Murray Genevra F, Rodriguez Hector P, Lewis Valerie A
Genevra F. Murray ( genevra. murray@dartmouth. edu ) is a research scientist at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, in Lebanon, New Hampshire.
Hector P. Rodriguez is a professor of health policy and management, director of the California Initiative for Health Equity and Action, and codirector of the Center for Healthcare Organizational and Innovation Research, at the School of Public Health, University of California Berkeley.
Health Aff (Millwood). 2020 Feb;39(2):199-206. doi: 10.1377/hlthaff.2019.01266.
Despite interest in addressing social determinants of health to improve patient outcomes, little progress has been made in integrating social services with medical care. We aimed to understand how health care providers with strong motivation (for example, operating under new payment models) and commitment (for example, early adopters) fared at addressing patients' social needs. We collected qualitative data from twenty-two accountable care organizations (ACOs). These ACOs were early adopters and were working on initiatives to address social needs, including such common needs as transportation, housing, and food. However, even these ACOs faced significant difficulties in integrating social services with medical care. First, the ACOs were frequently "flying blind," lacking data on both their patients' social needs and the capabilities of potential community partners. Additionally, partnerships between ACOs and community-based organizations were critical but were only in the early stages of development. Innovation was constrained by ACOs' difficulties in determining how best to approach return on investment, given shorter funding cycles and longer time horizons to see returns on social determinants investments. Policies that could facilitate the integration of social determinants include providing sustainable funding, implementing local and regional networking initiatives to facilitate partnership development, and developing standardized data on community-based organizations' services and quality to aid providers that seek partners.
尽管人们对解决健康问题的社会决定因素以改善患者治疗效果很感兴趣，但在将社会服务与医疗保健整合方面进展甚微。我们旨在了解那些积极性高（例如，按照新的支付模式运作）且有决心（例如，早期采用者）的医疗服务提供者在满足患者社会需求方面的表现。我们从22个责任医疗组织（ACO）收集了定性数据。这些ACO是早期采用者，正在开展旨在满足社会需求的举措，包括交通、住房和食品等常见需求。然而，即使是这些ACO在将社会服务与医疗保健整合方面也面临重大困难。首先，ACO常常“盲目行事”，既缺乏关于患者社会需求的数据，也不了解潜在社区合作伙伴的能力。此外，ACO与社区组织之间的伙伴关系至关重要，但仍处于发展初期。鉴于资金周期较短以及社会决定因素投资的回报期较长，ACO在确定如何实现最佳投资回报率方面存在困难，这限制了创新。有助于整合社会决定因素的政策包括提供可持续资金、实施地方和区域网络倡议以促进伙伴关系发展，以及开发关于社区组织服务和质量的标准化数据，以帮助寻求合作伙伴的提供者。
