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Psychosocial Vital Signs

New (2014) Recommendations from the Institute of Medicine
Elizabeth Barnett Pathak, PhD, FAHA

IOM Recommends Additions to Electronic Health Records
Currently, the absence of social and behavioral determinants of health in EHRs limits the capacity of health systems to address key contributors to the onset and progression of disease. The addition and standardization of a parsimonious panel of social and behavioral measures into EHRs can help spur policy, system design, interoperability, and innovation to improve health outcomes and reduce health care costs.
The Institute of Medicine has released a new report titled "Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2."  A free PDF copy of the 375-page full report is available for download here.
The committee, chaired by Nancy Adler of the University of California at San Francisco and William W. Stead of Vanderbilt University, was comprised of an impressive array of experts on social determinants of health. Notable members include Ana Diez Roux, Dean of the Drexel University School of Public Health and David R. Williams, Professor of African American Studies, Sociology and Public Health at Harvard University.
What are Psychosocial Vital Signs?
Psychosocial vital signs are simple measures of a patient's social, economic, and psychological well-being (or distress) which can be collected at the time of healthcare encounters and included in the patient's medical record. This information will then be available later for physicians and researchers to better understand the connections between psychosocial and physical health.
Psychosocial Domains and Measures - Priorities
The chart below (page 232) summarizes the prioritized domains, along with specific recommended measures (questions) for each domain. So for example, race/ethnicity is a domain, and there are 2 alternative measures - the US Census 2 questions vs. the Office of Management and Budget (OMB) 2 questions. The committee rated the US Census race/ethnicity questions to be of higher usefulness.
The chart is not well-labeled, unfortunately, and a typo in the text on page 233 may create confusion in interpretation, so refer to my legend here:
1 = low usefulness/readiness
2 = moderate usefulness/readiness
3 = high usefulness/readiness
purple triangles    = highest priority measures  (high usefulness and high readiness)
blue pentagons    = moderate priority measures
orange diamonds = lowest priority measures
The committee recommends a "parsimonious" panel of 11 domains and 12 measures - however, the actual number of questions a patient would have to answer is 24 (census tract income would be imputed later based on residential address).
Formal Recommendations
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