Submitted by cmayo@med.umich.edu on 2022-04-27
Add element for Primary caregiver of disabled person
We suggest including the SDOH measure for "Caregiver of disabled person status" that is included in the standardized ontology developed by AAPM and ASTRO. The question uses the value set in the American Community Survey as a basis for identifying if the respondent is a primary care giver for a person with Hearing difficulty ,Vision difficulty ,Cognitive difficulty, Ambulatory difficulty, Self-care difficulty or Independent living difficulty .
This is important to understanding ability of patients to undergo treatments that take them outside of the home, compromising their ability to provide care for the person dependent upon them. It is also a co-factor for other SDOH measures such as employment and insurance status.
Charles Mayo
Submitted by LisaRNelson on 2022-04-29
Problems
The Problems Data Class in USCDI separates Problems as a distinct data element from SDOH Problems/Health Concerns. This approach to organizing the data elements is problematic because it doesn’t draw a clear distinction. Problems, as a notion is being used for the Category as well as a data element, and as a data element Problems is differentiated from SDOH Problems/Health Concerns. The lack of semantic clarity creates an avoidable burden for implementers.
Problems are the conditions a person has. Health Concerns are the risks a person is working to reduce or the issues a person is working to address. Problems are an assertion that person has a particular condition. Health Concerns are the focus of change that is being managed toward an agreed upon outcome. Without disambiguating these notions, by definition, the overlap and confusion creates a barrier to interoperability. A Problem can be a Health Concern, but it doesn’t necessarily need to be. A Health Concern that is a focus of care planning, may be a factor that is not, by definition, an issue that belongs on a patient’s Problem list.
Historically, a patient’s “Problem list” was the worklist of medical issues clinicians were addressing with a patient. The notion of Health Concerns came on the scene as new focus was placed on expressing and exchanging Care Plans to track a patient’s progress toward goals that have been set for their care. Now that there is widescale agreement about the important of social determinants being important to address as part of achieving better health outcomes, we need to revise our understanding of what goes on a patient’s Problem List and what issues may be the focus for improvement in a patient’s plan of care.
SDOH Problems should be Problems and SDOH Health Concerns should be Health Concerns. The distinction between a person’s medical and social problems is an arbitrary and outdated practice which does not advance whole-person care. Care Plans created to achieve optimal health outcomes need to address all types of concerns. Medical as well as social concerns can be the focus of interventions designed to support patients in making progress toward their health goals. The whole point of the SDOH movement is to integrate the thinking and treatment of SDOH issues in conjunction with other medical issues, and to recognize that SDOH issues can’t be separated from medical issues when optimate health outcomes is the goal.
To reinforce and accelerate the important progress being made to incorporate care for social factors of health in concert with medical factors, the Problems Data Class should be reorganized. The Problems data element should include medical as well as SDOH Problems and the Health Concerns data element should include medical as well as SDOH health concerns. This change would support clarity and consistency that would empower and enable standardization for SDOH information as an integral part of a patient’s longitudinal health record.
Currently, the Problem data element has several standardized types:
This list of “problem types” could be expanded to include and additional problem type or types that are relevant for issues related to social determinants of health.
USCDI V3 Comment 20220429_3.pdf