在美国紧急部门实施健康查的社会决定因素
Stephanie Loo1, Melanie Molina2, N Jia Ahmad1
1Department of Emergency Medicine, Massachusetts General Hospital, Boston.
JAMA network open
|March 6, 2025
概括
在急诊室 (ED) 进行健康不良社会决定因素 (SDOH) 查面临着各种实践和资源限制等挑战. 解决方案包括量身定制的工具,利益相关者的参与,以及政策层面的资金,以确保成功实施.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
- 健康差异 在健康上的差异
背景情况:
- 健康的不利社会决定因素 (SDOH) 显著影响健康结果,特别是在服务不足的人群中.
- 应急部门 (ED) 越来越多地被认为是识别和解决SDOH的关键点.
- 在ED中对SDOH进行查可以帮助缓解健康差异.
研究的目的:
- 在多样化的美国EDs样本中探索选,记录和解决不良SDOH的障碍和促进者.
- 确定基于ED的SDOH查当前的做法和挑战.
- 收集改善ED环境中SDOH查实施的建议.
主要方法:
- 定性研究采用深度采访,对有意抽样美国EDS的领导者进行了深入采访.
- 参与者是从ED中招募的,这些ED在2022年美国国家紧急部门清单 (NEDI) 调查中自我报告了不良SDOH查.
- 诱导主题分析用于分析2023年4月至9月收集的采访数据.
主要成果:
- 在ED不利的SDOH查和记录实践中存在异质性.
- 对基于ED的SDOH查和转诊的有用性持怀疑态度.
- 关键驱动因素包括监管任务,而资源,人员和时间限制带来了重大挑战.
- 建议包括定制工具,让利益相关者参与,增加专门的查人员 (例如社会工作者) 和加强社区伙伴关系.
结论:
- 美国EDs表现出对不利SDOH查的多样化方法,面临实施障碍.
- 政策层面的SDOH查任务应该包含专门的资金机制.
- 进一步的研究对于开发和实施有效的基于ED的SDOH查计划至关重要.
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