Organizational Characteristics Associated with Addressing Community Social Determinants of Health in U.S. Hospitals: A National Perspective

Background: With so much emphasis currently on Social Determinants of Health (SDOH), we examined the characteristics of U.S. hospitals making commitments to SDOH and engagement with community social determinant programs and activities (CSDPAs). Methods: This cross-sectional study used the 2021 American Hospital Association (AHA) Annual Survey with a total of 5992 hospitals included. The dependent variables were the community social determinants composite score, community partnership composite score, and the use of CSPDAs to assess outcomes. Results: Hospitals most influenced by payment policies and regulations were most likely to engage in CSDPAs. Hospitals with ACOs implement 3.38 more CSPDAs and hospitals participating in bundled payments are 41% more likely to address SDOH (OR = 1.41, 95% CI = [1.14, 1.75]). Hospitals in competitive markets and hospitals with ≥400 beds are positively associated with both SDOH activities and partnerships. Teaching hospitals, not-for-profit hospitals, Medicare mix, and rural hospitals, as well as market competition, were positively associated with higher levels of CSDPAs. Conclusion: Reimbursement requirements, organizational size and resources, and external pressures were shown as drivers for hospitals to implement CSDPAs.