5 Ways Home Care Can Participate in New Social Determinant Quality Measures for Medical-Surgical Patients

March 27, 2025
A magnifying glass focuses on the acronym "SDOH" and "Social Determinants Of Health," with a red stethoscope and spiral notebook in the background.

The Ambulatory Surgical Center Quality Reporting (ASCQR) program introduced requirements for screening and reporting on Social Drivers of Health (SDOH) as part of its focus on improving patient outcomes and addressing health disparities. Home care agencies can participate in these initiatives by collaborating with ambulatory surgical centers (ASCs) to support effective SDOH screening and intervention processes. Here’s how:

1. Support Pre- and Post-Operative Screening

Collaboration with ASCs: Work with ASCs to integrate SDOH screening into the care process for patients undergoing surgery. This could involve collecting patient-reported data on factors like housing stability, transportation needs, food security, and social support.

Screening Tools: Use standardized tools like the PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences) or the CMS-recommended Health-Related Social Needs screening tool.

Home Assessments: Conduct in-home assessments that include SDOH-related questions to identify barriers patients may face in accessing care or adhering to post-operative instructions.

2. Facilitate Data Sharing

Electronic Health Records (EHR): Share findings with ASCs through compatible EHR systems to provide a more comprehensive view of the patient’s needs.

Data Integration: Ensure that the SDOH data collected by home care teams aligns with the ASCQR program’s reporting requirements.

3. Address Identified Needs

Link to Resources: Use home care staff to connect patients with local resources to address SDOH issues, such as food banks, transportation services, or housing assistance programs.

Education and Navigation: Provide patient education and navigation support, helping them access resources for managing identified social barriers.

4. Track and Report Outcomes

Monitoring Interventions: Track the impact of interventions on health outcomes and share these results with ASCs to contribute to quality improvement efforts.

Quality Reporting: Work with ASCs to ensure the captured data contributes to the ASCQR program’s reporting measures.

5. Participate in Training and Protocol Development

Staff Training: Train home care staff to understand SDOH and effectively administer screening tools.

Develop Protocols: Collaborate with ASCs to develop workflows for incorporating SDOH screening into the patient care continuum.

By integrating their services into the SDOH screening and intervention process, home care providers can help ASCs meet ASCQR program requirements while improving patient outcomes and addressing disparities. Begin a conversation to discuss the different areas your organization will be participating in.

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Lisa Remington

Lisa is a turnaround expert who excels in navigating unsteady, complex, and ambiguous environments. She has provided C-suite education to over 10,000 organizations in the home care sector for decades. Lisa’s trusted voice in the industry has been recognized for her ability to manage disruption, identify new growth and revenue opportunities, and develop high-level engagement strategies between home care and referral partnerships. Her contributions are instrumental in advancing the future of home care.

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