Feature August 18, 2022 John Bernot, MD

Making SDOH actionable at the point of care

Making SDOH actionable at the point of care makes it easier for providers. Find out how Ayva can help.

Before a procedure, it’s critical that providers understand all the potential variables outside the healthcare setting that could impact their patient’s health and outcomes. Knowing the social determinants of health (SDOH) factors of your patients is crucial to identify those who may be at-risk for poor outcomes and may have challenges managing their post-op care. While SDOH data may be found in a patient’s EHR, it’s likely outdated. 

Let’s discuss collecting SDOH data and how Ayva can help patients get the care they need when they need it. 

Overview of SDOH 

SDOH are essential to assess before a surgical procedure. This information can significantly impact a patient’s health, quality of life, and recovery.1 SDOH data include: 

  • Safe Housing
  • Transportation
  • Education
  • Access to nutritional foods 
  • Income
  • Language and literacy skills 

Not only is having this information necessary, but it should be as up-to-date as possible. SDOH data is often not collected in the EHR and data that is there could be significantly outdated. Providers need to know if a patient has transportation the week leading up to surgery, not from three years ago. Using Ayva so that patients can self-report potential issues, can help ensure care teams have exactly what they need to help their patients by making SDOH actionable at the point of care. 

Four ways SDOH data can be integrated into care plans 

1: Transportation issues

One of the biggest barriers to surgery is transportation. Often, patients need a ride to and from the procedure. Follow-up appointments also require transportation. Utilizing Ayva allows patients to provide up-to-date information so care teams can assist in finding transportation if necessary. 

2: Housing conditions 

Another factor that providers need to consider before a procedure is housing conditions. For example, if a patient is having hip surgery, the home should be screened for accessibility, including access to railings. There should be checks for narrow walkways or other challenges that put patients at-risk during recovery.

3: Nutrition 

Providers need to assess the health of their patients before a procedure. For example, if they have nutritional deficiencies, they need to know why or how these deficiencies can be supported. They may not be a good candidate for the surgery at that point in time if their blood count is low or lack valuable nutrients in their diet.

4: Social work consultations 

Having SDOH data before surgery can help providers determine if their patient is at a higher risk of poor outcomes. Clinicians want to deal with the issue but they can’t address issues they don’t know about. Once you’ve identified the risk, the challenges are much easier to manage. 

Knowing ahead of time that patients will need access to food, transportation, and medication delivery allows providers to involve social services. Social workers can get involved early to ensure a smooth pre- and post-op experience.

How Ayva can gather actionable SDOH data

With actionable SDOH data being crucial to effective care plans, providers can use Ayva to bridge the gap. Not all EHRs collect relevant SDOH factors, and those that are entered into the EHR may be out of date by the time of surgery2. Using Ayva enables you to collect timely SDOH data from your patients. 

Having up-to-date actionable SDOH data will help you provide optimal care plans while improving outcomes and lowering costs to support value-based care initiatives.

 Learn how a dynamic patient engagement platform can help your team collect actionable SDOH data.

 Meet Ayva today!

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Media Contacts

Shane Andreasen

Bravado Health


Bravado Health Media Line


(561) 805-5935

  1. Social Determinants of Health. Office of Disease Prevention and Health Promotion.
  2. EHRs are slowing health tech innovation. Bravado Health.