Primary Submission Category: Health systems
A National Overview of Nonprofit Hospital Programs to Address the Social Determinants of Health
Authors:Â Berkeley Franz Kristin Kueffner Simone Singh Neeraj Puro Cory Cronin
Presenting Author: Berkeley Franz*
Decades of research have solidified the crucial role that social determinants of health (SDOH) play in shaping health outcomes and health equity. The aim of this study was to understand what hospitals mean when they publicly commit to address SDOH as part of their community benefit responsibilities. Our research team created a novel dataset of identified needs within hospital community health needs assessments and adopted strategies within corresponding implementation plans. This dataset included a 20% random sample of all nonprofit hospitals in the US (n=506), of which 321 had programs to address SDOH. We analyzed data on hospitals who adopted one or more programs to address SDOH as part of their implementation plan. Using the Kaiser Family Foundations’ (KFF) framework of SDOH, we coded each strategy under one of their six categories and then also created a dichotomous categorization of whether each program addressed health care or nonmedical needs. We conducted bivariate and multivariable analyses to assess hospital and community characteristics associated with hospitals addressing each type of need. We found that hospitals are most often addressing needs related to health care with 43% of programs within this category. When compared with hospitals addressing health care focused SDOH, we found that hospitals offering programs focused on upstream, nonmedical SDOH are larger in size and significantly more likely to be academic medical centers. At the broader county level, hospitals focused on nonmedical SDOH are located in communities with higher average income, fewer non-white residents, and more hospital beds. Nearly half of hospital programs to address SDOH remain focused on the health care needs of individual patients rather than upstream, nonmedical causes of poor health. Communities with greater economic and social needs are less likely to have hospitals investing upstream which has important implications for improving health equity in the U.S.