Collecting Data on Patient SDOH & Interventions to Address Them

Presented by: National Association of Community Health Centers and Association of Asian Pacific Community Health Organizations Health Outreach Partners

A hallmark of community health centers is their ability to address the multiple, complex needs of their patient populations, both through high quality clinical services as well as non-clinical enabling services that promote full patient engagement. Having comprehensive data on both clinical and non-clinical needs is essential for understanding patient circumstances, developing interventions that address their needs, allocating resources effectively, and proving the value of services provided. During this webinar, presenters will provide an introduction to PRAPARE, a standardized, social determinant of health risk assessment tool, and how it has been used in health center settings through different workflow models, its use to inform diabetes care, and its impact on care and community transformation. They will also describe tools and resources for documenting enabling services, such as care coordination, language assistance, transportation, and/or other support services, as well as present a case study describing how efforts to track enabling services provided the data necessary to support a health center in targeting and improving diabetes management services.

By the end of this webinar, participants will be able to:

• Compare and contrast different workflow models for collecting standardized data on the social determinants of health using PRAPARE and using PRAPARE data for care and community transformation.
• List at least two ways that using PRAPARE data can inform diabetes care.
• Describe the importance of enabling services data collection and documentation in demonstrating their value in addressing patients with uncontrolled diabetes.
• Use existing resources and TA support to launch PRAPARE and Enabling Services Data Collection initiatives in their own health centers.