Palacio Ana, Seo David, Medina Heidy, Singh Vivek, Suarez Maritza, Tamariz Leonardo
1 Division of Population Health and Computational Medicine, Miller School of Medicine, University of Miami , Miami, Florida.
2 GRECC, Veterans Affairs Medical Center , Miami, Florida.
Popul Health Manag. 2018 Dec;21(6):501-508. doi: 10.1089/pop.2017.0166. Epub 2018 Mar 29.
Social determinants of health (SDH) impact health outcomes. Medical centers have begun to collect SDH data, urged by government and scientific entities. Provider perspectives on collecting SDH are unknown. The aim is to understand differences in views and preferences according to provider characteristics. A cross-sectional survey of University of Miami clinical faculty was conducted in late 2016. The survey contained 11 questions: 8 demographic and departmental responsibilities questions and 3 Likert scale questions to capture collection and use of SDH perspectives. The main outcome was whether providers thought the benefit of collecting SDH outweighs the burden and risks. In all, 240 faculty members were included. The majority were men (64%), with a mean age of 51 years. Among participants, 53.5% were non-Hispanic white, 32% were Hispanic, 5% were Black/African American, and 5% were Asian. The majority agreed that SDH are important predictors of health outcomes and quality of care (83%). When comparing minority to nonminority faculty, 25% believed that SDH should only be available to PCPs, compared to 8% of nonminorities (P < 0.01). In a multivariate model, belonging to a racial ethnic minority was the only characteristic associated with believing that benefits of collecting SDH outweigh the risks (odds ratio 1.87, 95% confidence interval 1.02- 3.5) after adjusting for age, sex, minority status, health care provider type, type of responsibilities, and department. This study reveals that although most providers of a health system believe social risks impact health outcomes and quality metrics, the buy-in to collect SDH varies according to the racial/ethnic composition of the faculty.
健康的社会决定因素（SDH）会影响健康结果。在政府和科学机构的敦促下，医疗中心已开始收集SDH数据。目前尚不清楚医疗服务提供者对收集SDH的看法。目的是了解根据医疗服务提供者特征在观点和偏好上的差异。2016年末对迈阿密大学临床教员进行了一项横断面调查。该调查包含11个问题：8个关于人口统计学和部门职责的问题，以及3个李克特量表问题，以获取对收集和使用SDH观点的看法。主要结果是医疗服务提供者是否认为收集SDH的益处大于负担和风险。总共纳入了240名教员。大多数为男性（64%），平均年龄51岁。参与者中，53.5%为非西班牙裔白人，32%为西班牙裔，5%为黑人/非裔美国人，5%为亚洲人。大多数人同意SDH是健康结果和医疗质量的重要预测因素（83%）。将少数族裔教员与非少数族裔教员进行比较时，25%的人认为SDH应仅提供给初级保健医生，而非少数族裔的这一比例为8%（P＜0.01）。在多变量模型中，在调整年龄、性别、少数族裔身份、医疗服务提供者类型、职责类型和科室后，属于少数族裔是唯一与认为收集SDH的益处大于风险相关的特征（比值比1.87，95%置信区间1.02 - 3.5）。这项研究表明，尽管卫生系统的大多数医疗服务提供者认为社会风险会影响健康结果和质量指标，但对收集SDH的接受程度因教员的种族/族裔构成而异。
