COLUMBUS, Ohio - Where a person lives, works and plays can shape their overall health outcomes. And in Ohio, Community Health Centers are working to identify how social determinants may be affecting their patients.
Medical staff at the centers are using a screening tool called "PRAPARE" during routine office visits to detect social, economic and environmental variables in a patient's life. Erin Trapp, clinical director with Compass Community Health in Portage County, said by using this tool, they discovered one patient had been living in her car.
"It's a matter of survival for her; following our care plan and getting her medication was not a priority," Trapp said. "So, we were able to link her with different community resources, and she is one of our success stories now. She actually has a job, she has an apartment."
PRAPARE stands for the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences. It's estimated just 20% of health outcomes are attributed to clinical care, while social determinants account for the remaining 80%.
Dr. Ron Yee, chief medical officer with the National Association of Community Health Centers, explained the goal is to connect patients to local resources and interventions that can improve their situation, whatever it may be.
"Whether it's housing, whether it's finding a job, whether it's having no insurance or language barriers," Yee said; "they are experts at a tapping into the community - whether they have it there on-site themselves or they use somebody in the community - of making those linkages to address those issues."
Trapp said they've had so much success with PRAPARE, they adapted the questions to use with kids.
"Do you ride a bus to school or walk, or how do you get to school? Do you have a lot of friends at school? Do you feel safe at school? Tell me about, like, a typical day - what do you have for breakfast?" Trapp explained. "Well, you quickly find out they do have a food insecurity, and maybe they have transportation barriers, so they're always tardy."
Yee noted social factors may indicate a person is struggling, but they don't tell the whole story.
"Our patients that we work with are some of the hardest-working people, strongest family ties, very focused on what they do," Yee said. "And a lot of times, that gets buried in the negativity of social determinants."
PRAPARE is also used by hospitals, health plans and others. It was developed by a group of national and state health-center associations, including the National Association of Community Health Centers, the Association of Asian Pacific Community Health Organizations, and the Oregon Primary Care Association.