Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
Department of Medicine, Northwell Health, New York, New York.
Am J Prev Med. 2019 Dec;57(6 Suppl 1):S6-S12. doi: 10.1016/j.amepre.2019.07.013.
The body of research on social determinants of health is rapidly accumulating. The U.S. Preventive Services Task Force is conducting evaluations to consider the inclusion of screening and counseling for social risks as a clinical preventive service. Yet, for many social risks, evidence is still likely needed before the U.S. Preventive Services Task Force can recommend universal screening or counseling. This manuscript offers a brief review of the social determinants of health that may be germane to the U.S. Preventive Services Task Force, the methods the U.S. Preventive Services Task Force uses to evaluate relevant evidence, and current evidence gaps for social risks. Key methods for making clinical preventive service recommendations are applied for considering the integration of social and clinical care. These methods include determining the certainty of the evidence, assessing the net benefit, defining appropriate prevention frameworks, defining health outcomes versus intermediate outcomes, fully assessing the harms, and defining to what populations and care contexts the evidence applies. This road map for research is intended to spark ingenuity and purpose in the next generation of research studies, thereby ensuring that future recommendations to address and prevent social risks in primary care are informed by high-quality evidence. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
关于健康的社会决定因素的研究文献正在迅速增加。美国预防服务工作组正在进行评估，以考虑将社会风险的筛查和咨询纳入临床预防服务。然而，对于许多社会风险，在美国预防服务工作组能够推荐普遍筛查或咨询之前，可能仍需要证据。本文简要回顾了可能与美国预防服务工作组相关的健康社会决定因素、美国预防服务工作组用于评估相关证据的方法以及社会风险的当前证据差距。用于考虑将社会和临床护理相结合的临床预防服务建议的关键方法包括确定证据的确定性、评估净效益、定义适当的预防框架、定义健康结果与中间结果、全面评估危害以及定义证据适用的人群和护理环境。该研究路线图旨在激发下一代研究的创造力和目的性，从而确保未来解决和预防初级保健中社会风险的建议得到高质量证据的支持。补充信息：本文是一个题为“在临床环境中识别和干预社会需求：证据和证据差距”的补充的一部分，该补充由美国卫生与公众服务部的医疗保健研究与质量局、凯撒永久医疗集团和罗伯特伍德约翰逊基金会赞助。
