Abstract
Objective
To investigate social determinants of health (SDoH) interventions on individual health
outcomes, population health, and cost for persons in the United States over age 18
living with disabilities and receiving long-term services and supports (LTSS) in noninstitutional
settings.
Data Sources
A review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines was conducted of literature from PubMed, PsycINFO, REHABDATA, and Web of
Science Core Collection published between January 1997 and July 2020.
Study Selection
Search terms were based on the primary SDoH domains identified by the Centers for
Medicare and Medicaid's Accountable Health Communities Model. A total of 5082 abstracts
were screened based on identification criteria of persons age 18 and above living
in non-institutional, community-based settings receiving LTSS.
Data Extraction
During Level 2 review, articles were reviewed based on population focus, type of LTSS
(personal assistance services, home care, adult day care, home modification, durable
medical equipment, community transition services, caregiver supports and/or prevention
services related to home- and community-based care), SDoH intervention and association
with health outcomes, population health and/or cost. A total of 1037 abstracts underwent
Level 2 review, yielding 131 publications or 1.3% for full review.
Data Synthesis
Studies (n=33) designed a priori to test outcomes of interventions were rated according
to Grading Recommendations Assessment Development and Evaluation (GRADE) criteria.
Qualifying articles that did not include interventions (n=98) were included in our
summary of the literature but were not assessed by GRADE.
Conclusions
The preponderance of research surrounding SDoH and health outcomes has focused on
older adults living with disabilities, and most interventions scored low or very low
using GRADE criteria. Evidence is limited to the extent SDoH interventions are measured
against outcomes for persons of all ages living with disabilities. Robust evaluation
of models that feature SDoH interventions in partnership with community-based organizations
is recommended as home and community-based care infrastructure expands in response
to the American Rescue Plan Act of 2021.
Keywords
List of abbreviations:
GRADE (Grading Recommendations Assessment Development and Evaluation), HCBS (home- and community-based services), HDM (home-delivered meal), IDD (intellectual and developmental disabilities), LTSS (long-term services and supports), MLTSS (managed long-term services and supports), PACE (Program for All-Inclusive Care for the Elderly), SDoH (social determinants of health), SNAP (Supplemental Nutrition Assistance Program)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 27, 2021
Accepted:
June 25,
2021
Received in revised form:
June 18,
2021
Received:
April 16,
2021
Footnotes
Supported by the Disability and Rehabilitation Research Projects Program: Health Service Delivery Models (grant no. HHS-2016-ACL-NIDILRR-DPGE-0165).
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine.
