Rangachari Pavani, Thapa Alisha
Department of Population Health and Leadership, School of Health Sciences, University of New Haven, 300 Boston Post Road, West Haven, CT, 06516, USA.
BMC Health Serv Res. 2025 Mar 5;25(1):342. doi: 10.1186/s12913-025-12494-2.
Hospital and health system initiatives addressing Social Determinants of Health (SDOH) are essential for achieving whole-person care and advancing health equity. Building on prior research characterizing these efforts (Part 1), this scoping review (Part 2) evaluates the effectiveness of these initiatives, with a focus on SDOH data integration, EHR utilization, and the broader scope of hospital efforts in addressing individual- and system-level determinants of health. Using an integrated conceptual framework combining the DeVoe & Cottrell framework for operational assessment and the National Academy of Medicine (NAM) 5A framework for systemic evaluation, this study provides a multidimensional assessment of hospital-based SDOH interventions.
Guided by PRISMA-ScR criteria, this review analyzed 41 U.S.-based studies published between 2018 and 2023, identified through three academic databases. Eligible studies examined hospital initiatives addressing SDOH with measurable outcomes. Analyses assessed SDOH data collection, integration into care practices, EHR use, and overall initiative effectiveness.
Most studies (66%) were randomized controlled trials in urban settings (68%), targeting patients with chronic or mental health conditions (39%) or high-risk healthcare users (20%). Nearly half of initiatives (49%) addressed multiple SDOH domains, focusing on Social & Community Context, Economic Stability, and Neighborhood & Built Environment. Only 24% of initiatives utilized EHRs for SDOH data collection. EHR-based initiatives demonstrated significantly higher adherence to evidence-based practices, including use of community resource guides for referrals (90% vs. 45%, p = 0.013). Across all outcome measures, 79% demonstrated improvement, with no instances of worsening outcomes. However, 85% of initiatives lacked community-level SDOH data integration, and few employed upstream, universal strategies. Process, clinical, and social outcomes were unevenly prioritized, with only 10% of studies addressing all three outcome types.
While these initiatives reflect progress in integrating SDOH into care workflows and improving whole-person care at the individual level, progress toward health equity remains insufficient. Persistent gaps in EHR use, community-level data integration, and upstream strategies hinder systemic impact, potentially perpetuating disparities. Strengthening SDOH-EHR integration, fostering community partnerships, and supporting policy advocacy are critical to bridging individual and community needs. Future research should emphasize long-term, sustainable, and community-level impacts of hospital-led SDOH interventions.
医院和卫生系统针对健康的社会决定因素（SDOH）所采取的举措对于实现全人护理和促进健康公平至关重要。基于之前对这些努力进行特征描述的研究（第1部分），本范围综述（第2部分）评估了这些举措的有效性，重点关注SDOH数据整合、电子健康记录（EHR）的利用，以及医院在解决个人和系统层面健康决定因素方面更广泛的努力范围。本研究使用了一个综合概念框架，该框架结合了用于操作评估的德沃伊和科特雷尔框架以及用于系统评估的美国国家医学院（NAM）5A框架，对基于医院的SDOH干预措施进行了多维度评估。
在PRISMA - ScR标准的指导下，本综述分析了2018年至2023年间发表的41项美国研究，这些研究通过三个学术数据库确定。符合条件的研究考察了针对SDOH且有可衡量结果的医院举措。分析评估了SDOH数据收集、整合到护理实践中、EHR的使用以及整体举措的有效性。
大多数研究（66%）是城市环境中的随机对照试验（68%），目标人群为患有慢性疾病或精神疾病的患者（39%）或高风险医疗使用者（20%）。近一半的举措（49%）涉及多个SDOH领域，重点关注社会与社区背景、经济稳定性以及邻里与建成环境。只有24%的举措利用EHR进行SDOH数据收集。基于EHR的举措在遵循循证实践方面表现出显著更高的比例，包括使用社区资源指南进行转诊（90%对45%，p = 0.013）。在所有结果指标中，79%显示有改善，没有出现结果恶化的情况。然而，85%的举措缺乏社区层面的SDOH数据整合，很少采用上游的、普遍适用的策略。过程、临床和社会结果的优先级不均衡，只有10%的研究涉及所有三种结果类型。
虽然这些举措反映了在将SDOH整合到护理工作流程以及在个体层面改善全人护理方面取得的进展，但在实现健康公平方面的进展仍然不足。在EHR使用、社区层面数据整合和上游策略方面持续存在的差距阻碍了系统性影响，可能使差异长期存在。加强SDOH - EHR整合、促进社区伙伴关系以及支持政策倡导对于弥合个人和社区需求至关重要。未来的研究应强调医院主导的SDOH干预措施的长期、可持续和社区层面的影响。
