The MetroHealth System, Cleveland, OH, USA.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241273214. doi: 10.1177/21501319241273214.
INTRODUCTION/OBJECTIVES: Many health systems screen patients for social determinants of health and refer patients with social needs to community service organizations for assistance. However, few studies have examined how social determinants of health change over time in the same individuals.
We examined patients screened by The MetroHealth System in Cleveland, Ohio for 11 social determinants of health, including food insecurity, financial strain, transportation, housing stability, utilities affordability, other housing problems, intimate partner violence, social connection, physical activity, daily stress, and digital connectivity. We determined changes in these social determinants among patients screened at baseline and again after 6 to 18 months of follow-up. We further examined correlates of changes in food insecurity, because it is a common need among our patients and leads to numerous referrals to community organizations for assistance.
A substantial majority of patients had no change in each social determinant. For example, among 18 038 patients screened twice for food insecurity, 13 913 (77.1%) did not screen positive for food insecurity at baseline and follow-up and 1726 (9.6%) screened positive for food insecurity at both times. A total of 1080 (6.0%) did not screen positive for food insecurity at baseline but screened positive at follow-up while 1319 (7.3%) screened positive for food insecurity at baseline but not at follow-up. Among patients screening positive for food insecurity at baseline, screening negative at follow-up was independently associated with being age ≥60 years (odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.02-2.10), not screening positive for financial strain (OR = 1.64, CI = 1.27-2.13), not screening positive for housing problems (OR = 1.65, CI = 1.28-2.13), and not screening positive for intimate partner violence (OR = 1.45, OR = 1.02-2.08). A longer duration between baseline and follow-up screening was also independently associated with not screening positive for food insecurity at follow-up. Being referred for food assistance was not associated with absence of food insecurity at follow-up (OR = 0.71, CI = 0.47-1.08).
Most patients report no change in specific social determinants of health over 6 to 18 months. Examining changes may identify subgroups at greatest risk for persistence of adverse determinants and help to evaluate the impact of assistance efforts.
简介/目的：许多医疗系统会对患者进行健康的社会决定因素筛查，并将有社会需求的患者转介给社区服务组织以获得帮助。然而，很少有研究调查同一人群的社会决定因素随时间如何变化。
我们检查了俄亥俄州克利夫兰市 MetroHealth 系统筛查的 11 项社会决定因素的患者，包括食物不安全、经济压力、交通、住房稳定、水电费负担能力、其他住房问题、亲密伴侣暴力、社会联系、身体活动、日常压力和数字连接。我们确定了在基线筛查后 6 至 18 个月随访期间这些社会决定因素在患者中的变化。我们进一步研究了食物不安全变化的相关性，因为这是我们患者的常见需求，并导致许多患者转介给社区组织以获得帮助。
绝大多数患者在每个社会决定因素方面都没有变化。例如，在 18038 名两次接受食物不安全筛查的患者中，有 13913 名（77.1%）在基线和随访时未筛查出食物不安全，而 1726 名（9.6%）两次均筛查出食物不安全。共有 1080 名（6.0%）在基线时未筛查出食物不安全，但在随访时筛查出阳性，而 1319 名（7.3%）在基线时筛查出阳性，但在随访时未筛查出阳性。在基线时筛查出食物不安全的患者中，在随访时筛查出阴性与年龄≥60 岁（比值比[OR]1.46，95%置信区间[CI]1.02-2.10）、未筛查出经济压力（OR 1.64，CI 1.27-2.13）、未筛查出住房问题（OR 1.65，CI 1.28-2.13）和未筛查出亲密伴侣暴力（OR 1.45，OR 1.02-2.08）独立相关。基线和随访筛查之间的时间间隔较长也与随访时未筛查出食物不安全独立相关。接受食物援助转介与随访时无食物不安全无关（OR 0.71，CI 0.47-1.08）。
大多数患者在 6 至 18 个月内报告特定健康社会决定因素无变化。检查变化可以确定处于不利决定因素持续存在风险最大的亚组，并有助于评估援助工作的影响。
