How Hospitals Tackle Social Determinants

by Jon Scaccia May 31, 2024

When we think of hospitals, we usually imagine them as places that treat illness and injury. However, the role of hospitals extends beyond just medical care. They also play a crucial part in addressing the social determinants of health (SDOH)—the conditions in which people are born, grow, live, work, and age. These determinants significantly influence health outcomes and quality of life. A recent scoping review sheds light on how hospitals in the U.S. are addressing SDOH and reveals both progress and gaps in their efforts.

Understanding Social Determinants of Health

Social Determinants of Health (SDOH) are the non-medical factors that affect health outcomes. These include things like access to healthy food, safe housing, quality education, and supportive communities. Addressing SDOH is essential because they account for a larger share of health outcomes than medical care alone.

Why Hospitals are Involved

Nonprofit hospitals in the U.S., which constitute nearly half of all hospitals, have a legal obligation to benefit their communities. The Affordable Care Act (ACA) has further incentivized hospitals to address SDOH by shifting payments towards value-based care. This means hospitals are now encouraged to look beyond treating diseases and address the underlying social factors that contribute to health.

Key Findings from the Review

The scoping review analyzed 70 peer-reviewed articles published between January 2018 and June 2023. Here are some of the key findings:

1. Geographical and Institutional Disparities: Most initiatives (73%) were launched during or after 2020, with a significant number (37%) based in the Northeast U.S. More initiatives were undertaken by academic health centers (34%) compared to safety-net facilities (16%).
2. Types of Initiatives: The majority of initiatives (79%) were research-based, including clinical trials (40%). However, only 34% used Electronic Health Records (EHR) to collect SDOH data. Most initiatives (74%) were focused on addressing individual health-related social needs (HRSNs) such as food and housing, rather than community-level structural SDOH.
3. Methods and Tools: Most initiatives used a hot-spotting approach (74%) to target high-risk patients, while 26% relied on screening and referral methods. This shows a trend towards proactive identification and intervention for those at the highest risk.
4. Internal Capacity vs. Community Partnerships: A significant number of initiatives (60%) relied on internal hospital capacity rather than community partnerships (4%). This indicates a potential area for growth, as community partnerships can enhance the reach and effectiveness of interventions.
5. Attention to Health Disparities: Only 11% of the initiatives focused on reducing health disparities. This suggests that more attention is needed in addressing the inequalities that contribute to poor health outcomes.

Challenges and Barriers

Several challenges were identified in the review:

• Implementation Issues: Many hospitals faced difficulties integrating services across sectors and dealing with patient hesitancy due to social stigma. And you know me, I just love hearing about implementation issues!
• Organizational Barriers: Limited institutional support for screening and referral, provider buy-in, and professional training were common hurdles.
• Data and Evidence: Comprehensive data on the systemic impact of these initiatives was lacking, making it hard to assess their long-term benefits and cost savings.

The Way Forward

Addressing the gaps identified in the review requires a multi-faceted approach:

1. Integrating SDOH into EHR Systems: Policymakers should create incentives for hospitals to integrate SDOH data into EHR systems. This would allow for more holistic patient care and better tracking of social needs.
2. Expanding Community Partnerships: Hospitals should seek to build more robust partnerships with community organizations. These partnerships can help extend the reach of hospital initiatives and provide more comprehensive support to patients.
3. Focusing on Upstream Interventions: While addressing immediate social needs is crucial, hospitals should also invest in upstream interventions that target the root causes of health disparities. This could include advocating for policies that improve housing, education, and economic stability in their communities.
4. Enhancing Research on Impact: More research is needed to understand the long-term impact and cost savings of hospital-led SDOH initiatives. This evidence can support the scaling up of successful interventions and inform policy decisions.

Let us know in the comments!

1. What are some examples of social determinants of health in your community, and how do you think hospitals can address them more effectively?
2. How can hospitals balance the need for immediate health interventions with the long-term goal of addressing upstream social determinants of health?

Conclusion

Hospitals have made significant strides in addressing the social determinants of health, but there is still much work to be done. By integrating SDOH data into care practices, expanding community partnerships, focusing on upstream interventions, and enhancing research on the impact, hospitals can play a vital role in promoting health equity and improving the overall health of their communities.

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About the Author

Jon Scaccia, with a Ph.D. in clinical-community psychology and a research fellowship at the US Department of Health and Human Services with expertise in public health systems and quality programs. He specializes in implementing innovative, data-informed strategies to enhance community health and development. Jon helped develop the R=MC² readiness model, which aids organizations in effectively navigating change.