Schultz Emily A, Zhuang Thompson, Shapiro Lauren M, Kamal Robin N
From the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (Schultz), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Zhuang), Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA (Shapiro), Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Stanford, CA (Kamal).
J Am Acad Orthop Surg. 2025 Jan 16. doi: 10.5435/JAAOS-D-24-00989.
Social drivers of health (SDOH) are area-level, nonmedical factors that affect health outcomes. By contrast, health-related social needs (HRSNs) are individual patient reported and are being deployed in some payment models. SDOH are often used to broadly represent health disparities of communities through metrics, such as the Social Vulnerability Index (SVI); however, the association of area-level SVI to individual HRSNs has not been well studied in hand surgery, which has implications for addressing social risks to improve health and in quality measurement.
We conducted a prospective cohort study of new patients presenting to an outpatient hand surgery clinic. Patients completed a questionnaire that included demographic information, zip code, the Accountable Health Communities HRSNs Screening Tool, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). Following completion of the survey, zip code was used to calculate SVI. Cohen kappa coefficients (k) were calculated to measure interrater agreement between SVI and HRSNs, SVI and QuickDASH, and HRSNs and QuickDASH.
We included 80 patients in the study. The most commonly reported HRSNs were safety (33, 41.25%) followed by housing (14, 17.5%) and food (11, 13.75%). Seven SVIs were represented across the cohort. No notable agreement was observed between SVI and HRSNs. In addition, no notable agreement was observed between SVI or HRSNs and QuickDASH score.
Although the importance of identifying SDOH is growing, the ability of these area-level measures to accurately reflect individual HRSNs is not well understood. HRSNs may represent an opportunity for patient-centered assessments of needs and to guide resource deployment to improve outcomes for hand surgery patients.
Level II prognostic study.
健康的社会驱动因素（SDOH）是影响健康结果的区域层面非医学因素。相比之下，与健康相关的社会需求（HRSNs）是患者个人报告的，并且正在一些支付模式中得到应用。SDOH通常用于通过社会脆弱性指数（SVI）等指标广泛代表社区的健康差异；然而，区域层面的SVI与个体HRSNs之间的关联在手外科领域尚未得到充分研究，这对解决社会风险以改善健康和质量测量具有重要意义。
我们对一家门诊手外科诊所的新患者进行了一项前瞻性队列研究。患者完成了一份问卷，其中包括人口统计学信息、邮政编码、可问责健康社区HRSNs筛查工具以及手臂、肩部和手部快速残疾评估量表（QuickDASH）。调查完成后，使用邮政编码计算SVI。计算科恩kappa系数（k）以衡量SVI与HRSNs、SVI与QuickDASH以及HRSNs与QuickDASH之间的评分者间一致性。
我们纳入了80名患者进行研究。最常报告的HRSNs是安全（33例，41.25%），其次是住房（14例，17.5%）和食物（11例，13.75%）。整个队列中有七种SVI。未观察到SVI与HRSNs之间有显著一致性。此外，未观察到SVI或HRSNs与QuickDASH评分之间有显著一致性。
尽管识别SDOH的重要性日益增加，但这些区域层面的措施准确反映个体HRSNs的能力尚未得到充分理解。HRSNs可能为以患者为中心的需求评估以及指导资源配置以改善手外科患者的治疗结果提供机会。
二级预后研究。
