PCORI Evidence Map: Social needs interventions to improve health outcomes: Review and evidence map

Why was this review performed? Social needs refer to adverse social conditions that are associated with poor health and are identified or prioritized based on patients’ perspectives. Addressing these social needs could help improve health outcomes and reduce disparities. Related interventions vary greatly and may be difficult to find in the literature. This review and its accompanying evidence map will help users find relevant studies and conduct customized searches for an array of study and population characteristics, social needs, health outcomes, and study quality.

What are the findings? We identified 139 studies of social needs interventions that reported on behavioral outcomes, health outcomes, or healthcare utilization outcomes. Nearly half (42%) of eligible studies were published in the past 5 years (2016-2021). As research accumulates, the total number of randomized controlled trials has increased, but observational single-arm studies have become a larger proportion of the evidence base. Of studies, 75% addressed multiple social needs or a combination of social and medical needs. Included studies most commonly cited healthcare services access and quality as well as housing stability and quality as social needs addressed. Most recruited participants in 34% of the studies were black and in 15% of studies were Hispanic or Latino. A total of 18 studies focused on children and adolescents, 5 focused on older adults, 6 reported on the proportion of immigrants, 4 required participants to be pregnant, and none reported on sexual and gender minority communities. Commonly reported healthcare utilization outcomes included resource-intensive events such as emergency department visits and inpatient admissions. Most studies reported positive or mixed effects; a minority reported negative outcomes. More commonly reported outcomes were more likely to present a mixed picture, whereas less commonly reported outcomes generally favored the intervention.

What do the findings imply? Future research priorities should include more rigorous designs to address confounding and attrition. Evidence gaps persist in understanding whether these interventions have differential effects on racially and ethnically diverse populations and on whether the interventions are impactful for adolescents, children, older adults, pregnant persons, immigrants, and sexual and gender minority communities. Findings from unpublished studies, regardless of direction of effect, should be made available through publications or study repositories; these results are critical to understanding how to best to address patients’ social needs.

See accompanying PCORI Evidence Map here.