Social and behavioral domains Paul K. Crane, MD MPH Department of Medicine University of Washington

Perspective Attending physician, internal medical wards, Harborview Medical Center Measurement expertise, involvement in PROMIS first as part of the Statistical Coordinating Center and now as multiple PI of UW site – I chair the PROMIS’s Clinical Practice Sub-Committee Collaborations with investigators from Cleveland Clinic Neurological Institute Researcher, especially with people living with HIV through CNICS (Centers for AIDS Research Network of Integrated Clinical Systems)

Social determinants of health Socio-economic status is HUGE – Stable housing – Stable food supply – Safety and capacity for feeling like one has choices Psychiatric co-morbidity is incredibly important Substance use is incredibly important Reliable and safe transportation is incredibly important

Measurement and EHRs Cannot assume everyone has access to the internet – Especially those at the very bottom end of the SES spectrum Patient-reported data collection has worked well in CNICS and Cleveland Clinic with an offset clinical day – Interact with a tablet before clinician visit – Data delivered to provider at point of care – Data also valuable for (and sought by) case managers and others in the care delivery team Domains have been dictated by direct clinical utility

Routine assessment and chronic care model

Suicide

Domain considerations Clinical relevance should drive what gets measured – For most chronic conditions adherence to self management is critical – Factors associated with adherence should be assessed to ensure attention paid to factors related to adherence barriers Suicidality is common among people with chronic disease – Less concern with follow-up if assessed immediately prior to visits

Measurement considerations To date we have not found important quantitative differences between PROMIS and legacy scales – Some important difference in content though, such as suicidality – CAT is an efficient means of collecting information Many of the social and behavioral determinants most important to measure are not typical latent traits – Many present / absent type domains, ASSIST, AUDIT, self- reported adherence, etc. – Housing and transportation stability: an area of needed improvement (not currently formally assessed in CNICS, for example) Certainly CAT makes sense for domains with a latent trait

Thanks! Appreciate the opportunity to speak with you There are important opportunities to assess patient-reported data routinely to identify factors that may be critically important to successful healthcare delivery