Emergency Department-based Interventions Affecting Social Determinants of Health in the United States: a Scoping Review
Background: Social determinants of health (SDoH) have significant implications for health outcomes in the United States (US). Emergency Departments (EDs) function as the safety nets of the American healthcare system, caring for many vulnerable populations. ED-based interventions to assess social risk and mitigate social needs have been reported in the literature. However, the breadth and scope of these interventions have not been evaluated. As the field of Social Emergency Medicine expands, a mapping and categorization of previous interventions may help shape future research.
Objective: We sought to identify, summarize, and characterize ED-based interventions aimed at mitigating negative SDoH.
Methods: We conducted a scoping review to identify and characterize peer-reviewed research articles that report ED-based interventions to address or impact SDoH in the US. We designed and conducted a search in Medline, CINAHL, and Cochrane CENTRAL databases. Abstracts and subsequently, full manuscripts, were reviewed independently by two reviewers to identify potentially relevant articles. Included articles were categorized by type of intervention and primary SDoH domain. Reported outcomes were also categorized by type and efficacy.
Results: A total of 10,856 abstracts were identified and reviewed, and 596 potentially relevant studies were identified. Full manuscript review identified 135 articles for inclusion. These articles were further subdivided into three intervention types: a) Provider Educational Intervention (18%), b) Disease Modification with SDoH Focus (26%), and c) Direct SDoH intervention (60%), with 4% including two 'types.' Articles were subsequently further grouped into seven SDoH domains: 1) Access to Care (33%), 2) Discrimination/Group Disparities (7%), 3) Exposure to Violence/Crime (34%), 4) Food Insecurity (2%), 5) Housing Issues/Homelessness (3%), 6) Language/Literacy/Health literacy (12%); 7) Socioeconomic Disparities/Poverty (10%). The majority of articles reported that the intervention studied was effective for the primary outcome identified (78%).
Conclusion: ED-based interventions that address seven different SDoH domains have been reported in the peer-reviewed literature over the past thirty years, utilizing a variety of approaches including provider education and direct and indirect focus on social risk and need. Characterization and understanding of previous interventions may help identify opportunities for future interventions as well as guide a Social Emergency Medicine research agenda.
Keywords: emergency medicine; population health; social determinants of health; social emergency medicine.
Walter LA, Schoenfeld EM, Smith CH, Shufflebarger E, Khoury C, Baldwin K, Hess J, Heimann M, Crosby C, Sontheimer SY, Gragg S, Hand D, McIlwain J, Greene C, Skains RM, Hess EP. Emergency Department-based Interventions Affecting Social Determinants of Health in the United States: a Scoping Review. Acad Emerg Med. 2020 Dec 24. doi: 10.1111/acem.14201. Epub ahead of print.