Nov 30 2022
Data Analytics

Why Collecting and Analyzing SDOH Data Can Improve Maternal Health

Organizations that can act on data regarding social determinants of health can provide better patient care.

It’s easy to focus on patient complaints in the healthcare setting. Injuries, worrisome labs and other symptoms are obvious red flags for patient health. But medical interventions like these influence patient outcomes only 20 percent of the time or less. Social determinants of health affect the remaining 80 percent.

When we talk about SDOH, we mean social factors such as housing, food and personal safety; whether or not people have access to or know where to seek healthcare; and if they have the transportation to get there. Without these things, patients can’t be proactive about their care, leaving serious health conditions and outcomes to worsen over time.

Considering the great influence such resources have over patient health, it’s critical for healthcare organizations to screen patients for SDOH risk factors. How they collect that data and use it to improve patient outcomes varies. In many cases, there’s room for improvement.

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Screening for SDOH Helps Maternity Patients and Providers Alike

Numerous health concerns can arise during a pregnancy and the postpartum period, including gestational diabetes and increased strain on essential body systems. Eating well, remaining as active as possible and getting adequate healthcare are all things that can increase the likelihood of a healthy pregnancy. These are also all social determinants of health.

Analyzing SDOH within a community can improve the health of the people who live there. Communities that lack access to grocery stores where people can buy fruits, vegetables, lean proteins and other healthy foods are called food deserts. Likewise, they’re called maternity care deserts if they lack facilities where people can seek specified help.

Screening patients for SDOH such as these allows healthcare organizations and other community partners to build programs to better serve the people who live there. Across the country, states are using Medicaid 1115 demonstration waivers to do just that. For example, managed care organizations in North Carolina are required to connect Medicaid recipients with programs to assist with housing, food security and other SDOH. Other states are using the waiver program to address substance abuse, maternal care and more.

EXPLORE: How healthcare can move the needle on SDOH data.

Collecting SDOH Data to Improve Maternal Health Outcomes

Pervasive disparities exist in the U.S. healthcare system, the result of a long history of medical abuse of marginalized people. There's a lot of mistrust that providers need to address in these communities, and this is a SDOH that providers can take note of during patient visits.

Medical records include geographic data and supplemental ICD-10 SDOH diagnosis codes for documentation. There are codes for everything from domestic violence to a lack of housing and food insecurity. But providers don’t always use SDOH screening tools as frequently as they should. It may be uncomfortable to ask patients about these things, but the issues patients are experiencing can put their overall health at risk.  

Many providers also struggle to take the next step after collecting this data: What are they supposed to do with it? Ideally, providers should be able to counsel patients and connect them with programs and other support services to address the SDOH that puts them at risk.

Improving SDOH Screening for At-Risk Patients

To really improve health outcomes and address SDOH, our healthcare system needs to improve the way it screens for risk factors. Removing stigma and utilizing technology can prioritize SDOH screening.

Questions about interpersonal safety and other sensitive issues can be uncomfortable to ask and answer, so we have to find ways to make it less so — namely, by removing the associated stigma. Working in patient care, you have to humanize and empathize with patients to create an atmosphere where they feel safe enough to share with you.

Health technology companies such as Lucina Analytics collect a tremendous amount of data in an effort to improve maternal health outcomes with SDOH data analysis. Such data can help providers guide patients through a healthy pregnancy and delivery instead of costly adverse outcomes and sickness.


The percentage of insured women who did not receive prenatal care within the first trimester of pregnancy

Source: Blue Cross Blue Shield Association, “Trends in Pregnancy and Childbirth Complications in the U.S.,” June 2020

Here are three ways to utilize SDOH data collection to improve maternal health outcomes:

  1. Identify pregnancies early: The earlier a pregnancy is diagnosed, the better. That way, people can seek prenatal care and adjust their lifestyles for a healthy pregnancy. Lucina helps with this by analyzing 3,000 possible indicators of pregnancy. Then, it collects data about the patient’s health, SDOH, medical history and more, and shares it with health plans and health organizations to ensure the best possible birth outcome.
  2. Analyze the patient’s risk frequently: A patient’s risk fluctuates throughout pregnancy. They may develop gestational diabetes, preeclampsia or other pregnancy-related conditions. In addition to medical conditions, the risk profile should also include the social challenges that can occur during pregnancy that contribute to risk.

    Frequent data analysis helps Lucina identify pregnant women who are at risk for things such as preterm birth or low birth weight, and monitor how that risk changes over time using models created with historical data. This is especially helpful for Black women and those with certain health conditions.
  3. Refer patients to wraparound services: After reviewing SDOH data, providers can connect patients with services that address their needs. They can also prioritize these patients’ care. As a result, patients whose health plans collaborate with Lucina are experiencing better health or birth outcomes than those that don’t. Among the patients Lucina has data for, there are fewer preterm births among Black women and reductions in NICU admissions and stays. These improvements lead to better health outcomes for patients, as well as decreased costs for health plans.

The greatest enemy in all of this is inaction. We can’t fail to address health disparities because the questions are uncomfortable or because discussing structural racism is difficult. We must acknowledge the need to change and take the first step to completing more SDOH screenings so patients can be connected to much-needed support and services.

UP NEXT: Telehealth offers relief for prenatal care and newborn health.

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