Exploring the Evidence on Social Needs Interventions to Improve Health Outcomes

More than 250,000 peer-reviewed articles and conference proceedings on health, biological, and biomedical sciences are published each year in the United States. With an average length of 30 pages, a stack of the manuscripts would reach 4.7 miles in height.

Imagine the daunting task of sifting through these publications to find evidence that patients, clinicians, and others could use to make better-informed healthcare decisions and improve healthcare delivery and outcomes. One tool used to display where the evidence is—and where it is not—is evidence maps.

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The latest PCORI evidence map is a novel repository of studies that address social needs interventions to improve health outcomes. The visualization and corresponding scoping review summarize evidence on social needs interventions that assessed impacts on health and healthcare utilization outcomes, including examining study quality and evidence of benefit.

About Social Needs

Social needs refer to adverse social conditions associated with poor health and are identified or prioritized by the patient. Social needs include food insecurity, transportation, housing instability and quality, interpersonal violence, education, financial strain, employment, and social isolation. Other factors center on access to legal services, childcare, early childhood education and development, and health care and primary care. Interventions aimed at addressing patients’ social needs not only help meet these needs but also have the potential to improve health outcomes—the focus of this evidence product.

The evidence map was designed in collaboration with social needs experts from the Social Interventions Research and Evaluation Network (SIREN) and complements the SIREN Evidence & Resource Library.

Trends

The evidence map visualizes 157 of studies on social needs interventions that evaluated health outcomes as of November 2021. The evidence map was first published in August 2021, with a first update to the data completed in February 2022.

• What social needs have been studied? Nearly three-fourths of all studies addressed more than one social need, with healthcare services access and quality (113 studies) the most frequently studied, followed by housing stability and quality (95 studies). Less-well-addressed needs, such as social isolation, childcare assistance, and financial strain, will require heightened attention, particularly in the context of COVID-19.
• What types of outcomes have been studied? Most commonly, studies reported healthcare utilization outcomes (108 studies). Healthcare utilization outcomes were largely high-resource events, such as emergency department visits or inpatient admissions, while lower-resource outcomes like missed appointments or immunizations were less frequently reported. Studies also commonly reported health outcomes (84 studies). Many of these studies evaluated mental health status, but other health outcomes included quality of life, functional status, and less frequently morbidity and mortality. Least commonly reported were behavioral health outcomes (42 studies) such as substance use.
• What populations have been studied? Very few studies recruited children and adolescents, only older adults, immigrants, pregnant persons, and individuals identifying as sexual and gender minorities. In nearly one-third of studies, most participants identified as Black, while hardly any studies reported a majority of participants identifying as Asian/Pacific Islander (one study) or American Indian/Alaska Native (one study). Future studies should assess how to best address social needs in these communities.
• What is the quality of the evidence? While reviewers found that the evidence base was rapidly expanding, they noted more recent studies were composed of a higher proportion of nonrandomized studies, indicating the need for more rigorous study designs like randomized controlled trials.

For a comprehensive assessment of trends in the evidence, see the full scoping review report and an additional report outlining findings from the first data update. To view data on all studies included in this evidence map, please see the link for the downloadable spreadsheet on the evidence map landing page.

How Can This Evidence Map Be Used and Why Is It Important?

The Social Needs Interventions to Improve Health Outcomes evidence map paves the way for accelerated research in health equity and disparities, supporting PCORI’s new National Priority for Health, Achieving Health Equity. Research on social needs interventions is accumulating rapidly, and the breadth and complexity of the literature can make it challenging to identify studies of interest. This interactive evidence map seeks to curate and provide easy access to studies of social needs interventions that report health outcomes across the expanding body of research.

The evidence map is intended to serve as a resource for a broad audience of stakeholders with interest in research, programs, and policy addressing social needs. As such, the map can be used as a starting point for viewers interested in exploring their own research questions or when thinking about a formal synthesis of the literature. For example, PCORI has sponsored a Rapid Review of Health Equity and Social Needs Interventions, which will use the scoping review and evidence visualization as the foundation for its own synthesis. In addition to supporting future evidence synthesis products, the evidence map may also serve to inform future PCORI funding opportunities.

We intend regular updates with the latest social needs literature in support of PCORI’s new national priority. The next update is planned for Summer 2022.

As always, we appreciate your thoughts and suggestions on this latest evidence synthesis product. Please visit a brief survey to provide your feedback.