Despite compelling evidence linking social needs to health outcomes, there is a limited assess- ment of hospital- and health-system-led interventions to address social needs. To address this literature gap, this study examines hospital and health systems’ reports of population health outcomes associated with social needs programming. Using data primarily from the 2021 American Hospital Association’s Annual Hospital Survey, the study examines whether hospital- and health-system-led efforts to address housing, hunger, utility needs, interpersonal violence, transportation, employment, education, social isolation, and health behaviors are associated with hospital reports of improved health outcomes, reduced health care utilization, lower health care costs, and improved community health status. Four separate multivariable logistic regression models are fitted for each outcome. Education and health behavior programs or strategies were positively associated with 3 of the 4 outcomes examined, while programs or strategies targeting employment and housing were each associated with 1 outcome. Efforts addressing interpersonal violence were linked to reduced health care utilization but were negatively associated with improved health outcomes. Overall, the results demonstrate both the promise and the variability of social needs interventions across health care settings, reinforcing an emerging consensus that these interventions may not be uniformly effective.
Adults with part-year or year-round uninsurance are less likely to receive recommended preventive services. Sex differences in preventive care use have been documented, but it remains unclear whether sex moderates the association between insurance coverage disruptions and preventive care use. The current study analyzed data from 37,659 adults aged 18–64 in the 2019 and 2023 National Health Interview Survey. Insurance coverage over the past 12 months was categorized as continuous private, continuous public, coverage gap, or continuously uninsured. Outcomes included blood pressure and cholesterol tests, having a usual source of care, dental and eye exams, preventive care visits, and unmet need for medical care. Each outcome was analyzed using multivariate logistic regression interacting insurance category with sex. Continuously uninsured adults or adults with coverage gaps in the past 12 months reported lower preventive care utilization and higher unmet need for medical care than adults who were continuously insured. Relationships between part-year or year-round uninsurance and preventive care generally did not vary by sex. Female respondents with continuous public insurance were less likely to report a usual source of care but had lower unmet needs for medical care than female respondents with continuous private insurance. Health insurance coverage disruptions are associated with reduced use of preventive services regardless of sex. Policies promoting continuity of health insurance coverage may improve uptake of preventive services and reduce unmet needs for medical care.
To advance local health equity, a large urban fire department’s Mobile Integrated Healthcare (MIH) Unit worked with a Chicago-based health care organization to refer patients in “medical homes” to a MIH program. Medical home coordinators referred individuals to Community Paramedics (CPs) in the MIH Unit for program enrollment with a 4-visit model in 4 clinical pathways (hypertension, diabetes, asthma/Chronic Obstructive Pulmonary Disease [COPD], and heart failure). A total of 911 utilization of ambulance transportation, emergency department (ED) visits, and inpatient hospitalizations before and after intervention were measured to gauge program impact. A postgraduation survey was distributed to participants. From November 2022 to March 2025, 68 referred individuals completed the program and graduated with a total of 321 in-person visits by CPs. Data were gathered for 6 months before program enrollment and 6 months post-intervention. The most common clinical pathway for graduated patients was hypertension (75%), diabetes (57%), asthma/COPD (47%), and heart failure (41%). Among graduated patients, there was a 43% decrease in 911 ambulance transports, a 46% decrease in ED utilization, and a 42% decrease in hospital admissions. The postgraduation survey was completed by 53% of program graduates; 81% reported symptom improvement, 58% indicated an improved relationship with their primary care clinic, and 74% agreed that CPs improved their overall health care experience. Creating a partnership between a patient’s primary care medical home and a large urban fire department’s MIH program is a successful strategy for decreasing 911 ambulance transports, ED utilization, and inpatient hospital admissions for individuals at risk for poor health outcomes.
Stroke remains a leading cause of death and disability in Mississippi, accounting for approximately 1,844 deaths annually and substantial health care costs. Persistent geographical and racial disparities, driven by SDOH, contribute to an unequal burden. The publicly available CDC PLACES dataset and the CDC/ATSDR Social Vulnerability Index (SVI) provide opportunities to examine geographic disparities and identify communities at the greatest risk. An ecological analysis was conducted across 870 Mississippi census tracts (∼2.28 million adults) using CDC PLACES 2022 stroke prevalence estimates and SVI 2022 data across all four thematic domains. Stroke prevalence was categorized as low (0.7–3.8%, n = 225), moderate (3.9–5.9%, n = 433), or high (6.0–11.6%, n = 212). Spearman’s rank correlation and bivariate choropleth mapping were used to assess associations between stroke burden and social vulnerability and their geographic concordance. An estimated 109,348 Mississippi adults have experienced a stroke, with 33,167 (30%) residing in highly vulnerable tracts. Stroke prevalence correlated strongly with overall SVI (ρ = 0.74), socioeconomic status (ρ = 0.75), and minority status (ρ = 0.60; all P < 0.0001). High-prevalence tracts showed extreme social vulnerability (median overall SVI = 0.82; socioeconomic SVI = 0.85), substantially higher poverty (50% vs. 15%), and predominantly minority populations (78% vs. 27%) compared with low-prevalence tracts. High-burden clusters were concentrated in the Mississippi Delta and central corridor, while Gulf Coast tracts showed comparatively lower prevalence. Stroke prevalence and social vulnerability are strongly and spatially co-patterned across Mississippi census tracts. Routinely updated CDC datasets provide actionable tools for identifying high-risk communities and guiding equity-focused stroke prevention that addresses social determinants alongside clinical risk factors.
