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Effect of Social Determinants of Health Interventions on Adults Living With Disabilities: A Scoping Review

Published:October 27, 2021DOI:https://doi.org/10.1016/j.apmr.2021.06.021

      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)
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