Department of Health Promotion, Education, and Behavior.
Department of Epidemiology/Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.
Med Care. 2023 Jul 1;61(7):423-430. doi: 10.1097/MLR.0000000000001800. Epub 2022 Dec 12.
Health systems are increasingly investing in social determinants of health (SDoH), but there is limited research on how such efforts impact health care resource use. This study presents pilot work on an SDoH screening and referral platform recently implemented in South Carolina's largest private nonprofit health system.
To assess the feasibility and sustainability of SDoH screening and SDoH-related referrals in a large health system and examine how they affect health resource use.
Observational study using electronic medical records and SDoH screening data from June 1, 2019 to December 31, 2020.
Patients (18 y+) engaged in community health, inpatient case management, or ambulatory care and condition management programs.
We describe the use of SDoH screening by providers (community health workers, nurse case managers, and social workers) and SDoH referral volumes among patients. We use multivariate analyses to predict changes in emergency department visits, inpatient admission s (length of stay and volume), and primary care visits from referral volume, SDoH screening question responses, and patient characteristics (eg, comorbidities).
Of 2687 patients, 662 (24.6%) screened positive for 1 or more SDoH domains. SDoH screening performance remained consistent among providers over time. Six hundred fifty-eight (24.5%) patients received SDoH referrals. Patients receiving an increasing volume of referrals had decreasing primary care visits but their comorbidities moderated this effect.
The study provides initial descriptive information on SDoH needs, implementation of referrals and resource use, guiding SDoH screening implementation in population health, and care management programs.
卫生系统越来越多地投资于健康的社会决定因素（SDoH），但对于这些努力如何影响医疗资源利用，相关研究却很有限。本研究介绍了南卡罗来纳州最大的非营利性健康系统最近实施的 SDoH 筛查和转介平台的初步工作。
评估在大型卫生系统中进行 SDoH 筛查和 SDoH 相关转介的可行性和可持续性，并研究它们如何影响卫生资源的使用。
使用电子病历和 2019 年 6 月 1 日至 2020 年 12 月 31 日的 SDoH 筛查数据进行的观察性研究。
参与社区卫生、住院病例管理或门诊护理和疾病管理计划的患者（18 岁及以上）。
我们描述了社区卫生工作者、护士病例管理者和社会工作者等提供者进行 SDoH 筛查的情况以及患者的 SDoH 转介量。我们使用多元分析来预测转介量、SDoH 筛查问题的回答以及患者特征（如合并症）对急诊就诊、住院入院（住院时间和数量）和初级保健就诊的变化。
在 2687 名患者中，有 662 名（24.6%）筛查出 1 个或多个 SDoH 领域呈阳性。随着时间的推移，提供者的 SDoH 筛查表现保持一致。658 名（24.5%）患者收到了 SDoH 转介。收到转介量增加的患者的初级保健就诊量减少，但他们的合并症会对此产生影响。
该研究提供了有关 SDoH 需求、转介和资源使用实施情况的初步描述性信息，为人群健康和护理管理计划中的 SDoH 筛查实施提供了指导。
