Best Practices for Collecting Social Determinants of Health, Sexual Orientation and Gender Identity

FQHCs are required to capture social determinants of health (SDoH) and SOGI: sexual orientation (SO) and gender identity (GI); preferred pronouns; and preferred name and report it to HRSA, the overseeing body that enforces certain requirements on FQHCs that serve the underserved. These are more than just points of data for each patient but truly are key to ensuring holistic, patient-centered focused care.

Social Determinants of Health include areas like housing, food insecurity, transportation issues, etc. Sexual Orientation and Gender Identify are two separate entities. Sexual Orientation describes a patient’s preference for who they are attracted to romantically/emotionally/sexually. Sexual orientations include gay, lesbian, straight, bisexual, and asexual. Gender Identity is how a patient defines themselves, the “who” they are. This can include but not limited to male, female, genderqueer, etc. Preferred pronoun refers to the pronoun that a person prefers to be associated with. For example, a trans woman might prefer the pronouns “she / her / hers”, and a cisgender man might prefer “he / him / his”. There are also people who prefer gender neutral pronouns like “they / them / theirs”. Preferred name is the name a person prefers to be called. This goes for everyone.

Admittedly, this information can be sensitive to capture and share. However, it is critical that all of us focus on educating ourselves and respecting each individual person. These are what makes a person them. When I think about these key areas to a patient, I like to think of them like “vital signs”. Just like we would check a patient’s blood pressure (clinical vital sign) every visit, so too should we check their personal “vital signs”. These items (SDoH, SOGI, preferred pronouns/name) are the patients’ vital signs-they guide us how to take care of and respectfully communicate with them.  

I personally have had colleagues/acquaintances who have transitioned from a gender identity that differs from their gender at birth. These patients need that extra care when checking their “vitals”. If we don’t ask the questions, we are setting both the patient and our care up for failure. Patients that are transitioning need these questions asked to drive correct clinical care.  

It is crucial staff don’t assume a patient’s SOGI preference or preferred pronouns by observing them. It is also imperative that any bias staff may have be set aside to provide the best care for their patients. It is also important that we check these “vitals” every visit, as someone’s SOGI preferences may have changed since the last visit.  

Jen Calohan is an amazing woman I met recently at a conference focused on FQHCs. She is the owner and principal consultant for a company called ‘CURIS’. She has devoted her work to helping FQHCs to best support their patients, and ensuring they are meeting their requirements and all the things they need in between.  

Jen joined me recently on a QliqSOFT panel discussion on these patient-centered data points. One of the quotes she used/uses in her help with health centers is: We are likely not seeing individuals when they are having their “best day” or experiencing their best set of circumstances.’ A patient walks through the door already unsure of how the clinical visit may go. Perhaps they even had a tough time getting to the provider’s office due to transportation issues. They may even be a patient struggling with their SOGI status, possibly nervous to tell anyone out of fear. We don’t know what they are going through when they come in. We haven’t walked in their shoes. If we did put ourselves in their shoes, we might look up at them when the check-in and call them their preferred name. Ideally, we would set their clinical visit on the right foot, relieving some of their nervousness, some of their fears.

Jen also focuses on the importance of health equity. Health equity is not the same as health equality. Health equity is striving for each patient to have the opportunity to have a fair and just opportunity to attain their highest level of health. By focusing on these areas per patient, we are giving them the best care we can, the care they deserve. By asking the (sometimes) hard questions, we can ensure patients get set up with the right resources they may need. This could be a ride to the clinic, this could be access to a food pantry, possibly to put them in touch with a social worker to ensure they have what they need.  

Jen agrees that these items, due to their vulnerability and need for confidentiality, would be best self-disclosed by the patient. Consider opportunities along the patient journey to allow them to safely disclose this information. Best practice for the collection of these data points can be through a digital platform/health technology workflow prior to the clinic visit. For example, QliqSOFT offers patient communication tools such as conversational chatbots, the chatbot is used to reach out to the patient to prepare for their visit. Patients can provide this and other information in the privacy of their homes, instead of staff verbally asking these questions. This allows patients to be greeted by their preferred name upon arrival, setting an accepting and inclusive tone for the appointment.  

QliqSOFT recently worked with an FQHC in New York to reach out to patients around gaps in care such as the need for mammograms. This FQHC increased collection of SDoH collection from 16% to 58% by using chatbots to collect this information. Not only did the percentage of collection of this data increase, but the actions then taken on this information increased. Patients were set up with the right resources based on their individual needs, whether their need was transportation, housing, food insecurity, or legal needs, to name a few.  

The option for patients to self-disclose via the chatbot is a win-win. The patients not only are able to self-disclose and ensure accuracy and privacy around areas such as SDoH, SOGI, etc., this also allows for less burden on staff, especially if data are integrated into the electronic health record. This then sets the patient up for a successful clinical visit.  

It is important to not only have ways to display this information, but also clear workflows on the who, where, when this is being collected by the care team. This data is not one you want to skip over because you are too busy. It is also okay to tell a patient who e.g. has a preferred pronoun of they/them, that you may not get it right every time, but you are going to try your best. This information is what starts your patient off on a successful journey with you, the ones they trust with their care. A conversational chatbot can help provide them with this opportunity.  

Give your patients the health equity and respect they all deserve.