Context:
Based on a growing body of research documenting inverse relationships between social adversity and health and well-being, social determinants of health (SDH)—including access to food, housing, transportation, and education—have sidled into the national discussion around healthcare improvement. Examples come from national bellwethers in healthcare services decision making. In 2014, the National Quality Forum launched a 2-year trial to examine how including patients’ social factors in risk adjustment models may change reimbursement and prospective payment rates. In 2015, the National Academy of Medicine (then the Institute of Medicine) Committee on Recommended Social and Behavioral Domains to Include in Electronic Health Records included education level, housing stability, and financial strain among measures recommended to be collected routinely in healthcare delivery.
The increasing awareness of the contribution of SDH to health has provoked questions about the impact of SDH interventions on the healthcare Triple Aim: improved patient experience of care, better population health, and reduced per capita costs. Recent reviews of experiments on SDH interventions undertaken in healthcare settings provide an overview of the existing range of interventions in this emerging field. There are more interventions to come. This year, the Center for Medicare and Medicaid Innovation will begin a 5-year $157-million grants initiative to support healthcare-based screening for social needs and community resource navigation for community-dwelling Medicare and Medicaid beneficiaries.
Despite the increasing experimentation around social and medical care delivery integration, little information has been compiled across studies about the impacts of these interventions or their comparative effectiveness. As health systems begin to more routinely integrate SDH programs into clinical practice, a strong evidence base could better inform dissemination efforts. With the assumption that effectiveness should guide future investments in this area, this qualitative systematic review examines the existing peer-reviewed literature on evaluations of interventions bridging social and medical care delivery.
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