Data_Sheet_2_Characteristics of hospital and health system initiatives to address social determinants of health in the United States: a scoping review of the peer-reviewed literature.docx

BackgroundDespite 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.
MethodsPRISMA-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.
ResultsMost 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.
ConclusionHospital/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.

背景：尽管美国《平价医疗法案》针对基于价值的支付与社区健康需求评估为医院制定了相关激励措施与条款，但目前学界仍对医院解决社会决定健康因素（Social Determinants of Health，SDOH）相关工作的充分性与分布情况存在担忧。本范围综述对同行评议文献进行系统梳理，旨在明确美国医院/医疗系统解决SDOH相关举措的关键特征，以洞察其进展与现存不足。

方法：本研究采用范围综述系统报告条目（PRISMA-ScR）开展文献范围综述。文献检索以“健康民众（Healthy People）SDOH领域”及行业推荐的医院SDOH类型整合框架为指引，检索了3个学术数据库，纳入2018年1月1日至2023年6月30日期间的符合条件的文献。数据库检索共得到3027篇文献，其中70篇同行评议文献符合本综述的纳入标准。

结果：多数文章（73%）发表于2020年及以后，37%的研究驻地位于美国东北部地区。学术医疗中心开展的相关举措占比（34%）高于安全网医疗机构（16%）。其中绝大多数（79%）为研究类举措，包含40%的临床试验。仅有34%的举措利用电子健康记录（Electronic Health Record，EHR）收集SDOH数据。多数举措（73%）覆盖两类及以上SDOH类型，例如食品与住房保障需求。绝大多数（74%）为解决个体健康相关社会需求（Health-Related Social Needs，HRSN）的下游干预举措，仅9%为针对社区层面结构性SDOH的上游努力，例如住房投资项目。多数举措（74%）采用患者热点定位模式以靶向高风险患者的HRSN，剩余26%则依赖筛查与转诊流程。多数举措（60%）依托内部能力开展，仅4%采用社区合作模式。健康差异问题仅得到11%的有限关注。研究面临的挑战包括实施难题，以及干预措施的系统影响与成本节约相关证据的匮乏。

结论：当前美国医院/医疗系统的SDOH相关举措主要以解决个体HRSN的下游干预为主，通过患者热点定位或筛查-转诊模式开展。对临床试验的过度重视，加之EHR在SDOH数据收集中的低使用率，限制了该类举措向安全网医疗机构的推广应用。政策制定者应制定激励措施，推动医院将SDOH数据整合至EHR系统，并依托社区合作模式应对SDOH问题。未来仍需开展针对医院SDOH相关举措的系统影响研究。