Department of Family and Community Medicine, Center for Health and Community, University of California, San Francisco, 3333 California St, Ste 465, Campus Box 0844, San Francisco, CA 94143-0844, USA.
JAMA Intern Med. 2013 Jun 10;173(11):1017-20. doi: 10.1001/jamainternmed.2013.560.
Despite strong evidence linking patients' social circumstances to their health, little guidance exists for health care practitioners and institutions on addressing social needs in clinical settings. Current approaches to social determinants generally focus on population-level and policy interventions; these overlook individual and clinical innovations within health care that can address patients' social circumstances. This article proposes a framework for how social determinants interventions in the health care system can be construed across 3 tiers-patient, institution, and broader population-and describes ways to collect data and target interventions at these levels.
尽管有强有力的证据表明患者的社会环境与其健康状况密切相关，但在临床环境中解决社会需求方面，医疗保健从业者和机构几乎没有得到任何指导。目前，社会决定因素的方法通常侧重于人群层面和政策干预；这些方法忽视了医疗保健中可以解决患者社会环境的个体和临床创新。本文提出了一个框架，说明如何在医疗保健系统中构建社会决定因素干预措施，可以分为三个层次-患者、机构和更广泛的人群，并描述了在这些层次上收集数据和针对干预措施的方法。
