NIHB National Tribal Public Health Summit 

Determinants of Health Quality Improvement Efforts

Tribal Public Health Infrastructure, Policy and Systems 

Kyle Wark 

Researcher Southcentral Foundation

Scott LaBrie

Researcher Southcentral Foundation

Social determinants of health (SDOH) affect up to 70% of health outcomes. It’s not clear how to best integrate SDOH into healthcare practice & policy. This project engaged stakeholders to help define SDOH factors most relevant in an ANAI health system & how to best integrate SDOH data into health programs and electronic health records (EHR). We utilized an internal steering committee; held focus groups; developed workgroups to engage within our health system; and met with allied health orgs. The Steering Committee prioritized uses of SDOH data. Focus groups grounded our work in local community values and refined our SDOH subdomains. Workgroups made data visualizations (e.g., EHR dashboards to automate data collection). External stakeholders identified ways to utilize SDOH data for community advocacy work. Stakeholders liked the holistic approach of SDOH, how it can improve patient-provider relationships, and help reduce health disparities. They were concerned about outdated SDOH data, and how sensitive SDOH could lead to unanticipated harms. Leaders stressed looking at SDOH from a actionable, strengths-based framework. Findings may help healthcare orgs with stakeholder engagement generally and to understand how stakeholders can inform integration of SDOH into EHR. Lessons learned include the benefits of having a standing research department already working with a data services and program evaluation department, and the importance of iterative engagement with stakeholderseduction in Emergency Department visits and a 79 percent reduction in substance use visits.