{"id":3972,"date":"2019-06-27T11:58:41","date_gmt":"2019-06-27T17:58:41","guid":{"rendered":"https:\/\/dsiohn098w.mpqhf.org\/blog\/?p=3972"},"modified":"2019-06-27T12:28:44","modified_gmt":"2019-06-27T18:28:44","slug":"social-determinants-health-sdoh-action-findings-field","status":"publish","type":"post","link":"https:\/\/dsiohn098w.mpqhf.org\/blog\/social-determinants-health-sdoh-action-findings-field\/","title":{"rendered":"Social Determinants of Health (SDOH) in Action-Findings from the Field"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2019\/06\/Blog-3-SDOH-in-Action-blog-LS.png\" alt=\"\" width=\"1200\" height=\"357\" class=\"alignnone size-full wp-image-3975\" \/><\/p>\n<h1>Social Determinants of Health (SDOH) in Action-Findings from the Field<\/h1>\n<p>What are the most prevalent SDOHs in Montana? <\/p>\n<p>In 2015, Mountain-Pacific Quality Health partnered with three Montana communities to work on a Centers for Medicare &#038; Medicaid Services (CMS) project to address complex care patients who frequently use the emergency department (ED) and experience hospital readmissions. The communities expected to see transportation and affordable housing as key SDOH, and they did, but these issues were not as prevalent as other factors that complicate patients\u2019 medical care.<\/p>\n<p>Health literacy and psychosocial issues topped the  SDOH list for high-cost, high-needs patients in the program. This information caused Mountain-Pacific and its partners to reassess their approach for working with complex care patients. <\/p>\n<p>Medication and doctors\u2019 instructions were often confusing to patients who were taking multiple medications, dealing with more than one chronic condition and experiencing several episodes of care. As one patient described, \u201cThere are so many medicines I am taking, I don\u2019t know which ones are helping and which aren\u2019t at this point.\u201d Therefore, interdisciplinary team members like pharmacists and care coordinators helped simplify medication lists and explain medications and their side effects to patients. <\/p>\n<p>Behavioral health issues are also prevalent SDOH for these patients. Incorporating behavioral health professionals is key to providing better, more coordinated care. In one pilot location, the team was able to reduce readmissions for enrolled patients by 136 percent in a one-year period.<\/p>\n<p>For a more in-depth view of this work, view the nationally televised <a href=\"https:\/\/www.youtube.com\/watch?v=TuQV9Oa9iaE&#038;feature=youtu.be&#038;t=38m3s\" rel=\"noopener\" target=\"_blank\">PBS NewsHour segment<\/a> or contact Lara Shadwick at <a href=\"mailto:lshadwick@mpqhf.org\" rel=\"noopener\" target=\"_blank\">lshadwick@mpqhf.org<\/a>.<\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p>Take a minute to subscribe and start receiving the latest Health Care in the Community blogs by email.<\/p>\n<a href=\"http:\/\/eepurl.com\/ccGNQv\" class=\"su-button su-button-style-flat\" style=\"color:#ffffff;background-color:#385173;border-color:#2d415c;border-radius:5px\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"color:#ffffff;padding:0px 30px;font-size:22px;line-height:44px;border-color:#74869d;border-radius:5px;text-shadow:0px 0px 0px #f4f4f4\"> Subscribe<\/span><\/a>\n<p>&nbsp;<\/p>\n<hr \/>\n","protected":false},"excerpt":{"rendered":"<p>Social Determinants of Health (SDOH) in Action-Findings from the Field What are the most prevalent SDOHs in Montana? In 2015, Mountain-Pacific Quality Health partnered with three Montana communities to work on a Centers for Medicare &#038; Medicaid Services (CMS) project to address complex care patients who frequently use the emergency department (ED) and experience hospital [&hellip;]<\/p>\n","protected":false},"author":13,"featured_media":612,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[140],"tags":[],"class_list":{"0":"post-3972","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care-in-the-community","8":"entry"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Social Determinants of Health (SDOH) in Action-Findings from the Field - Mountain Pacific Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/social-determinants-health-sdoh-action-findings-field\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Social Determinants of Health (SDOH) in Action-Findings from the Field - Mountain Pacific Blog\" \/>\n<meta property=\"og:description\" content=\"Social Determinants of Health (SDOH) in Action-Findings from the Field What are the most prevalent SDOHs in Montana? In 2015, Mountain-Pacific Quality Health partnered with three Montana communities to work on a Centers for Medicare &#038; Medicaid Services (CMS) project to address complex care patients who frequently use the emergency department (ED) and experience hospital [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/social-determinants-health-sdoh-action-findings-field\/\" \/>\n<meta property=\"og:site_name\" content=\"Mountain Pacific Blog\" \/>\n<meta property=\"article:published_time\" content=\"2019-06-27T17:58:41+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-06-27T18:28:44+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/dsiohn098w.mpqhf.org\/blog\/wp-content\/uploads\/2016\/09\/1-Thumbnail.png\" \/>\n\t<meta property=\"og:image:width\" content=\"200\" \/>\n\t<meta property=\"og:image:height\" content=\"200\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Dale Applegate\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Dale Applegate\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/dsiohn098w.mpqhf.org\/blog\/social-determinants-health-sdoh-action-findings-field\/\",\"url\":\"https:\/\/dsiohn098w.mpqhf.org\/blog\/social-determinants-health-sdoh-action-findings-field\/\",\"name\":\"Social Determinants of Health (SDOH) in Action-Findings from the Field - 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