Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Emergency Medicine, University of Massachusetts Medical School-Baystate Medical Cente, Springfield, Massachusetts, USA.
Acad Emerg Med. 2021 Jun;28(6):666-674. doi: 10.1111/acem.14201. Epub 2021 Feb 2.
Social determinants of health (SDoH) have significant implications for health outcomes in the United States. Emergency departments (EDs) function as the safety nets of the American health care system, caring for many vulnerable populations. ED-based interventions to assess social risk and mitigate social needs have been reported in the literature. However, the breadth and scope of these interventions have not been evaluated. As the field of social emergency medicine (SEM) expands, a mapping and categorization of previous interventions may help shape future research. We sought to identify, summarize, and characterize ED-based interventions aimed at mitigating negative SDoH.
We conducted a scoping review to identify and characterize peer-reviewed research articles that report ED-based interventions to address or impact SDoH in the United States. We designed and conducted a search in Medline, CINAHL, and Cochrane CENTRAL databases. Abstracts and, subsequently, full articles were reviewed independently by two reviewers to identify potentially relevant articles. Included articles were categorized by type of intervention and primary SDoH domain. Reported outcomes were also categorized by type and efficacy.
A total of 10,856 abstracts were identified and reviewed, and 596 potentially relevant studies were identified. Full article review identified 135 articles for inclusion. These articles were further subdivided into three intervention types: a) provider educational intervention (18%), b) disease modification with SDoH focus (26%), and c) direct SDoH intervention (60%), with 4% including two "types." Articles were subsequently further grouped into seven SDoH domains: 1) access to care (33%), 2) discrimination/group disparities (7%), 3) exposure to violence/crime (34%), 4) food insecurity (2%), 5) housing issues/homelessness (3%), 6) language/literacy/health literacy (12%), 7) socioeconomic disparities/poverty (10%). The majority of articles reported that the intervention studied was effective for the primary outcome identified (78%).
Emergency department-based interventions that address seven different SDoH domains have been reported in the peer-reviewed literature over the past 30 years, utilizing a variety of approaches including provider education and direct and indirect focus on social risk and need. Characterization and understanding of previous interventions may help identify opportunities for future interventions as well as guide a SEM research agenda.
社会决定因素对美国的健康结果有重大影响。急诊部（ED）作为美国医疗保健系统的安全网，为许多弱势群体提供服务。文献中已经报道了在 ED 中评估社会风险和减轻社会需求的干预措施。然而，这些干预措施的广度和范围尚未得到评估。随着社会急诊医学（SEM）领域的扩展，对以前干预措施的映射和分类可能有助于塑造未来的研究。我们旨在确定、总结和描述旨在减轻负面社会决定因素的基于 ED 的干预措施。
我们进行了范围界定审查，以确定和描述在美国报告的旨在解决或影响 SDoH 的基于 ED 的干预措施的同行评审研究文章。我们在 Medline、CINAHL 和 Cochrane CENTRAL 数据库中进行了设计和搜索。两名审查员独立审查摘要，随后审查全文，以确定潜在的相关文章。纳入的文章按干预类型和主要 SDoH 领域进行分类。报告的结果也按类型和疗效进行分类。
共确定并审查了 10,856 篇摘要，确定了 596 篇潜在相关研究。全文审查确定了 135 篇文章纳入。这些文章进一步细分为三种干预类型：a）提供者教育干预（18%），b）以 SDoH 为重点的疾病改变（26%），和 c）直接 SDoH 干预（60%），其中 4%包括两种“类型”。文章随后进一步分为七个 SDoH 领域：1）获得医疗保健（33%），2）歧视/群体差异（7%），3）暴露于暴力/犯罪（34%），4）粮食不安全（2%），5）住房问题/无家可归（3%），6）语言/读写能力/健康素养（12%），7）社会经济差异/贫困（10%）。大多数文章报告说，研究中干预措施对确定的主要结果有效（78%）。
在过去 30 年的同行评审文献中，已经报道了针对七个不同 SDoH 领域的基于 ED 的干预措施，这些干预措施采用了多种方法，包括提供者教育以及直接和间接关注社会风险和需求。对以前干预措施的描述和理解可能有助于确定未来干预措施的机会，并指导 SEM 研究议程。
