Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, CT, United States.
Northeast Medical Group, Yale New Haven Health System, Stratford, CT, United States.
Front Public Health. 2024 May 30;12:1413205. doi: 10.3389/fpubh.2024.1413205. eCollection 2024.
Despite the incentives and provisions created for hospitals by the US Affordable Care Act related to value-based payment and community health needs assessments, concerns remain regarding the adequacy and distribution of hospital efforts to address SDOH. This scoping review of the peer-reviewed literature identifies the key characteristics of hospital/health system initiatives to address SDOH in the US, to gain insight into the progress and gaps.
PRISMA-ScR criteria were used to inform a scoping review of the literature. The article search was guided by an integrated framework of Healthy People SDOH domains and industry recommended SDOH types for hospitals. Three academic databases were searched for eligible articles from 1 January 2018 to 30 June 2023. Database searches yielded 3,027 articles, of which 70 peer-reviewed articles met the eligibility criteria for the review.
Most articles (73%) were published during or after 2020 and 37% were based in Northeast US. More initiatives were undertaken by academic health centers (34%) compared to safety-net facilities (16%). Most (79%) were research initiatives, including clinical trials (40%). Only 34% of all initiatives used the EHR to collect SDOH data. Most initiatives (73%) addressed two or more types of SDOH, e.g., food and housing. A majority (74%) were downstream initiatives to address individual health-related social needs (HRSNs). Only 9% were upstream efforts to address community-level structural SDOH, e.g., housing investments. Most initiatives (74%) involved hot spotting to target HRSNs of high-risk patients, while 26% relied on screening and referral. Most initiatives (60%) relied on internal capacity vs. community partnerships (4%). Health disparities received limited attention (11%). Challenges included implementation issues and limited evidence on the systemic impact and cost savings from interventions.
Hospital/health system initiatives have predominantly taken the form of downstream initiatives to address HRSNs through hot-spotting or screening-and-referral. The emphasis on clinical trials coupled with lower use of EHR to collect SDOH data, limits transferability to safety-net facilities. Policymakers must create incentives for hospitals to invest in integrating SDOH data into EHR systems and harnessing community partnerships to address SDOH. Future research is needed on the systemic impact of hospital initiatives to address SDOH.
尽管美国平价医疗法案为医院提供了与基于价值的支付和社区健康需求评估相关的激励措施和规定，但人们仍然对医院为解决社会决定因素健康问题所做努力的充分性和分布情况表示担忧。本研究对同行评议文献进行了范围界定审查，以确定美国医院/卫生系统解决社会决定因素健康问题的举措的主要特征，从而深入了解进展和差距。
PRISMA-ScR 标准被用于指导文献的范围界定审查。文章搜索以健康人社会决定因素健康领域的综合框架和行业推荐的医院社会决定因素健康类型为指导。从 2018 年 1 月 1 日至 2023 年 6 月 30 日，在三个学术数据库中搜索符合条件的文章。数据库搜索共产生了 3027 篇文章，其中 70 篇同行评议文章符合审查标准。
大多数文章（73%）是在 2020 年或之后发表的，37%的文章基于美国东北部。与安全网设施（16%）相比，学术医疗中心（34%）开展了更多的举措。大多数（79%）是研究举措，包括临床试验（40%）。只有 34%的举措使用电子健康记录收集社会决定因素健康数据。大多数举措（73%）针对两种或两种以上类型的社会决定因素健康问题，例如食品和住房。大多数举措（74%）是下游举措，旨在解决与个人健康相关的社会需求（HRSNs）。只有 9%的举措是解决社区层面结构性社会决定因素健康问题的上游努力，例如住房投资。大多数举措（74%）涉及热点定位以针对高风险患者的 HRSNs，而 26%依赖于筛查和转诊。大多数举措（60%）依赖于内部能力，而不是社区伙伴关系（4%）。卫生差异受到的关注有限（11%）。挑战包括实施问题和干预措施对系统影响和成本节约的有限证据。
医院/卫生系统的举措主要采取下游举措，通过热点定位或筛查和转诊来解决 HRSNs。临床试验的重点以及电子健康记录收集社会决定因素健康数据的使用率较低，限制了向安全网设施的可转移性。政策制定者必须为医院创造激励措施，使其投资于将社会决定因素健康数据整合到电子健康记录系统中，并利用社区伙伴关系来解决社会决定因素健康问题。需要对医院解决社会决定因素健康问题的举措的系统影响进行进一步研究。
