Feasibility of a family-centered intervention for depressed older men in primary care

Characteristics of hospital and health system initiatives to address social determinants of health in the United States: a scoping review of the peer-reviewed literature

Background

Despite the incentives and provisions created for hospitals by the US Affordable Care Act related to value-based payment and community health needs assessments, concerns remain regarding the adequacy and distribution of hospital efforts to address SDOH. This scoping review of the peer-reviewed literature identifies the key characteristics of hospital/health system initiatives to address SDOH in the US, to gain insight into the progress and gaps.

Methods

PRISMA-ScR criteria were used to inform a scoping review of the literature. The article search was guided by an integrated framework of Healthy People SDOH domains and industry recommended SDOH types for hospitals. Three academic databases were searched for eligible articles from 1 January 2018 to 30 June 2023. Database searches yielded 3,027 articles, of which 70 peer-reviewed articles met the eligibility criteria for the review.

Results

Most articles (73%) were published during or after 2020 and 37% were based in Northeast US. More initiatives were undertaken by academic health centers (34%) compared to safety-net facilities (16%). Most (79%) were research initiatives, including clinical trials (40%). Only 34% of all initiatives used the EHR to collect SDOH data. Most initiatives (73%) addressed two or more types of SDOH, e.g., food and housing. A majority (74%) were downstream initiatives to address individual health-related social needs (HRSNs). Only 9% were upstream efforts to address community-level structural SDOH, e.g., housing investments. Most initiatives (74%) involved hot spotting to target HRSNs of high-risk patients, while 26% relied on screening and referral. Most initiatives (60%) relied on internal capacity vs. community partnerships (4%). Health disparities received limited attention (11%). Challenges included implementation issues and limited evidence on the systemic impact and cost savings from interventions.

Conclusion

Hospital/health system initiatives have predominantly taken the form of downstream initiatives to address HRSNs through hot-spotting or screening-and-referral. The emphasis on clinical trials coupled with lower use of EHR to collect SDOH data, limits transferability to safety-net facilities. Policymakers must create incentives for hospitals to invest in integrating SDOH data into EHR systems and harnessing community partnerships to address SDOH. Future research is needed on the systemic impact of hospital initiatives to address SDOH.

Family-Centered Interventions and Quality of Life of Clients with Ostomy

Background. Family-centered intervention can be used as a therapeutic intervention to improve the quality of life (QOL) in clients with ostomy. This study aimed to determine the effects of family-centered intervention on the QOL in ostomy clients. Methods. A quasi-experimental study was carried out with participation of 70 clients with colostomy and 70 caregivers (family members). The participants were selected through convenient sampling and randomly allocated into the experimental and control groups. The experimental group received family-centered education. The education program included four sessions, 50–60 min each, that were implemented in two weeks at hospital wards or clients’ houses for the clients’ companions. Afterwards, the caregivers implemented the care at home for one month. The subjects in the control group received routine care before being discharged. The QOL of the clients in both groups was measured using the city of hope-QOL-ostomy questionnaire before and one month after the intervention. Results. The mean scores of the QOL after family-centered intervention in the experimental and control groups increased from 197.97 to 207.49 and from 195.2 to 199.03, respectively. The paired t-test showed a significant change in the experimental and control groups after the intervention at a confidence level of 95% ( $p=0.0001$ ; $p=0.002$ ). In addition, after the intervention, however, there was a significant difference between the two groups in all these areas except for social aspects ( $p=0.007$ ). Conclusion. Family-centered intervention can be used as a therapeutic intervention to improve the QOL in clients with ostomy. The intervention was effective in the physical, spiritual, psychological, and social health of these clients.