Identifying and addressing social determinants of health in outpatient practice: results of a program-wide survey of internal and family medicine residents

Table 2 Bivariate Association between Resident Characteristics and Self-Reported Competence Identifying and Addressing Social Determinants of Health

Characteristic		Self-Reported Competence of Highly Experienced or Expert^a
	Denom. in category	Identifying Challenges^a		Discussing Challenges^a		Referring to Internal Resources^a		Referring to External Resources^a
	n	n (%)	P-value^b	n (%)	P-value^b	n (%)	P-value^b	n (%)	P-value^b
Overall	129	37 (29)		18 (14)		13 (10)		11 (9)
Prior Training in SDOH			0.007		0.04		1.00		0.21
Yes	108	36 (33)		18 (17)		11 (10)		11 (10)
No	21	1 (3)		0 (0)		2 (10)		0 (0)
Age, years			0.08		0.008		0.10		0.02
25 to 29	74	16 (22)		5 (7)		9 (12)		6 (8)
30 to 34	47	17 (36)		10 (21)		2 (4)		2 (4)
35 to 44	8	4 (50)		3 (38)		2 (25)		3 (38)
Annual household income during childhood, dollars^c			0.22		0.16		0.26		0.03
≤ $50,000	20	9 (45)		6 (30)		4 (20)		4 (20)
$50,001–$100,000	34	11 (32)		3 (9)		3 (9)		3 (9)
$100,001–$200,000	30	6 (20)		3 (10)		1 (3)		1 (3)
≥$200,001	31	7 (23)		3 (10)		4 (13)		0 (0)
Primary outpatient practice site^d			< 0.001		< 0.001		0.09		0.001
Academic/private practice	44	9 (21)		6 (14)		2 (5)		2 (5)
Safety-net^e	31	18 (58)		10 (32)		6 (19)		7 (23)
Veterans Administration	54	10 (19)		2 (4)		5 (9)		2 (4)
Intention to practice primary care^f			0.001		0.02		0.21		0.003
Yes	39	19 (49)		10 (26)		6 (15)		8 (21)
No/Unsure	90	18 (20)		8 (9)		7 (8)		3 (3)

^a Residents reported their competence at identifying and addressing the social determinants of health by answering: “What is your level of competence performing the following tasks? 1) identifying challenges to optimal health care that affect patients of low socioeconomic status; 2) discussing these challenges during your patients’ routine office visits; 3) referring patients to resources within Northwestern Medicine to address these challenges; and 4) referring patients to local community resources outside Northwestern Medicine to address these challenges.” Responses to these questions were answered on a 5-point Likert scale and dichotomized into Highly Experienced or Expert vs. Other
^b P-values were derived from Fisher’s exact tests examining the bivariate association between resident characteristics and self-reported competence addressing the social determinants of health
^c This bivariate analysis was limited to participants with non-missing values for the survey item about annual childhood household income (n = 115)
^d Determined based on residents’ response to a question asking them to identify the outpatient setting where they see the majority of ambulatory patients
^e Includes federally qualified health centers and a Northwestern clinic that serves uninsured and underinsured patients
^f Determined based on residents’ response to a question asking whether they planned to pursue a career in primary care after completing residency

ISSN: 1472-6920