HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA.
Fam Med Community Health. 2023 Sep;11(3). doi: 10.1136/fmch-2023-002227.
It is well known that social determinants of health (SDOH), including poverty, education, transportation and housing, are important predictors of health outcomes. Health Resources and Services Administration (HRSA)-funded health centres serve a patient population with high vulnerability to barriers posed by SDOH and are required to provide services that enable health centre service utilisation and assist patients in navigating barriers to care. This study explores whether health centres with higher percentages of patients using these enabling services experience better clinical performance and outcomes.
The analysis uses organisational characteristics, patient demographics and clinical quality measures from HRSA's 2018 Uniform Data System. Health centres (n=875) were sorted into quartiles with quartile 1 (Q1) representing the lowest utilisation of enabling services and quartile 4 (Q4) representing the highest. The researchers calculated a service area social deprivation score weighted by the number of patients for each health centre and used ordinary least squares to create adjusted values for each of the clinical quality process and outcome measures. Analysis of variance was used to test differences across enabling services quartiles.
After adjusting for patient characteristics, health centre size and social deprivation, authors found statistically significant differences for all clinical quality process measures across enabling services quartiles, with Q4 health centres performing significantly better than Q1 health centres for several clinical process measures. However, these Q4 health centres performed poorer in outcome measures, including blood pressure and haemoglobin A1c control.
These findings emphasise the importance of how enabling services (eg, translation services, transportation) can address unmet social needs, improve utilisation of health services and reaffirm the challenges inherent in overcoming SDOH to improve health outcomes.
众所周知，健康的社会决定因素（SDOH），包括贫困、教育、交通和住房，是健康结果的重要预测因素。卫生资源和服务管理局（HRSA）资助的医疗中心为容易受到 SDOH 障碍影响的患者群体提供服务，并且必须提供能够促进医疗中心服务利用和帮助患者克服护理障碍的服务。本研究探讨了 SDOH 障碍利用率较高的医疗中心是否具有更好的临床表现和结果。
该分析使用了 HRSA 2018 年统一数据系统的组织特征、患者人口统计学和临床质量指标。将医疗中心（n=875）分为四个四分位数，其中四分位数 1（Q1）代表启用服务利用率最低，四分位数 4（Q4）代表利用率最高。研究人员为每个医疗中心计算了加权患者数量的服务区域社会剥夺分数，并使用普通最小二乘法为每个临床质量过程和结果指标创建了调整值。方差分析用于检验不同启用服务四分位数之间的差异。
在调整了患者特征、医疗中心规模和社会剥夺因素后，作者发现所有临床质量过程指标在启用服务四分位数之间均存在统计学显著差异，Q4 医疗中心在多个临床过程指标上的表现明显优于 Q1 医疗中心。然而，这些 Q4 医疗中心在结果指标上的表现较差，包括血压和血红蛋白 A1c 的控制。
这些发现强调了启用服务（例如，翻译服务、交通服务）如何能够满足未满足的社会需求，提高卫生服务的利用率，并再次证实了克服 SDOH 以改善健康结果所面临的挑战。
