Monday, January 27, 2020
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Why Clinicians Should Ask Patients Where They Live as a Standard Part of Care

That where one lives plays an important role in one’s health is common knowledge, but many providers don’t actually have a handle on this information for their patients, according to a new study.

Published in the Annals of Family Medicine, the research found that many family physicians cannot accurately state where their patients live. On average, participants overestimated the “geographic footprint” of their practice by 116 miles — meaning they believe their patients are more widely distributed around the region than they are.

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Why does this matter? “Service area overestimation impedes implementation of targeted community interventions by practices,” such as “[identifying] those in need not accessing care, [engaging] potential community partners for collaborative care, and [considering] novel community-based interventions,” according to the study.

What’s more, value-based care models reward clinicians for improving patients’ health rather than paying them for each visit and procedure regardless of the outcome.

That said, the study authors do concede that creating a habit of asking patients where they live will require a shift among practitioners.

“The idea of thinking about where patients live is radical, because we’re not trained to ask for that information,” said Winston Liaw, MD, study co-investigator and chair of the Department of Health Systems and Population Health Sciences at the University of Houston College of Medicine, in a statement. “We need to get providers to integrate geography into their practice data and get them thinking about the health needs of specific communities.”

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In an ideal world, Dr. Liaw added, EHRs would outline challenges faced by specific communities to help providers develop strategic interventions.

“If I wanted to push a diabetic educator into the community, for example, then I need to know where to put them. I need to know the neighborhoods my clinic serves and more specifically, where diabetic patients are living. Otherwise we’re just guessing,” Liaw explained. “We need data in order to figure out how to allocate our resources on a geographic level.”

According to the statement, the University of Houston College of Medicine is adding a community-based element to its program that will empower PCPs to improve the health of underserved populations, though it’s still pending accreditation.

In the mean time, though, individual providers, can make a point of asking patients about where they live to gain a better understanding of their access to nutritious food, quality of housing, education, water and air, which can inform treatment measures.

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