Health care providers must adapt at a system level to overcome preventive services disparities tied to social determinants of health, according to a panel of experts. The panel was convened by the National Institutes of Health and culminated in an evidence report built on a review of evidence, discussion among panel attendees, and public comments.
The report, published in the Annals of Internal Medicine, examines the efficacy of U.S. Preventive Services Task Force–recommended clinical preventive services for cancer, heart disease, and diabetes. It identifies research gaps and suggestions for improving research.
The panel included five key question topics:
- barriers to preventive services attributable to providers;
- barriers to populations adversely affected by disparities;
- effectiveness of patient–provider interventions;
- effectiveness of health information technology (HIT) interventions; and
- effectiveness of health system interventions.
The panel made 26 recommendations for improving implementation of services proven to reduce disparities in preventable conditions.
The report calls for increased attention to intersectionality and interventions tailored to overlapping marginalized populations. Panelists noted the effectiveness of shared decision-making support and proactive use of checklists in reducing screening disparities. They stressed the importance of the “human touch” in successful HIT programs and called to re-evaluate the use of screening prompts in the electronic health record, which often cause “prompt fatigue,” reducing efficacy with increased use.
While the evidence review identified mostly single-component interventions targeted to a single preventive service, the report notes multicomponent interventions might provide more benefit.
Finally, analytics describing health care disparities must adapt when interventions result in changes to the underlying social or medical structure and data. The evidence review identified several mthods for developing new metrics to assess health equity, including using systems science, pragmatic trial designs, implementation research, modeling, economics, community-based participatory research, and quality improvement.
Most of the reviewed trials and cohort studies focused on cancer screening, and researchers called for additional research in other clinical areas. Advances in research methods, growing data interoperability, and improved collaboration with stakeholders will facilitate continued efforts to target health care disparities in the community.
To learn how essential hospitals are moving outside the clinical care setting to target social determinants of health, visit essentialcommunities.org.
Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.
