Yan Alice F, Chen Zhuo, Wang Yang, Campbell Jennifer A, Xue Qian-Li, Williams Michelle Y, Weinhardt Lance S, Egede Leonard E
Center for Advancing Population Science (CAPS), Division of Internal Medicine, Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA.
Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA.
Health Equity. 2022 Jun 24;6(1):454-475. doi: 10.1089/heq.2022.0010. eCollection 2022.
This systematic review examined and synthesized peer-reviewed research studies that reported the process of integrating social determinants of health (SDOH) or social needs screening into electronic health records (EHRs) and the intervention effects in the United States.
Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, a systematic search of Scopus, Web of Science Core Collection, MEDLINE, and Cochrane Central Register of Clinical Trials was performed. English language peer-reviewed studies that reported the process of integrating SDOH or social needs screening into EHRs within the U.S. health systems and published between January 2015 and December 2021 were included. The review focused on process measures, social needs changes, health outcomes, and health care cost and utilization.
In total, 28 studies were included, and half were randomized controlled trials. The majority of the studies targeted multiple SDOH domains. The interventions vary by the levels of intensity of their approaches and heterogeneities in outcome measures. Most studies (82%, =23) reported the findings related to the process measures, and nearly half (43%, =12) reported outcomes related to social needs. By contrast, only 39% (=11) and 32% (=9) of the studies reported health outcomes and impact on health care cost and utilization, respectively. Findings on patients' social needs change demonstrated improved access to resources. However, findings were mixed on intervention effects on health and health care cost and utilization. We also identified gaps in implementation challenges to be overcome.
Our review supports the current policy efforts to increase U.S. health systems' investment toward directly addressing SDOH. While effective interventions can be more complex or resource intensive than an online referral, health care organizations hoping to achieve health equity and improve population health must commit the effort and investment required to achieve this goal.
本系统评价对同行评审的研究进行了审查和综合分析，这些研究报告了将健康的社会决定因素（SDOH）或社会需求筛查纳入电子健康记录（EHR）的过程以及在美国的干预效果。
遵循PRISMA（系统评价和Meta分析的首选报告项目）指南，对Scopus、科学引文索引核心合集、医学期刊数据库和考科蓝临床对照试验中心注册库进行了系统检索。纳入了2015年1月至2021年12月期间发表的、报告了在美国卫生系统中将SDOH或社会需求筛查纳入EHR过程的英文同行评审研究。该评价聚焦于过程指标、社会需求变化、健康结局以及医疗保健成本和利用情况。
总共纳入了28项研究，其中一半是随机对照试验。大多数研究针对多个SDOH领域。干预措施因其方法的强度水平和结局指标的异质性而有所不同。大多数研究（82%，n = 23）报告了与过程指标相关的结果，近一半（43%，n = 12）报告了与社会需求相关的结果。相比之下，分别只有39%（n = 11）和32%（n = 9）的研究报告了健康结局以及对医疗保健成本和利用的影响。关于患者社会需求变化的研究结果表明获得资源的机会有所改善。然而，关于干预对健康以及医疗保健成本和利用的影响，研究结果不一。我们还确定了有待克服的实施挑战方面的差距。
我们的评价支持美国卫生系统目前为直接解决SDOH问题增加投资的政策努力。虽然有效的干预措施可能比在线转诊更为复杂或资源密集，但希望实现健康公平并改善人群健康的医疗保健组织必须付出努力并进行必要的投资以实现这一目标。
