Social Determinants of Health, Goals and Outcomes in High-Risk Children with Type 1 Diabetes

Background: Chronic heart failure (CHF) affects more than 5 million Americans and accounts for approximately 1 million hospitalizations annually. Readmission in CHF patients is associated with higher mortality and consumes a significant portion of hospital resources. Readmission rates may be higher when socioeconomic factors limit medication compliance and follow-up. In light of the high prevalence of CHF and the penalties associated with readmission rates, our study aims to identify factors that place our veterans with CHF at higher risk for readmission and in so doing, develop a profile for patients with a high risk of readmission that will benefit from focused intervention. Our goal is to use the information acquired in this study to reduce CHF readmission in the Miami VAMC by 10% over a 12-month period. Methods: This is an ongoing retrospective study conducted at the Miami VAMC. The Strategic Analysis for Improvement and Learning (SAIL) report was used to identify patients with CHF who were admitted to the Miami VAMC over fiscal year 2019 (FY19), the period from September 2018 to August 2019. Data was collected on various clinical baseline characteristics and social determinants of health from the patients' electronic health records for those admitted as well as for those with recurrent admissions within FY19. Using a previously validated questionnaire, identified patients will undergo further interview, in person or by phone, to identify social factors that may place them at higher risk for readmission. Results/Anticipated Results: A total of 185 patients were admitted during FY19 and of these, 38 had recurrent admissions. The mean time to readmission was 82 days. 76% of the patients readmitted had heart failure with reduced ejection fraction. Multiple co-morbidities were seen in the readmitted group, the commonest being hypertension (82%), diabetes (63%) and chronic kidney disease (39%). Thirty percent of those readmitted had a history of illicit drug use compared to 26% of those who were not readmitted. This population was also found to have multiple psychiatric co-morbidities - depression, anxiety and post-traumatic stress disorder. The odds of having one or more readmission within 12 months was 25% greater in those with psychiatric illness than in those without. Conclusion: Preliminary data analysis shows that psycho-social factors may play a role in recurrent admission in CHF patients. Further data will be collected to determine the impact of factors such as housing, education level and income on readmission risk so that patients at high risk can be identified and targeted with improved care co-ordination services to reduce this risk. As a unified health system, the VAMC is uniquely equipped with resources to address these disparities.

Download Full-text

Increasing HbA1c levels predict the onset of type 1 diabetes in high-risk children

Nature Clinical Practice Endocrinology &#38 Metabolism ◽

10.1038/ncpendmet0378 ◽

2007 ◽

Vol 3 (2) ◽

pp. 76-76

Keyword(s):

Type 1 Diabetes ◽

High Risk ◽

Hba1c Levels ◽

High Risk Children

Download Full-text

35. Pneumococcal Vaccination in High-Risk Adults: An Initial Analysis Incorporating Social Determinants of Health

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.080 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S41-S42

Author(s):

Justin Gatwood ◽

Chi-Yang Chiu ◽

Sohul A Shuvo ◽

Sujith Ramachandran ◽

Kenneth Hohmeier ◽

...

Keyword(s):

High Risk ◽

Social Determinants Of Health ◽

Invasive Pneumococcal Disease ◽

Social Determinants ◽

Pneumococcal Disease ◽

Pneumococcal Vaccination ◽

Determinants Of Health ◽

Outpatient Clinics ◽

Research Support ◽

Seeking Behavior

Abstract Background Despite CDC’s recommendation, vaccination rates for adults at high-risk of invasive pneumococcal disease are below HealthyPeople 2020 goals. Comparatively little is known about influencers on vaccine-seeking behavior in this population, particularly related to social determinants of health. To address this gap, this study assessed the potential influence of select social determinants on uptake of and time to pneumococcal vaccination among a high-risk, insured US population. Methods Using the MarketScan commercial claims databases between 2013–2016, adult patients (aged 18–64 years) were followed from their first diagnosis for a condition deeming them high-risk for invasive pneumococcal disease through one year following the diagnosis and observed for pneumococcal vaccination in outpatient clinics and pharmacies. Publicly-available data on select social determinants of health were incorporated into analyses, guided by the WHO vaccine hesitancy matrix. Logistic regression determined predictors of vaccination and a generalized linear model compared days to being vaccinated while controlling for baseline demographic and clinical characteristics. Results A total of 173,712 patients were analyzed of which 25.3% were vaccinated against invasive pneumococcal disease within the first year of being deemed high risk, nearly all of which (98.5%) were received in outpatient clinics. The odds of vaccination were higher in urban areas (OR: 1.18; 95% CI: 1.144–1.223), areas of higher health literacy (OR: 1.02; 95% CI: 1.019–1.025), and more liberal-voting communities (OR: 1.5; 95% CI: 1.23–1.88). Conversely, the odds of vaccination were particularly low in areas of higher poverty (OR: 0.14; 95% CI: 0.068–0.304) and with more limited Internet access (OR: 0.14; 95% CI: 0.062–0.305) as well as among adults who did not also get a seasonal influenza vaccine (OR: 0.05; 95% CI: 0.048–0.052). Time to vaccination was longer in rural areas (B=8.3, p< 0.0001) and communities with less Internet access (B=75.6, p< 0.001). Conclusion Results suggest that some social determinants may be influencing pneumococcal vaccine-seeking behavior among those deemed high-risk. A more formal framework must be assessed to determine the full impact of these factors across vaccines recommended in adults. Disclosures Justin Gatwood, PhD,MPH, AstraZeneca (Grant/Research Support)GlaxoSmithKline (Grant/Research Support)Merck & Co. (Grant/Research Support) Tracy Hagemann, PharmD, GSK (Grant/Research Support)Merck (Grant/Research Support)

Download Full-text