scholarly journals Toward Understanding the Value of Missing Social Determinants of Health Data in Care Transition Planning

2020 ◽  
Vol 11 (04) ◽  
pp. 556-563
Author(s):  
Sue S. Feldman ◽  
Ganisher Davlyatov ◽  
Allyson G. Hall
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Transition Planning ◽  
Program Planning ◽  
Relative Weight ◽  
Determinants Of Health ◽  
Care Transition ◽  
Data Set ◽  
Independent Variables ◽  
Weight Analysis

Abstract Background Social determinants of health play an important role in the likelihood of readmission and therefore should be considered in care transition planning. Unfortunately, some social determinants that can be of value to care transition planners are missing in the electronic health record. Rather than trying to understand the value of data that are missing, decision makers often exclude these data. This exclusion can lead to failure to design appropriate care transition programs, leading to readmissions. Objectives This article examines the value of missing social determinants data to emergency department (ED) revisits, and subsequent readmissions. Methods A deidentified data set of 123,697 people (18+ years), with at least one ED visit in 2017 at the University of Alabama at Birmingham Medical Center was used. The dependent variable was all-cause 30-day revisits (yes/no), while the independent variables were missing/nonmissing status of the social determinants of health measures. Logistic regression was used to test the relationship between likelihood of revisits and social determinants of health variables. Moreover, relative weight analysis was used to identify relative importance of the independent variables. Results Twelve social determinants were found to be most often missing. Of those 12, only “lives with” (alone or with family/friends) had higher odds of ED revisits. However, relative logistic weight analysis suggested that “pain score” and “activities of daily living” (ADL) accounted for almost 50% of the relevance for ED revisits when compared among all 12 variables. Conclusion In the process of care transition planning, data that are documented are factored into the care transition plan. One of the most common challenges in health services practice is to understand the value of missing data in effective program planning. This study suggests that the data that are not documented (i.e., missing) could play an important role in care transition planning as a mechanism to reduce ED revisits and eventual readmission rates.

scholarly journals Harnessing multiple data sources to good program planning for Rural US Veterans

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Teresa Hudson ◽  
Alyson Littman ◽  
Mary Bollinger ◽  
Edwin Wong ◽  
Karen Drummond ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Geographical Variation ◽  
Program Planning ◽  
The United States ◽  
Determinants Of Health ◽  
Data Sources ◽  
Wide Range ◽  
Cold Spots ◽  
Us Veterans

ABSTRACT ObjectivesIdentify geographic variations in health and healthcare among US Veterans living in rural areas and understand the relationships between social determinants of health and these variations. ApproachData from 11 data sources will be leveraged to create the US Veterans Rural Health Atlas and chart book (VeRHA) patterned after the Dartmouth Atlas, The VeHRA will provide an interactive map and chart book can be used to efficiently examine a wide range of factors related to health and healthcare of rural Veterans. The analyses will assess the relationships between socioeconomic, cultural and environmental factors and geographical variation in access, utilization, quality, satisfaction and outcomes. Semi-structured qualitative interviews will be used to elicit the perspective of Veterans not using VA care and to identify non-governmental organizations who provide care and support to US Veterans. The project will also identify community, state, and federal entities with which ORH could form strategic partnerships to improve health and healthcare for Rural Veterans. Initially, three maps will be created for Veterans who are not enrolled in care, those enrolled but not using care and those enrolled and using care. Areas where many Veterans live and use VA healthcare will be identified as “hot spots” while areas where Veterans live but do not use care will be identified as “cold spots”. Metrics for determining “hot and cold spots” will include measures of temporal and geographic access as well as measures of quality of care. We will first calculate raw rates for outcomes across geographic areas (census tract, county, and market/regions) Exploratory Spatial Data Analysis (ESDA) will be conducted by mapping the geographic distribution of key measures and then calculate the values of the local and global Moran’s I measures of spatial autocorrelation. The relationship between social determinants of health and geographical variation in access, needs, utilization, quality, satisfaction, and outcomes for rural Veterans will be assessed, focused primarily on the “cold spots” – areas of greatest need. ResultsThe project is a work in progress with initial maps created showing the density of Veterans across the United States. More extensive results will be available for presentation. ConclusionThis work demonstrates the value of using large data sets to guide development of policies and programs at a national level.

Addressing the Social Determinants of Health

2019 ◽  
Vol 101 (4) ◽  
pp. 357-395 ◽  
Author(s):  
Saty Satya-Murti ◽  
Jennifer Gutierrez
Keyword(s):  
Twentieth Century ◽  
Los Angeles ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Activism ◽  
Determinants Of Health ◽  
Medical Attention ◽  
Community Center ◽  
Early Twentieth Century ◽  
The Social

The Los Angeles Plaza Community Center (PCC), an early twentieth-century Los Angeles community center and clinic, published El Mexicano, a quarterly newsletter, from 1913 to 1925. The newsletter’s reports reveal how the PCC combined walk-in medical visits with broader efforts to address the overall wellness of its attendees. Available records, some with occasional clinical details, reveal the general spectrum of illnesses treated over a twelve-year span. Placed in today’s context, the medical care given at this center was simple and minimal. The social support it provided, however, was multifaceted. The center’s caring extended beyond providing medical attention to helping with education, nutrition, employment, transportation, and moral support. Thus, the social determinants of health (SDH), a prominent concern of present-day public health, was a concept already realized and practiced by these early twentieth-century Los Angeles Plaza community leaders. Such practices, although not yet nominally identified as SDH, had their beginnings in the late nineteenth- and early twentieth-century social activism movement aiming to mitigate the social ills and inequities of emerging industrial nations. The PCC was one of the pioneers in this effort. Its concerns and successes in this area were sophisticated enough to be comparable to our current intentions and aspirations.

648-P: Do Social Determinants of Health (SDoH) Influence Participant Outcomes of Those Enrolled in the Diabetes Prevention Program, Montana 2015-2018?

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 648-P
Author(s):  
DOROTA CARPENEDO ◽  
SONJA TYSK ◽  
MELISSA HOUSE ◽  
JESSIE FERNANDES ◽  
MARCI K. BUTCHER ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Determinants Of Health ◽  
Participant Outcomes

Social determinants of health affecting treatment of pediatric brain tumors

2019 ◽  
Vol 24 (2) ◽  
pp. 159-165
Author(s):  
Jillian M. Berkman ◽  
Jonathan Dallas ◽  
Jaims Lim ◽  
Ritwik Bhatia ◽  
Amber Gaulden ◽  
...  
Keyword(s):  
African American ◽  
Health Disparities ◽  
Brain Tumors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Cns Tumor ◽  
Initial Symptoms ◽  
Caucasian Patients

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.

Health Disparities and the Social Determinants of Health: Ethical and Social Justice Issues

2019 ◽  
pp. 265-276
Author(s):  
Sridhar Venkatapuram
Keyword(s):  
Health Disparities ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Global Justice ◽  
Social Epidemiology ◽  
Social Groups ◽  
Determinants Of Health ◽  
Housing Conditions ◽  
Early Infant ◽  
The Social

The term health disparities (also called health inequalities) refers to the differences in health outcomes and related events across individuals and social groups. Social determinants of health, meanwhile, refers to certain types of causes of ill health in individuals, including lack of early infant care and stimulation, lack of safe and secure employment, poor housing conditions, discrimination, lack of self-respect, poor personal relationships, low community cohesion, and income inequality. These social determinants stand in contrast to others, such as individual biology, behaviors, and proximate exposures to harmful agents. This chapter presents some of the revolutionary findings of social epidemiology and the science of social determinants of health, and shows how health disparities and social determinants raise profound questions in public health ethics and social/global justice philosophy.

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