Influence of Social Determinants of Health on Heart Failure Outcomes: A Systematic Review.

Background Prior research suggests an association between clinical outcomes in heart failure (HF) and social determinants of health (SDoH). Because providers should identify and address SDoH in care delivery, we evaluated how SDoH have been defined, measured, and evaluated in studies that examine HF outcomes. Methods and Results Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, databases were searched for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH on outcomes. Selected articles were assessed for quality using a validated rating scheme. We identified 1373 unique articles for screening; 104 were selected for full-text review, and 59 met the inclusion criteria, including retrospective and prospective cohort, cross-sectional, and intervention studies. The majority examined readmissions and hospitalizations (k=33), mortality or survival (k=29), and success of medical devices and transplantation (k=8). SDoH examined most commonly included race, ethnicity, age, sex, socioeconomic status, and education or health literacy. Studies used a range of 1 to 9 SDoH as primary independent variables and 0 to 7 SDoH as controls. Multiple data sources were employed and frequently were electronic medical records linked with national surveys and disease registries. The effects of SDoH on HF outcomes were inconsistent because of the heterogeneity of data sources and SDoH constructs. Conclusions Our systematic review reveals shortcomings in measurement and deployment of SDoH variables in HF care. Validated measures need to be prospectively and intentionally collected to facilitate appropriate analysis, reporting, and replication of data across studies and inform the design of appropriate, evidence-based interventions that can ameliorate significant HF morbidity and societal costs.

Improving Resilience and Combating Burnout in US Army Health Care Teams.

INTRODUCTION: In 2015, the Army Office of the Surgeon General adapted a Veterans Health Administration course for health care teams to implement holistic health practices to improve the resiliency of health care teams and patient care. The Army course Move to Health was piloted in health care teams at 8 military clinics. During the 20-hour course, health care teams learned techniques to improve their resiliency and created action plans to incorporate holistic health into the workplace, a known factor in decreasing burnout. METHODS: A process and outcome evaluation of this course was conducted using a within-group design. Surveys were administered to health care teams at precourse and 2-month follow-up, and 186 participants completed both surveys. RESULTS: Burnout among team members did not significantly change from precourse (52%, n = 96) to follow-up (48%, n = 90). At follow-up, team members described using resiliency building strategies for self-care, significantly improved their self-efficacy to treat patients holistically in the patient-centered care home model, and reported increased satisfaction with patient centered care home (all are p < 0.01). However, 70% (n = 131) of team members reported that they had not completed action plan implementation and did not report improved job satisfaction. DISCUSSION: Informed by the literature, Move to Health combines an individual resiliency intervention with organizational change, facilitating action plans to mitigate burnout. This manuscript explores potential reasons for why burnout did not significantly change within the 2-month period following the intervention. Reducing burnout among health care teams is vital to ensure that optimal health care is provided to the military and its beneficiaries.