<p>Scoping review inclusion and exclusion criteria.</p>

Introduction
Long-term acute care hospitals (LTACHs) are certified acute care facilities specifically designed to provide continuous specialized care and extended recovery for patients with chronic critical illness. LTACHs have high mortality rates because patients with complex care needs often experience fluctuations in their recovery trajectory; however, these outcomes are not solely driven by medically related factors. Social determinants of health (SDoH) contribute to up to 55% of all health outcomes; therefore, understanding how characteristics of SDoH influence patterns of health care utilization and health outcomes among patients in LTACH setting is crucial for optimizing outcomes in this population.
Methods and materials
This scoping review utilized the U.S. Department of Health and Human Services Healthy People 2030 SDoH framework to describe how SDoH influence outcomes for patients admitted to and discharged from LTACHs. The review covers the literature from 1982 to 2025 across four databases. The Joanna Briggs Institute (JBI) Manual for Evidence Synthesis guided the review and the PRISMA extension for scoping reviews guided the manuscript development.
Results
Five studies met the inclusion criteria. Findings indicate that the current literature focused on SDoH within the LTACH setting has predominantly concentrated on only three of the five established domains: social and community context, economic context, and healthcare access and quality. Race was identified as a key demographic variable in three studies that examined its association with outcomes such as mortality, morbidity, readmission rates, and health care costs. LTACH location and insurance coverage represented health care access and quality, and income reflected the broader economic context.
Conclusion
There is limited literature on this topic, and the review findings were insufficient to describe the complex interplay between SDoH variables and key patient outcomes. The degree to which the variables under each SDoH domain have been studied may not provide sufficient information to represent them. Comprehensive research on the effects of SDoH on outcomes of patients in the LTACH setting is warranted to explicate possibly complex causal relationships, inform targeted interventions to improve patient outcomes, and maximize the value of LTACHs, especially in light of the recent facility closures.

## 引言
长期急性护理医院（Long-term acute care hospitals, LTACHs）是经认证的急性护理医疗机构，专为慢性重症患者提供持续性专科护理与延长康复服务。LTACHs的患者死亡率较高，因存在复杂护理需求的患者其康复轨迹常出现波动；但此类结局并非仅由医疗相关因素决定。健康社会决定因素（Social determinants of health, SDoH）可解释多达55%的健康结局差异；因此，明确健康社会决定因素的特征如何影响长期急性护理医院环境下患者的医疗服务利用模式与健康结局，对于优化该群体的预后至关重要。

## 方法与材料
本范围综述采用美国卫生与公众服务部《健康人民2030》的健康社会决定因素框架，阐述健康社会决定因素对收治于长期急性护理医院及从该院出院的患者结局的影响。本综述检索了1982年至2025年间4个数据库中的相关文献。本综述的实施遵循《乔安娜·布里格斯研究所证据合成手册》（Joanna Briggs Institute, JBI），文稿撰写则采用范围综述的PRISMA扩展指南。

## 结果
共有5项研究符合纳入标准。研究结果显示，当前针对长期急性护理医院环境下健康社会决定因素的相关文献，主要聚焦于5个既定领域中的3个：社会与社区环境、经济环境，以及医疗服务可及性与质量。3项研究将种族作为关键人口统计学变量，探讨其与死亡率、发病率、再入院率及医疗成本等结局的关联。长期急性护理医院所在地与保险覆盖情况属于医疗服务可及性与质量范畴，而收入则对应更广泛的经济环境领域。

## 结论
目前针对该主题的文献较为匮乏，本次综述的结果不足以阐明健康社会决定因素变量与关键患者结局之间的复杂相互作用。各健康社会决定因素领域下的变量研究程度，可能不足以完整体现该领域的全貌。有必要开展针对健康社会决定因素对长期急性护理医院患者结局影响的综合性研究，以阐明可能存在的复杂因果关系，为改善患者预后的针对性干预措施提供依据，并最大化长期急性护理医院的价值——尤其是考虑到近期该类机构的关停现状。