Evaluating How Safety-Net Hospitals Are Identified: Systematic Review and Recommendations.

Area of Science:

• Health Services Research
• Public Health Policy
• Health Equity Studies

Background:

• Safety-net hospitals provide care to vulnerable populations but lack a standardized definition.
• Existing definitions are heterogeneous and often rely on limited socioeconomic proxies.
• This heterogeneity impedes consistent research and effective policy development.

Purpose of the Study:

• To systematically review how safety-net hospitals' status is identified and defined.
• To discuss the limitations of current definitions.
• To propose recommendations for a new classification and evaluation framework.

Main Methods:

• Systematic literature review adhering to PRISMA guidelines.
• MEDLINE database search for studies published before May 16, 2019.
• Extraction of data on identification methods, definitions, dimensions of disadvantage, and evaluation of safety-net status.

Main Results:

• 132 studies investigating safety-net hospitals were identified.
• Substantial heterogeneity exists in defining and measuring hospital disadvantage.
• Definitions predominantly used low-income proxies, rarely included social risk factors, and often created distinct categories.

Conclusions:

• A standardized definition for safety-net hospitals is crucial for research and policy consistency.
• Current definitions have significant limitations.
• A new framework, informed by health equity and precision public health, is needed to incorporate social determinants of health for more accurate hospital evaluation and targeted interventions.