PDF(Pubmed)
Abstract：
UNASSIGNED: Despite the incentives and provisions created for hospitals by the US Affordable Care Act related to value-based payment and community health needs assessments, concerns remain regarding the adequacy and distribution of hospital efforts to address SDOH. This scoping review of the peer-reviewed literature identifies the key characteristics of hospital/health system initiatives to address SDOH in the US, to gain insight into the progress and gaps.
UNASSIGNED: PRISMA-ScR criteria were used to inform a scoping review of the literature. The article search was guided by an integrated framework of Healthy People SDOH domains and industry recommended SDOH types for hospitals. Three academic databases were searched for eligible articles from 1 January 2018 to 30 June 2023. Database searches yielded 3,027 articles, of which 70 peer-reviewed articles met the eligibility criteria for the review.
UNASSIGNED: Most articles (73%) were published during or after 2020 and 37% were based in Northeast US. More initiatives were undertaken by academic health centers (34%) compared to safety-net facilities (16%). Most (79%) were research initiatives, including clinical trials (40%). Only 34% of all initiatives used the EHR to collect SDOH data. Most initiatives (73%) addressed two or more types of SDOH, e.g., food and housing. A majority (74%) were downstream initiatives to address individual health-related social needs (HRSNs). Only 9% were upstream efforts to address community-level structural SDOH, e.g., housing investments. Most initiatives (74%) involved hot spotting to target HRSNs of high-risk patients, while 26% relied on screening and referral. Most initiatives (60%) relied on internal capacity vs. community partnerships (4%). Health disparities received limited attention (11%). Challenges included implementation issues and limited evidence on the systemic impact and cost savings from interventions.
UNASSIGNED: Hospital/health system initiatives have predominantly taken the form of downstream initiatives to address HRSNs through hot-spotting or screening-and-referral. The emphasis on clinical trials coupled with lower use of EHR to collect SDOH data, limits transferability to safety-net facilities. Policymakers must create incentives for hospitals to invest in integrating SDOH data into EHR systems and harnessing community partnerships to address SDOH. Future research is needed on the systemic impact of hospital initiatives to address SDOH.
UNASSIGNED: PRISMA-ScR criteria were used to inform a scoping review of the literature. The article search was guided by an integrated framework of Healthy People SDOH domains and industry recommended SDOH types for hospitals. Three academic databases were searched for eligible articles from 1 January 2018 to 30 June 2023. Database searches yielded 3,027 articles, of which 70 peer-reviewed articles met the eligibility criteria for the review.
UNASSIGNED: Most articles (73%) were published during or after 2020 and 37% were based in Northeast US. More initiatives were undertaken by academic health centers (34%) compared to safety-net facilities (16%). Most (79%) were research initiatives, including clinical trials (40%). Only 34% of all initiatives used the EHR to collect SDOH data. Most initiatives (73%) addressed two or more types of SDOH, e.g., food and housing. A majority (74%) were downstream initiatives to address individual health-related social needs (HRSNs). Only 9% were upstream efforts to address community-level structural SDOH, e.g., housing investments. Most initiatives (74%) involved hot spotting to target HRSNs of high-risk patients, while 26% relied on screening and referral. Most initiatives (60%) relied on internal capacity vs. community partnerships (4%). Health disparities received limited attention (11%). Challenges included implementation issues and limited evidence on the systemic impact and cost savings from interventions.
UNASSIGNED: Hospital/health system initiatives have predominantly taken the form of downstream initiatives to address HRSNs through hot-spotting or screening-and-referral. The emphasis on clinical trials coupled with lower use of EHR to collect SDOH data, limits transferability to safety-net facilities. Policymakers must create incentives for hospitals to invest in integrating SDOH data into EHR systems and harnessing community partnerships to address SDOH. Future research is needed on the systemic impact of hospital initiatives to address SDOH.
摘要：
尽管美国平价医疗法案为医院制定了与基于价值的支付和社区健康需求评估相关的激励措施和规定，对于医院解决SDOH的努力的充分性和分布性仍然存在担忧。对同行评审文献的范围审查确定了美国解决SDOH的医院/卫生系统计划的关键特征，深入了解进展和差距。
■PRISMA-ScR标准用于对文献进行范围审查。文章搜索以健康人群SDOH领域和行业推荐的医院SDOH类型的集成框架为指导。从2018年1月1日至2023年6月30日，搜索了三个学术数据库中符合条件的文章。数据库搜索产生3,027篇文章，其中70篇同行评审文章符合评审资格标准。
■大多数文章（73%）是在2020年或之后发表的，37%的文章来自美国东北部。与安全网设施（16％）相比，学术卫生中心（34％）采取了更多举措。大多数（79％）是研究计划，包括临床试验（40%）。所有计划中只有34％使用EHR收集SDOH数据。大多数倡议(73%)涉及两种或两种以上的SDOH，例如，食物和住房。大多数（74％）是解决个人健康相关社会需求（HRSN）的下游举措。只有9%是上游努力解决社区层面的结构性SDOH，例如，住房投资。大多数计划（74％）涉及针对高危患者的HRSN的热点，而26%的人依赖于筛查和转诊。大多数计划（60%）依赖于内部能力社区伙伴关系(4%)。健康差异受到的关注有限(11%)。挑战包括执行问题和关于干预措施的系统性影响和成本节约的证据有限。
医院/卫生系统举措主要采取下游举措的形式，通过热点或筛查和转诊来解决HRSN。强调临床试验，加上较少使用EHR收集SDOH数据，限制了对安全网设施的可转让性。政策制定者必须激励医院投资将SDOH数据纳入EHR系统，并利用社区伙伴关系解决SDOH问题。未来需要研究医院举措对解决SDOH的系统性影响。
■PRISMA-ScR标准用于对文献进行范围审查。文章搜索以健康人群SDOH领域和行业推荐的医院SDOH类型的集成框架为指导。从2018年1月1日至2023年6月30日，搜索了三个学术数据库中符合条件的文章。数据库搜索产生3,027篇文章，其中70篇同行评审文章符合评审资格标准。
■大多数文章（73%）是在2020年或之后发表的，37%的文章来自美国东北部。与安全网设施（16％）相比，学术卫生中心（34％）采取了更多举措。大多数（79％）是研究计划，包括临床试验（40%）。所有计划中只有34％使用EHR收集SDOH数据。大多数倡议(73%)涉及两种或两种以上的SDOH，例如，食物和住房。大多数（74％）是解决个人健康相关社会需求（HRSN）的下游举措。只有9%是上游努力解决社区层面的结构性SDOH，例如，住房投资。大多数计划（74％）涉及针对高危患者的HRSN的热点，而26%的人依赖于筛查和转诊。大多数计划（60%）依赖于内部能力社区伙伴关系(4%)。健康差异受到的关注有限(11%)。挑战包括执行问题和关于干预措施的系统性影响和成本节约的证据有限。
医院/卫生系统举措主要采取下游举措的形式，通过热点或筛查和转诊来解决HRSN。强调临床试验，加上较少使用EHR收集SDOH数据，限制了对安全网设施的可转让性。政策制定者必须激励医院投资将SDOH数据纳入EHR系统，并利用社区伙伴关系解决SDOH问题。未来需要研究医院举措对解决SDOH的系统性影响。
