EasyPI: Health Equity/Social Determinants of Health

Welcome to the health equity/social determinants of health (SDOH) track page. The Ohio Academy of Family Physicians (OAFP) has curated all of the information you will need to complete a self-guided performance improvement (PI) project focused on health equity and addressing SDOH in practice in order to earn American Board of Family Medicine (ABFM) PI and continuing medical education (CME) credits.

As a new initiative for the OAFP, we would love your feedback on your current comfort in completing a PI activity for ABFM credit. In order to gauge effectiveness of this new tool, EasyPI, please take a few moments to share initial feedback before diving in by completing a quick survey.

And, once you’ve reviewed the content and/or submitted a project for credit, please let us know how it went by completing the post-survey.

Let’s Get Started!

The following is a quick step-by-step guide:
  1. As needed, review the background information and guidelines for health equity and SDOH.
  2. Determine what factor of health equity or SDOH you want to address – you may already be aware of equity gaps, may identify gaps by doing process mapping, or may use your Electronic Health Record to review data to find opportunities for improvement.
  3. Review the Performance Improvement Process Materials, complete the process mapping, determine your quality measures and interventions, and create a quality improvement plan.
  4. Collect preliminary data.
  5. Implement your change. Note: you will select the length of the PI activity (at least seven (7) days, but not more than 12 months).
  6. Collect post-intervention data.
  7. Submit your project for ABFM credit. See the ABFM Performance Improvement Activity section for detailed directions.

The resources provided below can be used prior to and during your PI project. Choose the resources you need most. You don’t have to click on every link included. There are a variety of options to match  where you might be in your quality journey. There’s something for everyone, no matter if this is your first PI activity or 30th!

Resources with indicate there may be additional CME credit available upon completion.

Utilize all or some of these resources to get you ready for your project.

Social Determinants of Health

Health Equity

Implicit Bias/Cultural Competency

Team-Based Care

Health Literacy

Population Health

Discussion Race/Microaggressions

Community Partnerships

Government/Payer Partnerships

Organizational Change

Z Codes

Disease Specific Information

Utilize these resources to educate your practice team on awareness and understanding of what patients may be experiencing and navigating on a daily basis. These tools will help prepare your team to consider health equity and social determinants of health for every patient.

The following resources are links to guidelines on health equity:

You and your team can utilize some or all of these tools to incorporate into patient care

Engaging in performance improvement (PI) activities can:
  • Improve patient outcomes and help meet quality metrics
  • Achieve team-based practice change
  • Make practices more efficient
  • Boost team morale
  • Improve revenue.

These materials will guide you through identifying areas for improvement, understanding and using data, planning and making changes, and tracking performance over time.

Choose the tools to help you and your team have a successful PI project.

Quality Measures & Intervention Selection

Process Mapping

Workflow & process mapping creates a visual map of the steps your practice is currently using for a specific patient care or administrative task.

Benefits of process mapping include allowing the entire team to visualize and appreciate what role/contribution they and their colleagues play in the care of patients; gives an overview of the current processes that allows the team to plan for change; identifies unintended variations in care, inefficient procedures, and opportunities to involve other team members in care; improves communication between team members; gives team members increased ownership in patient care; and can increase employee job satisfaction.

View an outline of the mapping process and the following instructional video on the process:

Data Collection

Now that you’ve collected data, implemented change, and have your outcomes, it’s time to submit your project for credit! Family physicians utilizing the EasyPI: Health Equity/SDOH track will use the ABFM’s Health Disparities/Equity Self-Directed Clinical Performance Improvement pathway to do so.

This activity provides a mechanism for satisfying your PI requirement for continuing certification by sharing with the ABFM how you have assessed and improved the way your practice addresses SDOH; health equity (broadly defined); and/or systemic ways in which you assure that patient access, experience, and care are equitable.

Some key things to know about this pathway:
  • You may report a project conducted alone or within a single practice group, an ACO, or other larger group practices
  • You can use this pathway whether you see patients in a continuity setting or if you are providing non-continuity episodic care (e.g., hospitalist, telemedicine, locums, urgent care, emergency department, etc.).

Log into your MyABFM Portfolio to access this PI activity. To help you through the process of applying for credit, here is a sample application to review and ensure you have all of the information you will need, and below is video guide that walks you through each step.

Once you’ve submitted your application and it has been approved (may take up to 10 days for approval), you will fulfill an ABFM certification requirement and you will have earned 20 ABFM points and 20 American Academy of Family Physicians Prescribed CME credits.

We’d love to hear how this process was for you and what impact you had on patient care by completing your PI activity. Let us know in a post-survey.

If you have any questions regarding your PI activity requirement for the ABFM or if you have any issues with your application, please contact Ann Williamson at the ABFM. You can also visit the OAFP’s ABFM Certification webpage for more information on all things ABFM!


If you have any questions regarding materials on this page or the PI process in general, please contact Deputy Executive Vice President Kaitlin McGuffie or call 800.742.7327.


This EasyPI track is sponsored by Humana, a proud Partner in Health of the OAFP.