Abstract
Applying a Population Health Equity Framework in the Clinical Setting—Incorporating Social and Behavioral Determinants of Health Into Estimations of Risk
Highlights
The VA health system uses a Care Needs Assessment (CAN) score to identify patients at high risk of hospitalization or death within 1 year
Using the Cycle of Complexity model to guide their selection of social determinants of health (SDH) survey measures, the authors found that behavioral determinants, such as resilience and health locus of
Future studies will need to address this question more fully by assessing how best to integrate this collection of SDH measures from patients as they are admitted to the hospital and how that integration will inform tailored strategies before and after discharge
Summary
The VA health system uses a Care Needs Assessment (CAN) score to identify patients at high risk of hospitalization or death within 1 year.
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