美国国家公共电台 NPR Your ZIP Code Might Be As Important To Health As Your Genetic Code

AUDIE CORNISH, HOST:

When a receptionist gives you a form to fill out in a doctor's office, the questions are usually about medical issues - family history of illness, allergies 1 or the last time you got vaccines 2. Some doctors are now asking more general questions about jobs and where patients live. It's as if your ZIP code is as important as your genetic 3 code. Kristian Foden-Vencil of Oregon Public Broadcasting reports.

KRISTIAN FODEN-VENCIL, BYLINE 4: Shannon McGrath was given a life situation form this spring when she turned up for her first OB-GYN appointment 36 weeks pregnant.

SHANNON MCGRATH: When I got pregnant, I was homeless. I didn't have a lot of structure. And so it was hard to make an appointment. I had struggles with child care for my other kids, transportation.

FODEN-VENCIL: The mother of four sits next to her new baby, Rayder. That's him snoring in the background. The form asked questions like, are you worried about your housing? Is it safe? Can you pay the rent? It asked about food, transportation and child care. On the strength of McGrath's answers, her doctor, who's part of Kaiser Permanente, assigned her a patient navigator.

MCGRATH: She automatically set up my next few appointments and then set up the rides for them because that was my No. 1 struggle. She assured me that the child care wouldn't be an issue and that it would be OK if they came. So I brought the kids, and everything was easy just like she said it would be.

FODEN-VENCIL: McGrath is on Oregon's version of Medicaid. Her navigator connected her with local nonprofits who helped her with rent and a phone. The hope is that making her life easier might keep her and her children healthier and lower Oregon's Medicaid costs. McGrath says her patient navigator was a bureaucratic 5 ninja, slicing through all the paperwork. She says for a pregnant mother with three children and tenuous 6 housing, it was just too daunting 7.

Patient navigators have been around for a while. What's new is the life situation form and, more importantly, having that information coded into a patient's permanent electronic medical record. Sarah Lambert is McGrath's gynecologist. She really appreciates seeing a patient's housing situation, debt or even their history of domestic abuse in the file.

SARAH LAMBERT: I find it incredibly helpful because it can be very hard to find out. And having it coded right there - we have this problem list that jumps up - really can give you a much better understanding as to what the patient is going through.

FODEN-VENCIL: Nicole Friedman with Kaiser Permanente agrees, and she goes a step further. She hopes these changes push health care away from more high-priced treatments and toward providing the basics.

NICOLE FRIEDMAN: My personal belief is that putting more money into health care is a moral sin and that we need to take money out of health care (laughter) and put it into other social inputs 8 like housing and food and transportation.

FODEN-VENCIL: Back with baby Rayder, I asked Shannon McGrath whether she was surprised her doctor's office helped her with things like rent and transportation.

MCGRATH: A hundred percent - I was skeptical 9. I didn't want someone to see my situation and have it raise alarms.

FODEN-VENCIL: But she says she was pleased she opened up, as it made her more likely to seek help in the future.

MCGRATH: I'm able to look at life and not feel overwhelmed or burdened or like I've got the whole world on my shoulders.

FODEN-VENCIL: Of course the idea has raised concerns. Patients may worry about privacy. And providing transportation or even a home doesn't necessarily cure a person's ailment 10. For NPR News, I'm Kristian Foden-Vencil in Portland.

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CORNISH: This story's part of a reporting partnership 11 with NPR, Oregon Public Broadcasting and Kaiser Health News.

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