Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States.
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States.
Knee. 2024 Aug;49:241-248. doi: 10.1016/j.knee.2024.07.010. Epub 2024 Jul 23.
Barriers stemming from Social Determinants of Health (SDOH) are known to contribute to higher rates of complications, poor patient adherence to treatment plans, and suboptimal outcomes following orthopaedic care. While SDOH's impact has been characterized, interventions to address SDOH-related inequities in orthopaedics have not yet been optimized.
The objective of the present systematic review was to identify and synthesize current peer-reviewed literature focused interventions to address SDOH-related inequities to develop optimal mitigation strategies that improve outcomes for orthopaedic patients.
A systematic search of PubMed, OVID, and CINAHL identified articles that referenced SDOH and an intervention to address inequities.
After screening 419 studies, 19 met inclusion criteria. Studies commonly looked at the impact of insurance policy change on the rate of the population with active insurance and associated use of elective surgery. Nine studies found that policy changes generally increased the rate of insured patients, though inequities remained for younger and racial minority patients. The relative paucity of literature in conjunction with methodological differences among studies highlights the need for further development and validation of effective interventions to address SDOH-related inequities in orthopaedics.
Insurance expansion was the focus of the majority of included articles, finding that expansion is associated with higher rates of insured patients undergoing elective and emergent procedures, however, gaps remain for young patients and racial minorities. Further research is needed to determine effective healthcare team, healthcare system, and policy-level interventions that overcome SDOH-related barriers to optimal care and outcomes for orthopaedic patients.
Level-II.
健康的社会决定因素（SDOH）所导致的障碍，已知会导致更高的并发症发生率、患者对治疗计划的依从性差，以及骨科治疗后的结果不理想。虽然已经描述了 SDOH 的影响，但针对骨科中与 SDOH 相关的不平等问题的干预措施尚未得到优化。
本系统评价的目的是确定和综合当前已发表的文献中针对 SDOH 相关不平等问题的干预措施，以制定最佳缓解策略，改善骨科患者的结局。
对 PubMed、OVID 和 CINAHL 进行系统检索，确定参考 SDOH 和干预措施以解决不平等问题的文章。
在筛选了 419 篇研究后，有 19 篇符合纳入标准。这些研究通常着眼于保险政策变化对有活跃保险人群的比例以及相关择期手术使用的影响。有 9 项研究发现，政策变化通常会增加有保险患者的比例，但对于年轻患者和少数族裔患者仍存在不平等现象。鉴于文献相对较少，以及研究之间存在方法学差异，需要进一步制定和验证有效的干预措施，以解决骨科中与 SDOH 相关的不平等问题。
保险范围扩大是大多数纳入文章的重点，发现扩大保险范围与更多接受择期和紧急手术的保险患者比例相关，但年轻患者和少数族裔仍存在差距。需要进一步研究，以确定有效的医疗团队、医疗系统和政策层面的干预措施，克服与 SDOH 相关的障碍，为骨科患者提供最佳护理和结局。
2 级。
