Documentation of social determinants of health across individuals from different racial and ethnic groups in home healthcare.
Mollie Hobensack, Danielle Scharp, Jiyoun Song and 1 others
PMID 38739091WHAT IT FOUND
Home health nurses and therapists documented more social risks for Black, Hispanic, and Native American patients than for White patients.
Differences were largest for housing, economic status, and access to care. The study does not show whether this reflects real disparities or documentation bias.
Key findings
01Overall, 46,805 (54%) home health episodes contained clinical notes with social determinants of health documented.
02Clinical notes for Hispanic (66%) and Native American (66%) patients had the most social determinants of health documented, while clinical notes for White (49%) patients had the least.
03After adjusting for confounders, Black patients were 92% more likely and Hispanic patients 77% more likely to have housing and economic circumstances documented compared to White patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used data from a single home health agency in New York, limiting generalizability. The data were collected between 2015 and 2017, and documentation policies and tools (like OASIS) have since changed. Race and ethnicity were reported as a single variable in the OASIS C2, which conflates distinct concepts. The Native American sample size was very small (n=189), making those results unstable. The study relied on natural language processing to extract social determinants of health, which may introduce measurement error. The study did not account for the documenter's race, implicit bias, or the number of notes written per patient. The analysis is cross-sectional and cannot determine causality or whether documentation differences reflect actual disparities or bias.
Declared interests
The authors declare no conflicts of interest. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not assume that higher documentation rates for minoritized patients prove they have more social needs. The study shows association, not causation. The difference could reflect implicit bias in what clinicians choose to write down, rather than a true difference in patient circumstances. Do not use race as a proxy for social risk in individual patient care.