Racial Disparities in Postoperative Length-of-Stay Persist for Minority Patients Even After Adjustment for Social Determinants of Health

2016 ◽  
Vol 223 (4) ◽  
pp. e173
Author(s):  
Tyler S. Wahl ◽  
Allison A. Gullick ◽  
Aerin J. DeRussy ◽  
Melanie S. Morris ◽  
Daniel I. Chu
Keyword(s):  
Length Of Stay ◽  
Racial Disparities ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Postoperative Length

The influence of social determinants of health on single-level anterior cervical discectomy and fusion outcomes

2021 ◽  
pp. 1-6
Keyword(s):  
Length Of Stay ◽  
Postoperative Complication ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Revision Surgery ◽  
Determinants Of Health ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Cervical Discectomy ◽  
Single Level

OBJECTIVE Methods of reducing complications in individuals electing to undergo anterior cervical discectomy and fusion (ACDF) rely upon understanding at-risk patient populations, among other factors. This study aims to investigate the interplay between social determinants of health (SDOH) and postoperative complication rates, length of stay, revision surgery, and rates of postoperative readmission at 30 and 90 days in individuals electing to have single-level ACDF. METHODS Using MARINER30, a database that contains claims information from all payers, patients were identified who underwent single-level ACDF between 2010 and 2019. Identification of patients experiencing disparities in 1 of 6 categories of SDOH was completed using ICD-9 and ICD-10 (International Classifications of Diseases, Ninth and Tenth Revisions) codes. The population was propensity matched into 2 cohorts based on comorbidity status: those with SDOH versus those without. RESULTS A total of 10,030 patients were analyzed; there were 5015 (50.0%) in each cohort. The rates of any postoperative complication (12.0% vs 4.6%, p < 0.001); pseudarthrosis (3.4% vs 2.6%, p = 0.017); instrumentation removal (1.8% vs 1.2%, p = 0.033); length of stay (2.54 ± 5.9 days vs 2.08 ± 5.07 days, p < 0.001 [mean ± SD]); and revision surgery (9.7% vs 4.2%, p < 0.001) were higher in the SDOH group compared to patients without SDOH, respectively. Patients with any SDOH had higher odds of perioperative complications (OR 2.8, 95% CI 2.43–3.33), pseudarthrosis (OR 1.3, 95% CI 1.06–1.68), revision surgery (OR 2.4, 95% CI 2.04–2.85), and instrumentation removal (OR 1.4, 95% CI 1.04–2.00). CONCLUSIONS In patients who underwent single-level ACDF, there is an association between SDOH and higher complication rates, longer stay, increased need for instrumentation removal, and likelihood of revision surgery.

scholarly journals 516: SOCIAL DETERMINANTS OF HEALTH IMPACT HOSPITAL LENGTH OF STAY FOR CHILDREN WITH SEVERE SEPSIS

2021 ◽  
Vol 50 (1) ◽  
pp. 249-249
Author(s):  
Alina West ◽  
Hunter Hamilton ◽  
Nariman Ammar ◽  
Fatma Gunturkun ◽  
Tamekia Jones ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Length Of Stay ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Health Impact ◽  
Hospital Length ◽  
Determinants Of Health ◽  
Hospital Length Of Stay

Leveraging social determinants of health to reduce hospital length of stay: A pilot quality improvement project to address inpatient cancer patients' barriers during the COVID 19 pandemic.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 233-233
Author(s):  
Sailaja Kamaraju ◽  
Dave Atkinson ◽  
Thomas Wetzel ◽  
Tamiah Wright ◽  
John A. Charlson ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Length Of Stay ◽  
Social Determinants Of Health ◽  
Cancer Patients ◽  
Social Determinants ◽  
Solid Tumor ◽  
Determinants Of Health ◽  
Patient Specific ◽  
Discharge Process ◽  
Oncology Patients

233 Background: Prior reports from our institution demonstrated high rates of racial segregation, unfavorable social determinants of health (SDoH) in Milwaukee, WI, and statewide reports of inferior outcomes for cancer patients from minority communities. At the Medical College of Wisconsin's Cancer Center (Milwaukee, WI), during the first through last quarters of 2018-2019, cancer patients from the low socioeconomic status (SES) communities who were hospitalized to inpatient oncology units had an average length of stay (LOS) of 7.2 days compared to 5.6 days for high SES group. Under the auspices of the American Society of Clinical Oncology's Quality Training Program (QTP) initiative, we aimed to reduce the hospital LOS by 10% or less by May 2021 for inpatient oncology teams. Methods: A multidisciplinary team collaboration between the inpatient and outpatient providers was developed during this QI initiative. We examined LOS index data, payer types, and other diagnostic criteria for the oncology inpatient solid tumor service and two comparator services (bone marrow transplant, BMT; internal medicine). We generated workflow, a cause-and-effect diagram, and a Pareto diagram to determine the relevant factors associated with longer hospital LOS. Institution-wide implementation of the SDH screen project was launched to evaluate and address specific barriers to SDoH to expedite a safe discharge process during the pandemic. Results: Through one test of change (Plan-Do-Study-Act cycles 1, 2 &3), we identified the problem of extended LOS and patient-related barriers to discharge during this QI initiative. Compared to the baseline LOS, after the launch of the SDoH screen project, there was a 6.5% decrease in the inpatient average LOS for oncology patients (7.89 to 7.40days, p = 0.004),10.7% for BMT (15.96 days to14.26, p = 0.166), and 2.4% for Internal Medicine (4.61 to 4.50 to days, p = 0.131). There was a 10.0% decrease in LOS (8.07 to 7.26 days, p = < 0.001) for the three specialties combined. With collaboration from inpatient and outpatient providers, appropriate referrals were generated to address patient-specific SDH before discharge (i.e., transportation coordination, nutritional and physical therapy referrals, social worker assistance with food, and housing insecurities). Conclusions: In this pilot project, implementing SDoH screening-based-care delivery at the time of inpatient admission demonstrated a slight improvement in LOS for solid tumor oncology patients and provided timely referrals, opportunities to engage and explore the discharge facilities early on during the COVID 19 pandemic. With this preliminary data, we plan to continue to expand our efforts through a systemwide implementation of this SDoH survey both in the inpatient and outpatient settings to address cancer inequities.

scholarly journals 463. Factors of Social Determinants of Health Associated with Length of Stay in COVID-19 Patients with Multimorbidity in Southwest Georgia, United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S333-S334
Author(s):  
Sahand Golpayegany ◽  
Sharmon P Osae ◽  
Geren Thomas ◽  
Henry N Young ◽  
Andrés F Henao Martínez ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Built Environment ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Healthcare Access ◽  
Community Context ◽  
Determinants Of Health ◽  
Secondary Outcome ◽  
Economic Stability ◽  
Access And Quality

Abstract Background Previous studies have observed that multimorbidity, defined as two or more comorbidities, is associated with longer lengths of stay (LOS) and higher mortality in patients with COVID-19. In addition, inequality in social determinants of health (SDOH), dictated by economic stability, education access and quality, healthcare access and quality, neighborhoods and built environment, and social and community context have only added to disparities in morbidity and mortality associated with COVID-19. However, the relationship between SDOH and LOS in COVID-19 patients with multimorbidity is poorly characterized. Analyzing the effect SDOH have on LOS can help identify patients at high risk for prolonged hospitalization and allow prioritization of treatment and supportive measures to promote safe and expeditious discharge. Methods This study was a multicenter, retrospective analysis of adult patients with multimorbidity who were hospitalized with COVID-19. The primary outcome was to determine the LOS in these patients. The secondary outcome was to evaluate the role that SDOH play in LOS. Poisson regression analyses were performed to examine associations between individual SDOH and LOS. Results A total of 370 patients were included with a median age of 65 years (IQR 55-74), of which 57% were female and 77% were African American. Median Charlson Comorbidity Index was 4 (IQR 2-6) with hypertension (77%) and diabetes (51%) being the most common, while in-hospital mortality was 23%. Overall, median length of stay was 7 days (IQR 4-13). White race (-0.16, 95% CI -0.27 to -0.05, p=0.003) and residence in a single-family home (-0.28, 95% CI -0.38 to -0.17, p&lt; 0.001) or nursing home/long term care facility (-0.36, 95% CI -0.51 to -0.21, p&lt; 0.001) were associated with decreased LOS, while Medicare (0.24, 95% CI 0.10 to 0.38, p=0.001) and part-time (0.35, 95% CI 0.13 to 0.57, p=0.002) or full-time (0.25, 95% CI 0.12 to 0.38, p&lt; 0.001) employment were associated with increased LOS. Conclusion Based on our results, differences in SDOH, including economic stability, neighborhood and built environment, social and community context, as well as healthcare access and quality, have observable effects on COVID-19 patient LOS in the hospital. Disclosures All Authors: No reported disclosures

scholarly journals Social Determinants of Health and Disparities in Linkage to Care Among Newly Diagnosed HIV Cases – South Carolina, 2009–2011

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S419-S420 ◽  
Author(s):  
Harmeet Gill ◽  
Oluwole Babatunde ◽  
Sharon Weissman
Keyword(s):  
South Carolina ◽  
Racial Disparities ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Census Tract ◽  
Linkage To Care ◽  
Male Gender ◽  
Determinants Of Health ◽  
Newly Diagnosed ◽  
Hiv Diagnosis

Abstract Background Key to improved HIV outcomes is early diagnosis, linkage to care (LTC), retention in care (RIC) and viral load (VL) suppression. As treatment for HIV has become more effective, the gap in racial disparities has widened for LTC, RIC and VL. Social determinants of health (SDH) are conditions such as poverty level, income, education, employment that are responsible for most health inequities. SDH are drivers of disparities in HIV prevalence. The objective of this study is to evaluate the impact of SDH on racial disparities on time to LTC for newly diagnosed HIV infected individuals in South Carolina (SC). Methods Data was obtained from the SC enhanced HIV/AIDS Reporting System. Analysis includes individuals diagnosed with HIV in SC from 2009–2011. LTC was calculated as the time from HIV diagnosis to first CD4 or VL test. Early LTC was defined as within 30 days. Late LTC was &gt;30 to 365 days. Individuals not LTC by 365 days were considered to have never been linked to care (NLTC). Census tract data was used to determine SHD (poverty, education, income, and unemployment) based on residence at the time of HIV diagnosis. Descriptive analysis was performed on data from newly infected individuals. Factors potentially associated with late LTC and NLTC including patient demographics, behavioral risk, residence at diagnosis and SDH were investigated. Results From 2009–2011, 2151 individuals were newly diagnosed with HIV. Of these 1636 (76.1%) were LTC early, 285 (13.2%) were LTC late and 230 (10.7%) were NLTC. NLTC was associated with male gender, lower initial CD4 count, and earlier stage of HIV at time of diagnoses (P &lt;0.01). In multivariable analysis early HIV stage at HIV diagnosis (aOR: 1.82; 95% CI 1.3, 2.5) and living in census tracts with lower income (aOR 0.65; 95% CI 0.44, 0.97) are associated with late LTC. Male gender (aOR 2.66; 95% CI 1.49, 4.76) unknown HIV risk group (aOR 2.03; 95% CI 1.11, 2.74) and early HIV stage at diagnosis (aOR 4.59; 95% CI 2.33, 9.04) are associated with NLTC. Conclusion In SC, almost ¼ of newly diagnosed HIV infected individuals from 2009–2011 were LTC late or NLTC. SDH were not associated with late LTC or NLTC. Living in a low income census tract was associated with a lower risk for late LTC, possible because of access to Ryan White Services. Male gender and earlier HIV stage were factors with greatest association with late LTC and NLTC. Disclosures All authors: No reported disclosures.

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