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Where you live can have a big impact on your health.
Non-medical factors like where we are born, live, work, and age — known as the non-medical drives of health (NMDoH) — can influence health for better or worse.
However, the U.S. has struggled to identify and help people with NMDoH issues.
That’s where NMDoH screening comes in.
NMDoH screening is a questionnaire given to patients in a healthcare setting to help providers identify non-medical challenges to health. These include issues like financial hardship, transportation, housing, food, employment, and safety.
Patients can then be referred to helpful community resources.
Here are seven reasons to implement NMDoH screening in your healthcare system, hospital, or clinic.
1. NMDoH Screening Helps Patients Speak Up
NMDoH screening provides a flexible method for patients to provide information about non-medical factors that impact their health.
Healthcare staff can conduct screening electronically, in writing, or verbally.
A systematic review of 21 NMDoH screening tools in 2018 found that the majority were administered by paper (n=11, 52.4%), followed by verbally (n=9, 42.9%) and electronically (n=7, 33.3%).
However, since this review, many electronic health record systems have included an NMDoH screening tool, thus much more screenings are being done electronically.
2. NMDoH Screening Helps Clinicians Better Understand Patients
NMDoH screening can help clinicians better understand patients’ immediate non-medical needs.
This gives them insight into the local experiences of their patients, which is crucial for clinicians to develop meaningful medical and behavioral treatment plans.
Sensitivity is important because meaningful medical and behavioral treatment plans can improve medical care, reduce hospital readmissions, and reduce healthcare costs.
3. NMDoH Screening Helps Clinicians Address Patients’ Needs
NMDoH screening can help clinicians and non-clinicians address patients’ immediate non-medical needs.
This, again, gives them insight into the local experiences of their patients, which is crucial for clinicians and non-clinicians to connect patients to relevant community resources.
For example, organizations using the PRAPARE® NMDoH screening tool “negotiated bulk discounts for taxi vouchers and bus tokens for patients in need of transportation,” and “partnered with Uber, Lyft, and other ride-sharing services to provide discounted transportation services for patients in need,” according to the PRAPARE® Implementation and Action Toolkit.
This is important because connecting patients to community resources can reduce needs that threaten health. This, in turn, improves health and reduces hospital re-admissions and healthcare costs.
4. NMDoH Screening Helps Foster Community Collaboration
A successful NMDoH screening program does more than gather information from patients.
Screening programs must establish connections with community-based organizations that can help address patients’ local needs.
Food banks, homeless shelters, and transportation agencies are important. Likewise, local gyms, faith-based organizations, and community centers provide additional opportunity for collaboration.
You may establish a team to connect with community-based organizations.
“Many healthcare organizations lack a formal inventory of a community’s available resources to address [NMDoH], as well as a standard process for tracking what happens after [NMDoH screening] referrals,” according to the Center for Health Care Strategies (CHCS). “Often there is a lack of coordination between a community’s … service organizations and healthcare providers, many of which serve the same clients.”
5. NMDoH Screening Helps Healthcare Assessment, Management
NMDoH screening can support hospital system performance management and recommendations to inform policy and payment in several areas.
Areas include process-of-care, efficiency, safety, costs, health care outcomes, and patient satisfaction.
“The expansion of value-based payment programs exacerbates concerns about the adverse effects of [NMDoH risk factors] on provider payment,” according to eight researchers across the country.
“Hospitals, clinicians, and other providers with the fewest resources often serve the [people in need of the most resources]. Without appropriate risk adjustment, these providers are most likely to be penalized.”
6. NMDoH Screening Can Increase Work to Address ‘Root Causes’
NMDoH screening can support understanding about NMDoH-related risk factors, which can spur work for upstream strategies to address the root causes of community health issues.
Some people face health challenges because of widespread issues in systems. These challenges curb their access to quality housing, transportation, food, jobs, schools, parks and other non-medical drivers.
Individuals often have no choice when it comes to these challenges.
“Despite the tremendous, lifelong impact of our community conditions on our health, we focus most of our energy and resources on treating the outcomes of these problems but lack the essential urgency for attacking the root causes of poor health,” according to Brian C. Castrucci, Dr. Johnathan Fielding, and John Auerbach.
7. NMDoH Screening Can Improve Health for All in the Healthcare System
Through NMDoH screening, adjusting for NMDoH-related risks can avoid issues in healthcare for many groups, according to eight researchers.
“[Issues for some groups of people] in the health care system and society at large have become a stain on the United States, and resources should not be taken away from those [systems]. The highest priority for physicians is to ‘first, do no harm.’ We should ask no less of performance measurement.”
Create an NMDoH Screening Tool in Your Healthcare Setting!
In summary, NMDoH screening can help healthcare better understand and address patients’ needs.
It can also aid in healthcare performance assessment, pushing for upstream change, and reducing health issues that impact certain groups.
So, how can you start?
You can use the new Salud America! Action Pack, “How to Start Screening for the Non-Medical Drivers of Health,” to launch screening in your clinic, hospital, or healthcare system!
The action pack, created by Dr. Amelie G. Ramirez at UT Health San Antonio, has a conversation-starting model email, fact sheet, checklist on how to develop screening, and a guide that reviews existing screening tools.
You can also see examples of NMDoH screening in action:
“Health is far more than what can be provided in a doctor’s office,” said Dr. Amelie Ramirez, director of Salud America! and the Institute for Health Promotion Research. “In the same way that a team of doctors develops a patient treatment plan to treat cancer, a team of doctors and community services should develop a patient treatment plan that includes addressing non-medical community needs and their root causes.”
By The Numbers
33
percent
of Latinos live within walking distance (<1 mile) of a park
