scholarly journals HOME CARE NURSES CLAIM MEDICARE IGNORES SOCIAL DETERMINANTS OF HEALTH

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S154-S154
Author(s):  
William D Cabin
Keyword(s):  
New York ◽  
Home Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Home Health ◽  
Determinants Of Health ◽  
Additional Patient ◽  
Convenience Sample ◽  
Related Services ◽  
Home Care Nurses

Abstract There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. The current study is an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 37 home care nurses between January 2013 and May 2014 in the New York City metropolitan area. Results indicate nurses believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs.

Home Care Nurses Claim Medicare Ignores Social Determinants of Health

2019 ◽  
Vol 31 (4) ◽  
pp. 224-230 ◽  
Author(s):  
William Cabin
Keyword(s):  
New York ◽  
Home Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Home Health ◽  
Determinants Of Health ◽  
Additional Patient ◽  
Convenience Sample ◽  
Related Services ◽  
Home Care Nurses

There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded the ability of Medicare Advantage plans to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. The current study is an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 37 home care nurses between January 2013 and May 2014 in the New York City metropolitan area. Results indicate that nurses believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs.

Social Workers Assert Medicare Home Care Ignores Social Determinants of Health

2020 ◽  
Vol 32 (4) ◽  
pp. 199-205
Author(s):  
William Cabin
Keyword(s):  
Social Work ◽  
Home Care ◽  
Social Determinants Of Health ◽  
Social Workers ◽  
Social Determinants ◽  
Home Health ◽  
Determinants Of Health ◽  
Additional Patient ◽  
Convenience Sample ◽  
Related Services

There is significant literature on the importance of addressing social determinants of health (SDOH) to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 29 home care social workers between January 2013 and May 2014 in the New York City metropolitan area. Results indicate social workers believe the lack of SDOH coverage, including social work, in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and rehospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs. Policymakers are urged to consider adding coverage of social work and SDOH to Medicare home health.

scholarly journals HOME CARE SOCIAL WORKERS CLAIM MEDICARE IGNORES PATIENT NEEDS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S325-S325
Author(s):  
William D Cabin
Keyword(s):  
New York ◽  
Home Care ◽  
Social Workers ◽  
Home Health ◽  
Additional Patient ◽  
Convenience Sample ◽  
Related Services ◽  
Health Care Outcomes ◽  
Care Outcomes ◽  
Improve Health

Abstract There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 29 home care social workers between January 2013 and May 2014 in the New York City metropolitan area. Results indicate social workers believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs. Policymakers are urged to consider adding coverage of SDOH to Medicare home health primarily through expanded social work coverage.

scholarly journals Pre-Existing Inequality: The Impact of COVID-19 on Medicare Home Health Beneficiaries

2021 ◽  
Vol 33 (2) ◽  
pp. 130-136
Author(s):  
William Cabin
Keyword(s):  
Mental Health ◽  
New York ◽  
Home Care ◽  
Population Based ◽  
Home Health ◽  
Physical And Mental Health ◽  
Convenience Sample ◽  
Medicare Population ◽  
Home Health Agencies ◽  
The Impact

There is significant data on the adverse impact of COVID-19 on persons who were poor, minorities, had compromised physical or mental health, or other vulnerabilities prior to the COVID-19 pandemic. A significant portion of the overall Medicare population has such vulnerabilities. The Medicare home health beneficiary population is even more vulnerable than the overall Medicare population based on gender, race, income level, living alone status, and number of chronic conditions. A literature review indicates there is only 1 study on the impact of COVID-19 in Medicare home health on home care workers and none on the impact on home health beneficiaries. The current study is a qualitative study based on interviews of a convenience sample of 48 home care nurses from 9 different home health agencies in New York City between April 1 and August 31, 2020. Six major themes emerged: need for social service supports increased; loneliness and depression increased among patients; physical and mental health conditions became exacerbated; substance use and abuse increased; evidence of domestic violence against patients increased; and there was a limited amount of staff and equipment to care for patients.

scholarly journals Primary and Secondary Health Impacts of COVID-19 among Minority Individuals in New York State

2021 ◽  
Vol 18 (2) ◽  
pp. 683
Author(s):  
Lauren A. Clay ◽  
Stephanie Rogus
Keyword(s):  
New York ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
New York State ◽  
Determinants Of Health ◽  
Health Impacts ◽  
Minority Populations ◽  
York State ◽  
The Social ◽  
Chi Square Analysis

In addition to the direct health impacts of COVID-19, the pandemic disrupted economic, educational, healthcare, and social systems in the US. This cross-sectional study examined the primary and secondary impacts of the COVID-19 pandemic among low-income and minority groups in New York State using the social determinants of health framework. New Yorkers were recruited to complete a web-based survey through Qualtrics. The survey took place in May and June 2020 and asked respondents about COVID-19 health impacts, risk factors, and concerns. Chi-square analysis examined the health effects experienced by race and ethnicity, and significant results were analyzed in a series of logistic regression models. Results showed disparities in the primary and secondary impacts of COVID-19. The majority of differences were reported between Hispanic and white respondents. The largest differences, in terms of magnitude, were reported between other or multiracial respondents and white respondents. Given the disproportionate burden of COVID-19 on minority populations, improved policies and programs to address impacts on lower-paying essential jobs and service positions could reduce exposure risks and improve safety for minority populations. Future research can identify the long-term health consequences of the pandemic on the social determinants of health among populations most at risk.

scholarly journals Usability Evaluation of a Portable Health Information Kiosk Using a SMAARTTM Intervention Framework

2017 ◽  
Vol 9 (8) ◽  
pp. 153 ◽  
Author(s):  
Ashish Joshi ◽  
Mohit Arora ◽  
Bhavya Malhotra
Keyword(s):  
Social Determinants Of Health ◽  
Health Information ◽  
Clinical Data ◽  
Social Determinants ◽  
Communicable Disease ◽  
Urban Slum ◽  
Determinants Of Health ◽  
Empirical Literature ◽  
Individual Risk ◽  
Convenience Sample

Empirical literature has shown that interventions to address social determinants of health are limited owing to poor integration of social and clinical data. The objective of this study was to describe a Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored framework (SMAARTTM) which was utilized to design and pilot test portable health information kiosk that can facilitate the integration of social determinants of health data with clinical data to enhance population health outcomes in global settings. The SMAART TM framework was designed using a combined approach of Data, Information Knowledge, Human Centered approach and behavioral humanistic and learning theories, and was applied to develop and evaluate an interactive, bi-lingual computer enabled portable health information kiosk. A convenience sample (recruitment based on accessibility to the researcher) of 149 individuals aged 18 years and above living in urban slum settings of India were enrolled in the year 2013. Subjective and objective data gathering included socio-demographics, clinical history, health behaviors and knowledge, attitude and practices. Weight and blood pressure levels were measured using physiological sensors. Usability assessment of the health information kiosk was also conducted. Results showed an increased burden of chronic non-communicable disease (NCD) risk factors and related knowledge, and lack of healthy lifestyle practices among urban slum individuals. Our study showed that the technology enabled SMAART TM framework can be utilized to develop an individual risk profile for better disease prevention, monitoring and management of chronic NCDs.

scholarly journals Social determinants of health associated with hemodialysis non-adherence and emergency department utilization: a pilot observational study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kamna S. Balhara ◽  
Lori Fisher ◽  
Naya El Hage ◽  
Rosemarie G. Ramos ◽  
Bernard G. Jaar
Keyword(s):  
Risk Factors ◽  
Health Literacy ◽  
Observational Study ◽  
Social Determinants Of Health ◽  
Resource Utilization ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Emergency Department Utilization ◽  
Convenience Sample ◽  
Physical Limitations

Abstract Background Dialysis patients who miss treatments are twice as likely to visit emergency departments (EDs) compared to adherent patients; however, prospective studies assessing ED use after missed treatments are limited. This interdisciplinary pilot study aimed to identify social determinants of health (SDOH) associated with missing hemodialysis (HD) and presenting to the ED, and describe resource utilization associated with such visits. Methods We conducted a prospective observational study with a convenience sample of patients presenting to the ED after missing HD (cases); patients at local dialysis centers identified as HD-compliant by their nephrologists served as matched controls. Patients were interviewed with validated instruments capturing associated risk factors, including SDOH. ED resource utilization by cases was determined by chart review. Chi-square tests and ANOVA were used to detect statistically significant group differences. Results All cases visiting the ED had laboratory and radiographic studies; 40% needed physician-performed procedures. Mean ED length of stay (LOS) for cases was 17 h; 76% of patients were admitted with average LOS of 6 days. Comparing 25 cases and 24 controls, we found no difference in economic stability, educational attainment, health literacy, family support, or satisfaction with nephrology care. However, cases were more dependent on public transport for dialysis (p = 0.03). Despite comparable comorbidity burdens, cases were more likely to have impaired mobility, physical limitations, and higher severity of pain and depression. (p < 0.05). Conclusions ED visits after missed HD resulted in elevated LOS and admission rates. Frequently-cited SDOH such as health literacy did not confer significant risk for missing HD. However, pain, physical limitations, and depression were higher among cases. Community-specific collaborations between EDs and dialysis centers would be valuable in identifying risk factors specific to missed HD and ED use, to develop strategies to improve treatment adherence and reduce unnecessary ED utilization.

US college students’ perceptions of social determinants of health, health equity and racial health disparities

2020 ◽  
Vol 79 (6) ◽  
pp. 700-711
Author(s):  
Rebecca Rich ◽  
Angelia Paschal
Keyword(s):  
College Students ◽  
Health Disparities ◽  
Social Determinants Of Health ◽  
Health Equity ◽  
Social Determinants ◽  
Good Health ◽  
Determinants Of Health ◽  
Racial Health Disparities ◽  
Cross Sectional ◽  
Convenience Sample

Objective: Healthy equity (HE) implies the highest possible standard of health for all people while giving special attention to the needs of those at greatest risk of poor health, based on social conditions. The social determinants of health (SDH) are conditions within the environment in which people live that shape their opportunity to attain good health. Despite efforts to promote HE and address SDH, there is limited research on college students’ perceptions of these concepts. The purpose of this study was to understand college students’ perceptions, awareness and education on HE and SDH with a specific focus on racial health disparities. Methods: A 28-item questionnaire was distributed electronically to a cross-sectional, campus-wide convenience sample of undergraduates at a large public university in the southeast USA. Results: While many students reported having knowledge or understanding about HE, SDH and related concepts, most had negative attitudes and beliefs about them. Students reported good understanding of these terms, but also believed that health disparities were due to individual behaviours. Conclusion: The contradiction in results show that while college students may think they have a good understanding of HE and SDH, their education on the topics could be improved. Study findings should encourage health education specialists to shift their focus from merely providing information to promoting the application of that knowledge. By so doing, students may be able to bridge the gap between understanding health equity and applying their knowledge in everyday life.

scholarly journals Covid-19 and Inequity: A comparative spatial analysis of New York City and Chicago hot spots

2020 ◽  
Author(s):  
Andrew Maroko ◽  
Denis Nash ◽  
Brian Pavilonis
Keyword(s):  
New York ◽  
New York City ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
York City ◽  
Hot Spots ◽  
Determinants Of Health ◽  
Cold Spots ◽  
The Impact ◽  
Zip Code

AbstractThere have been numerous reports that the impact of the ongoing COVID-19 epidemic has disproportionately impacted traditionally vulnerable communities, including well-researched social determinants of health, such as racial and ethnic minorities, migrants, and the economically challenged. The goal of this ecological cross-sectional study is to examine the demographic and economic nature of spatial hot and cold spots of SARS-CoV-2 rates in New York City and Chicago as of April 13, 2020.In both cities, cold spots (clusters of low SARS-CoV-2 rate ZIP code tabulation areas) demonstrated typical protective factors associated with the social determinants of health and the ability to social distance. These neighborhoods tended to be wealthier, have higher educational attainment, higher proportions of non-Hispanic white residents, and more workers in managerial occupations. Hot spots (clusters of high SARS-CoV-2 rate ZIP code tabulation areas) also had similarities, such as lower rates of college graduates and higher proportions of people of color. It also appears to be larger households (more people per household), rather than overall population density, that may to be a more strongly associated with hot spots.Findings suggest important differences between the cities’ hot spots as well. They can be generalized by describing the NYC hot spots as working-class and middle-income communities, perhaps indicative of service workers and other occupations (including those classified as “essential services” during the pandemic) that may not require a college degree but pay wages above poverty levels. Chicago’s hot spot neighborhoods, on the other hand, are among the city’s most vulnerable, low-income neighborhoods with extremely high rates of poverty, unemployment, and non-Hispanic Black residents.

Identifying Communities at Risk for COVID-19–Related Burden Across 500 US Cities and Within New York City: Unsupervised Learning of the Coprevalence of Health Indicators (Preprint)

2020 ◽  
Author(s):  
Andrew Deonarine ◽  
Genevieve Lyons ◽  
Chirag Lakhani ◽  
Walter De Brouwer
Keyword(s):  
New York ◽  
New York City ◽  
Built Environment ◽  
Social Determinants Of Health ◽  
Satellite Imagery ◽  
Risk Score ◽  
Social Determinants ◽  
York City ◽  
Complex Disease ◽  
Determinants Of Health

BACKGROUND Although it is well-known that older individuals with certain comorbidities are at the highest risk for complications related to COVID-19 including hospitalization and death, we lack tools to identify communities at the highest risk with fine-grained spatial resolution. Information collected at a county level obscures local risk and complex interactions between clinical comorbidities, the built environment, population factors, and other social determinants of health. OBJECTIVE This study aims to develop a COVID-19 community risk score that summarizes complex disease prevalence together with age and sex, and compares the score to different social determinants of health indicators and built environment measures derived from satellite images using deep learning. METHODS We developed a robust COVID-19 community risk score (COVID-19 risk score) that summarizes the complex disease co-occurrences (using data for 2019) for individual census tracts with unsupervised learning, selected on the basis of their association with risk for COVID-19 complications such as death. We mapped the COVID-19 risk score to corresponding zip codes in New York City and associated the score with COVID-19–related death. We further modeled the variance of the COVID-19 risk score using satellite imagery and social determinants of health. RESULTS Using 2019 chronic disease data, the COVID-19 risk score described 85% of the variation in the co-occurrence of 15 diseases and health behaviors that are risk factors for COVID-19 complications among ~28,000 census tract neighborhoods (median population size of tracts 4091). The COVID-19 risk score was associated with a 40% greater risk for COVID-19–related death across New York City (April and September 2020) for a 1 SD change in the score (risk ratio for 1 SD change in COVID-19 risk score 1.4; <i>P</i>&lt;.001) at the zip code level. Satellite imagery coupled with social determinants of health explain nearly 90% of the variance in the COVID-19 risk score in the United States in census tracts (<i>r</i><sup>2</sup>=0.87). CONCLUSIONS The COVID-19 risk score localizes risk at the census tract level and was able to predict COVID-19–related mortality in New York City. The built environment explained significant variations in the score, suggesting risk models could be enhanced with satellite imagery.

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