Abstract | November 6, 2020

Emergency Department-based Interventions Affecting Social Determinants of Health in the United States: A Scoping Review

Presenting Author: Joe Mcilwain, B.S. Biomedical Sciences, Auburn University, Medical Student, University of Alabama at Birmingham, Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama.

Co-authors: Lauren A. Walter, University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL; Catherine H. Smith, University of Alabama at Birmingham, Lister Hill Library, Birmingham, AL; Erin Shufflebarger, University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL; Jennifer Hess, University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL; Matthew Heimann, University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL; Cameron Crosby, University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL; Sylvia Sontheimer, University of Alabama at Birmingham, School of Medicine, Birmingham, AL; Stephen Gragg, University of Alabama at Birmingham, School of Medicine, Birmingham, AL; Delissa Hand, University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL; Katherine Baldwin, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, Christopher Greene, University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL, Rachel Skains, University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL, Erik P. Hess, Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN

Learning Objectives

  1. With the emergence of Social Emergency Medicine, further research is needed to discern healthcare disparities and their effects on patient care in the Emergency Department.
  2. Despite numerous recent publications, certain health disparities in the Emergency Department, including food and housing insecurity, are featured limitedly. This may limit our understanding of the impact or magnitude these disparities have on our patients.

Background: Social determinants of health (SDOH) have significant implications for health outcomes in the United States. Emergency medicine functions as the safety net of the American healthcare system, caring for our nation’s most vulnerable populations. In recent years, Social Emergency Medicine, a field that aims to assess and address healthcare disparities as they impact patients seeking emergency department care, has emerged.

Objective: We sought to summarize and categorize the peer-reviewed literature to identify ED-based interventions to mitigate the SDOH.

Methods: We conducted a scoping review to identify and characterize articles that report the impact of interventions that address SDOH in the emergency care setting. In collaboration with a medical librarian, we designed and conducted a search strategy in the Medline, CINAHL, and Cochrane CENTRAL databases. We also conducted a “pearl growing” search in PubMed for articles similar to 13 highly relevant citations identified before and during the screening process. Abstracts were reviewed independently and in duplicate by two reviewers to identify potentially relevant articles for inclusion. Full manuscripts were obtained to assess eligibility criteria for inclusion. Included articles were categorized by primary SDOH category and summarized.

Results: A total of 10,856 abstracts were identified. Following removal of duplicates, 10,358 abstracts were reviewed. Five hundred ninety-six potentially relevant studies were identified. Review of the full manuscripts identified 138 articles for inclusion. These articles were further subdivided into seven SDOH domains: 1) language/literacy/health literacy; 2) access to care; 3) exposure to violence; 4) food insecurity; 5) housing issues/homelessness; 6) discrimination/group disparities; and 7) socioeconomic status/poverty

Conclusion: ED-based interventions that address seven different SDOH domains have been reported in the peer-reviewed literature. Systematic reviews are needed to further characterize interventions in each of these seven domains and to define a future research agenda.

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