Economics Department, Ohio University College of Arts & Sciences; Appalachian Institute to Advance Health Equity Science, Athens, Ohio, USA.
Management-Health Administration, Florida Atlantic University College of Business, Boca Raton, Florida, USA.
J Rural Health. 2023 Sep;39(4):728-736. doi: 10.1111/jrh.12771. Epub 2023 Jun 9.
Greater health care engagement with social determinants of health (SDOH) is critical to improving health equity. However, no national studies have compared programs to address patient social needs among critical access hospitals (CAHs), which are lifelines for rural communities. CAHs generally have fewer resources and receive governmental support to maintain operations. This study considers the extent to which CAHs engage in community health improvement, particularly upstream SDOH, and whether organizational or community factors predict involvement.
Using descriptive statistics and Poisson regression, we compared 3 types of programs (screening, in-house strategies, and external partnerships) to address the patient social needs between CAHs and non-CAHs, independent of key organizational, county, and state factors.
CAHs were less likely than non-CAHs to have programs to screen patients for social needs, address unmet social needs of patients, and enact community partnerships to address SDOH. When we stratified hospitals according to whether they endorsed an equity-focused approach as an organization, CAHs matched their non-CAH counterparts on all 3 types of programs.
CAHs lag relative to their urban and non-CAH counterparts in their ability to address nonmedical needs of their patients and broader communities. While the Flex Program has shown success in offering technical assistance to rural hospitals, this program has mainly focused on traditional hospital services to address patients' acute health care needs. Our findings suggest that organizational and policy efforts surrounding health equity could bring CAHs in line with other hospitals in terms of their ability to support rural population health.
加强医疗保健与健康决定因素（SDOH）的互动，对于改善健康公平至关重要。然而，目前尚无全国性研究比较解决关键接入医院（CAHs）患者社会需求的方案，而 CAHs 是农村社区的生命线。CAHs 通常资源较少，并获得政府支持以维持运营。本研究考虑了 CAHs 参与社区健康改善的程度，特别是上游 SDOH，以及组织或社区因素是否可以预测其参与程度。
我们使用描述性统计和泊松回归，比较了 CAHs 和非 CAHs 之间 3 种类型的方案（筛查、内部策略和外部伙伴关系）在解决患者社会需求方面的差异，这些方案独立于关键组织、县和州因素。
与非 CAHs 相比，CAHs 更不可能有筛查患者社会需求、解决患者未满足的社会需求以及建立社区伙伴关系来解决 SDOH 的方案。当我们根据医院是否将以公平为重点的方法作为组织目标进行分层时，CAHs 在所有 3 种方案上都与非 CAHs 相匹配。
CAHs 在满足患者和更广泛社区的非医疗需求方面落后于城市和非 CAHs 医院。虽然 Flex 计划已经成功地为农村医院提供了技术援助，但该计划主要侧重于传统的医院服务，以解决患者的急性医疗保健需求。我们的研究结果表明，围绕健康公平的组织和政策努力可以使 CAHs 在支持农村人口健康方面与其他医院保持一致。
