Filtered field notes — SDOH.
Sorted newest first. Each post links primary sources and methodology.
26% of in-center hemodialysis patients miss sessions. Transportation is the most common reason. The KDQOL-36 captures it. Most centers do nothing with the data. Here is what the evidence shows.
Two-thirds of clinics now screen patients for housing instability, food insecurity, and social needs. But 1 in 4 positive screens never lead to a completed referral. If you've ever felt like the system asked a question it wasn't ready to answer — you were right.
CMS has removed SDOH reporting from inpatient quality programs while expanding outpatient screening mandates. For ESRD and transplant patients — who move across both settings — this creates a structural gap that clinical social workers are now expected to bridge alone.
Urban hospital closures disproportionately hit low-income and minority neighborhoods, driving patients toward ERs as primary care. This is not a supply problem. It is a structural failure that compounds every other social determinant of health.
CMS's new IOTA Model incentivizes transplant centers to improve kidney access. It's a meaningful policy move. But it starts at the wrong end of the pipeline — and the 80% of ESRD patients who never make it to evaluation are still being left behind.
Nephrodite's Holly system could eliminate dialysis — but it's years away. Here's what transplant patients and their care teams need to know right now.
Urban areas have more providers but longer wait times. Rural areas have fewer providers and longer drives. Neither population is well-served by the current model.
Hospitals screen millions of patients for social determinants of health every year. Almost none of them actually connect patients to the services they need. Screening without action is just documentation theater.
Industry analysis, technical deep-dives, field reports. Or book a discovery call to talk about your population.