Gurewich Deborah, Garg Arvin, Kressin Nancy R
VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
J Gen Intern Med. 2020 May;35(5):1571-1575. doi: 10.1007/s11606-020-05720-6. Epub 2020 Feb 19.
Social determinants of health (SDoH) are the conditions in which people live and work that shape access to essential social and economic resources. Calls for healthcare systems to intervene on unmet social needs have stimulated several large-scale initiatives across the country. Yet, such activities are underway in the absence of a unifying conceptual framework outlining the potential mechanisms by which healthcare-based unmet social need interventions can improve health outcomes. Drawing on theoretical foundations and empirical evidence about the relationship between unmet social needs and health, the authors developed the OASIS (Outcomes from Addressing SDoH in Systems) conceptual framework to map the known and hypothesized pathways by which unmet social need screening and referral interventions may impact outcomes. The OASIS framework may help guide policy makers, healthcare system leaders, clinicians, and researchers to utilize a more unified approach in their efforts to implement and evaluate unmet social need interventions and thus foster the development of an evidence base to inform healthcare systems to more effectively mitigate the consequences of unmet social needs. Adopting an overarching conceptual framework for addressing unmet social needs by healthcare systems holds promise for better achieving health equity and promoting health at the individual and population levels.
健康的社会决定因素(SDoH)是指人们生活和工作的条件,这些条件塑造了获取基本社会和经济资源的机会。呼吁医疗保健系统干预未得到满足的社会需求,这在全国范围内激发了几项大规模倡议。然而,这些活动是在缺乏一个统一概念框架的情况下开展的,该框架概述了基于医疗保健的未得到满足的社会需求干预措施可以改善健康结果的潜在机制。作者借鉴关于未得到满足的社会需求与健康之间关系的理论基础和实证证据,开发了OASIS(系统中解决社会决定因素的结果)概念框架,以描绘未得到满足的社会需求筛查和转诊干预措施可能影响结果的已知路径和假设路径。OASIS框架可能有助于指导政策制定者、医疗保健系统领导者、临床医生和研究人员在实施和评估未得到满足的社会需求干预措施时采用更统一的方法,从而促进形成一个证据基础,以便告知医疗保健系统更有效地减轻未得到满足的社会需求的后果。采用一个总体概念框架来解决医疗保健系统中未得到满足的社会需求,有望在个人和人群层面更好地实现健康公平并促进健康。