Ganatra Sarju, Khadke Sumanth, Kumar Ashish, Khan Sadiya, Javed Zulqarnain, Nasir Khurram, Rajagopalan Sanjay, Wadhera Rishi K, Dani Sourbha S, Al-Kindi Sadeer
Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, United States.
Department of Medicine, Cleveland Clinic, Akron General, Akron, OH 44307, United States.
Health Aff Sch. 2024 Nov 14;2(12):qxae151. doi: 10.1093/haschl/qxae151. eCollection 2024 Dec.
Social determinants of health (SDoH) significantly impacts health outcomes and disparities. While the Centers for Medicare and Medicaid Services has mandated hospitals to collect standardized SDoH data, existing tools lack key elements. This systematic review identified 78 studies and 20 screening tools addressing various SDoH domains. However, most tools were missing several key domains and lacked standardization. We propose a comprehensive tool meeting essential criteria: validated questions, brevity, actionability, cultural appropriateness, workflow integration, and community linkage. Our tool addresses gaps in available tools and incorporates standardized and validated questions to enable patient-centered screening for diverse social and environmental determinants of health. It uniquely includes detailed race/ethnicity data collection, housing characteristics, physical activity assessment, access to healthy food measures, and environmental exposure evaluation. The tool aims to provide actionable data for immediate interventions while informing broader population health strategies and policy initiatives. By offering a holistic assessment of SDoH across multiple domains, our tool enables standardized data collection, risk stratification, and focused initiatives to address health inequities at both individual and population levels. Further research is needed to develop evidence-based pathways for integrating SDoH data into real-world patient care workflows, improve risk prediction algorithms, address health-related social needs, and reduce disparities.
健康的社会决定因素(SDoH)对健康结果和差异有重大影响。虽然医疗保险和医疗补助服务中心已要求医院收集标准化的SDoH数据,但现有工具缺乏关键要素。这项系统综述确定了78项研究和20种针对不同SDoH领域的筛查工具。然而,大多数工具缺少几个关键领域且缺乏标准化。我们提出了一个符合基本标准的综合工具:经过验证的问题、简洁性、可操作性、文化适宜性、工作流程整合以及社区联系。我们的工具弥补了现有工具的不足,并纳入了标准化和经过验证的问题,以实现以患者为中心的对各种健康社会和环境决定因素的筛查。它独特地包括详细的种族/族裔数据收集、住房特征、身体活动评估、获得健康食品的措施以及环境暴露评估。该工具旨在提供可立即用于干预的可操作数据,同时为更广泛的人群健康战略和政策倡议提供信息。通过对多个领域的SDoH进行全面评估,我们的工具能够进行标准化数据收集、风险分层,并采取有针对性的举措来解决个体和人群层面的健康不平等问题。还需要进一步研究,以开发基于证据的途径,将SDoH数据整合到实际的患者护理工作流程中,改进风险预测算法,满足与健康相关的社会需求,并减少差异。