In an age of value-based payment, primary care providers are increasingly scrutinized on performance metrics that purport to measure quality of care, including patterns of health care use and health care outcomes of their patient populations. Social determinants of health (SDH), including the economic, social, and environmental characteristics of communities where people live, affect a wide range of health outcomes and risks. Research suggests that SDH contribute as much or even more to health outcomes than health care does. Although health care quality metrics frequently account for patient clinical complexity (ie, the number or severity of chronic conditions), they typically do not account for patient social complexity (ie, the presence of adverse SDH, or “social risk factors,” known to affect health). In this study, we leveraged data from the National Patient-Centered Clinical Research Network (PCORnet), a distributed network of clinical research networks (CRNs) that brings together data from millions of patients across different health systems, to assess whether accounting for both social complexity and clinical complexity better explains differences in quality-of-care metrics than patient clinical complexity alone.
