professional encounters patients with unmet social needs, however, medical training programs do not cover social determinants in a uniform way. The curriculum is designed to be an introduction to the social determinants of health, their impact, and how to identify and address unmet social needs in the clinical setting. Specifically, the curriculum has four main objectives:

  1. To demonstrate the intersection of social determinants of health, unmet social needs and acute emergency department visits as they relate to emergency department care and to connect these concepts to the overarching theme of health equity;
  2. To purvey this content in a case-based format that will be easily accessible to learners in healthcare;
  3. To support faculty in medical training programs (medicine, nursing, allied health professionals) who may not be experts but wish to teach about social determinants;
  4. To help the learner develop a process for identifying and addressing patients' challenges with social determinants of health.

We have included recommended screening questions for each domain. These questions are based on the recommendation of the Los Angeles County Health Agency's Social and Behavioral Determinants of Health workgroup (White Paper forthcoming).

Contributors

This curriculum is a collaborative effort of the faculty, fellow, and resident members of the Section of International and Domestic Health Equity and Leadership (IDHEAL) of the Department of Emergency Medicine of the University of California Los Angeles (UCLA).

Editors

Breena R. Taira, MD, MPH, CPH, FACEP
Director, IDHEAL-UCLA
btaira@ucla.edu 

Dennis Hsieh, MD, JD
dhsieh@dhs.lacounty.gov 

Adedamola Ogunniyi, MD
aogunniyi@emedharbor.edu 

Contributors

  • Dennis Hsieh, MD, JD
  • Vanessa Kreger, MD, MPH
  • Hannah Janeway, MD
  • Adedamola Ogunniyi, MD
  • Kian Preston-Suni, MD
  • Mohsen Saidinejad, MD. MBA, FAAP, FACEP
  • Shamsher Samra, MD, MPhil
  • Todd Schneberk, MD, MA, MSHPM
  • Breena R. Taira, MD, MPH, CPH, FACEP
  • Kathleen Yip, MD

We would like to acknowledge the following individuals for their support in the development of these modules: Jerome Hoffman, MD; Richelle Cooper, MD, MPH, and Phillipe Bourgois, PhD.