What is Maslow’s Hierarchy of Needs and how does it relate to care management?
For those of us who don't have a background in psychology, Maslow’s Hierarchy of Needs is the notion that the need to survive trumps the need for safety, security, health, and well-being. In other words, patients who are members of vulnerable populations are often more concerned with figuring out where their next meal is coming from than with taking their medications.
To encourage physicians to address social and environmental barriers to patient health, Cincinnati Children's Hospital is taking non-clinical factors into account during patient diagnosis and designing interventions that combat these underlying barriers to care.
Using zip code analysis to predict asthma, injuries, and prematurity
Cincinnati Children’s Hospital first pushed physicians to think about these important contextual influences by demonstrating the impact of environmental and social determinants of health. The hospital purchased software and developed the skill sets to geocode discharge data and determine neighborhood "hot spots" for asthma, unintentional injury, and premature births.
What they found was striking. The neighborhood at the highest risk for childhood asthma had 88 times more asthma-related admissions than the neighborhood at the lowest risk. And this difference could not be attributed to clinical or genetic factors—they found a clear correlation between asthma hot spots and hot spots for housing violations.
Embedding social risk factor assessment in regular care protocols
Although physicians were convinced of the relevance of non-clinical determinants of health, they had no standardized way to integrate an assessment of these factors into clinical visits.
Their solution? Build it into the EMR. The EMR templates now prompt primary care physicians to ask questions to identify any non-clinical red flags. This risk factor assessment—which covers food security, housing problems, and mental health status—has become a fundamental part of any well-child visit.
On top of this, the EMR facilitates several automatic referral processes, allowing a physician to order a referral for legal aid or health inspection as easily as if it were a referral to a pulmonary cardiologist.
Forming partnerships to facilitate non-clinical interventions
In addition to hardwiring community referrals with the EMR, Cincinnati Children’s has developed creative interventions for patient families demonstrating non-clinical risk factors.
They formed a partnership with the Legal Aid Society to help patient families with unmet legal needs, such as assistance in combatting the poor housing conditions exacerbating to their child’s asthma. Cincinnati Children’s has also engaged physicians to develop community-run efforts intent on reducing unintentional injuries in hot spot neighborhoods.
More recently, they installed a dedicated United Way 211 phone line in the waiting room, allowing patient parents to proactively identify resources for day care, GED support, or utility assistance—before their child has even been triaged.
How to relate to your patients—and your community
As your organization begins or continues to take on risk-based contracts, don’t forget about Maslow’s Hierarchy of Needs.
Proactively identifying social risk factors and partnering with community organizations to combat non-clinical barriers to care can be the simplest, yet most cost-effective way to promote population health.
Our research briefing, Three Key Elements for Successful Population Health Management, explores how to map services to patient needs, overcome non-clinical barriers, integrate patient values into the care plan, and partner with community stakeholders.