Addressing Social Determinants of Health Within Healthcare Delivery Systems: a Framework to Ground and Inform Health Outcomes

Abstract

Social determinants of health (SDoH) are the conditions in which people live and work that shape access to essential social and economic resources. Calls for healthcare systems to intervene on unmet social needs have stimulated several large-scale initiatives across the country. Yet, such activities are underway in the absence of a unifying conceptual framework outlining the potential mechanisms by which healthcare-based unmet social need interventions can improve health outcomes. Drawing on theoretical foundations and empirical evidence about the relationship between unmet social needs and health, the authors developed the OASIS (Outcomes from Addressing SDoH in Systems) conceptual framework to map the known and hypothesized pathways by which unmet social need screening and referral interventions may impact outcomes. The OASIS framework may help guide policy makers, healthcare system leaders, clinicians, and researchers to utilize a more unified approach in their efforts to implement and evaluate unmet social need interventions and thus foster the development of an evidence base to inform healthcare systems to more effectively mitigate the consequences of unmet social needs. Adopting an overarching conceptual framework for addressing unmet social needs by healthcare systems holds promise for better achieving health equity and promoting health at the individual and population levels.

Neighborhood Conditions and Recurrent Emergency Department Utilization by Children in the United States

“…At the individual level, health systems may incorporate geographic metrics about patients' neighborhoods of residence, such as the Child Opportunity Index, into their electronic health records to complement individual demographic data. 34,54 The use of survey data in this study also highlights the potential utility of validating new social screening tools, which traditionally focus on individual social risk factors, 55,56 to capture parent and caregiver perceptions of their neighborhoods. These approaches may yield valuable objective and subjective information to identify patients at elevated risk of recurrent ED visits by virtue of where they live, to whom educational and social supports could be targeted.…”

Does Parental Report of Having a Medical Home Attenuate the Negative Association Between Unmet Basic Needs and Health for Low-Income Children?

“…The framework postulates that these types of interventions may improve children’s outcomes by increasing families’ connectivity to community resources thereby reducing unmet material needs and its associated exposure to toxic stress for poor children. 27…”

Chronic disease stigma, skepticism of the health system, and socio-economic fragility: Qualitative assessment of factors impacting receptiveness to group medical visits and microfinance for non-communicable disease care in rural Kenya

“…Innovative approaches to NCD care delivery are being actively developed and evaluated. In particular, there is increasing recognition that social determinants of health need to be incorporated into care delivery, in order to simultaneously address socio-economic as well as health issues [ 2 , 3 ].…”