Social Determinants of Health: What's a Healthcare System to Do?
Social Determinants of Health: What's a Healthcare System to Do?
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DOI：
10.1097/jhm-d-18-00160
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发表时间：
2019-07-01
影响因子：
1.8
通讯作者：
Adler, Nancy
中科院分区：
文献类型：
--
作者：
Gottlieb, Laura;Fichtenberg, Caroline;Adler, Nancy
关于社会风险（如不合标准的住房和粮食不安全）对健康的影响的文献越来越多，加上越来越多地采用基于风险的支付模式，促成了一波侧重于健康的社会决定因素的卫生保健部门举措。然而，在决定如何以及何时处理不利的社会状况时，往往受到有关潜在干预措施的有限信息和缺乏有关其有效性的数据的指导。我们描述了四种互补的策略，医疗保健领导者可以追求干预社会逆境，分裂患者护理和社区一级的方法。患者护理策略依赖于患者社会风险的数据来调整医疗护理或直接改善患者的社会环境。社区一级的战略侧重于通过对社区的直接投资和通过多部门伙伴关系的协作，改善当地人口的更广泛的健康和福祉。每一种方法都有独特的激励和挑战，想要解决社会逆境的医疗保健系统可能会采用一种或多种方法。了解潜在选择的范围可以帮助医疗保健领导者做出更明智的选择，以响应患者需求和不断变化的支付和政策举措。
A growing literature regarding the health consequences of social risks, such as substandard housing and food insecurity, combined with increased adoption of risk-based payment models have contributed to a wave of healthcare sector initiatives focused on the social determinants of health. Yet decisions about how and when to address adverse social conditions are frequently guided by limited information about potential interventions and a lack of data on their effectiveness. We describe four complementary strategies that healthcare leaders can pursue to intervene on social adversity, split between patient care and community-level approaches. Patient care strategies rely on data about patients' social risks to adapt medical care or improve patients' social circumstances directly. Community-level strategies focus on improving the broader health and well-being of the local population through a mix of direct investments in communities and collaboration through multisector partnerships. Each approach presents unique incentives and challenges, and healthcare systems wanting to address social adversity may adopt one or more. Understanding the range of potential choices may help healthcare leaders make more informed choices in response to patient needs and changing payment and policy initiatives.