scholarly journals Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres

2021 ◽  
Vol 9 (3) ◽  
pp. e000853
Author(s):  
Michael Topmiller ◽  
Jessica McCann ◽  
Jennifer Rankin ◽  
Hank Hoang ◽  
Joshua Bolton ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Deprivation ◽  
Health Centre ◽  
Quality Measures ◽  
Service Area ◽  
Determinants Of Health ◽  
Clinical Quality ◽  
Health Centres

ObjectiveThis paper explores the impact of service area-level social deprivation on health centre clinical quality measures.DesignCross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres.SettingsHRSA-funded health centres in the USA.ParticipantsOur analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country.ResultsHigher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care.ConclusionsThis research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.

scholarly journals Pushing poverty off limits: quality improvement and the architecture of healthcare values

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Polly Mitchell ◽  
Alan Cribb ◽  
Vikki Entwistle ◽  
Guddi Singh
Keyword(s):  
Quality Improvement ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Deprivation ◽  
Ethical Dilemmas ◽  
Determinants Of Health ◽  
Ethical Challenges ◽  
The Social ◽  
Significant Burden ◽  
Health Related

Abstract Background Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI). Discussion Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. Conclusions We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.

scholarly journals The Impact of Social Determinants of Health on Lung Cancer Screening Utilization

2022 ◽  
Vol 19 (1) ◽  
pp. 122-130
Author(s):  
Donghoon Shin ◽  
Michael D.C. Fishman ◽  
Michael Ngo ◽  
Jeffrey Wang ◽  
Christina A. LeBedis
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Lung Cancer Screening ◽  
Determinants Of Health ◽  
The Impact

Primary care utilization and clinical quality performance: a comparison between health centres in Medicaid expansion states and non-expansion states

2018 ◽  
Vol 24 (1) ◽  
pp. 19-28 ◽  
Author(s):  
De-Chih Lee ◽  
Leiyu Shi ◽  
Hailun Liang
Keyword(s):  
Primary Care ◽  
Health Centre ◽  
Quality Measures ◽  
Care Utilization ◽  
Medicaid Expansion ◽  
Quality Performance ◽  
Clinical Quality ◽  
Medical Visits ◽  
Health Centres ◽  
Primary Care Utilization

Objectives The United States Government’s Medicaid expansion policy has important implications for health centres, since a large proportion of health centre patients are Medicaid enrollees. The objective of this study was to compare primary care utilization and clinical quality performance between health centres in Medicaid expansion states and those in Medicaid non-expansion states. Methods We conducted a cross-sectional study. Multiple regressions, using a standard linear model, were performed to examine the relationship between Medicaid expansion status and performance measures, accounting for covariates. Results Our results showed that in unadjusted analyses, health centres in Medicaid expansion states reported larger number of patients served, larger number of medical visits, a higher percentage of Medicaid patients, and better performance in seven of 16 clinical quality measures than those in Medicaid non-expansion states. After controlling for relevant health centre-level covariates, the differences in mean patients served, mean medical visits, percentage of Medicaid patients, and five clinical quality measures still existed. Conclusions These findings reveal significant associations between Medicaid expansion and primary care utilization and the quality of care. Medicaid expansion has demonstrated its potential role in promoting primary care for vulnerable populations served by health centres.

scholarly journals Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest

2020 ◽  
Vol 3 (3) ◽  
pp. e200618 ◽  
Author(s):  
Shaheen S. Kurani ◽  
Rozalina G. McCoy ◽  
Michelle A. Lampman ◽  
Chyke A. Doubeni ◽  
Lila J. Finney Rutten ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Social Determinants Of Health ◽  
Colorectal Cancer Screening ◽  
Social Determinants ◽  
Determinants Of Health ◽  
The Us ◽  
Us Midwest

Influence of social determinants of health on oncology care quality rankings.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 139-139
Author(s):  
Benjamin Urick ◽  
Sabree Burbage ◽  
Christopher Baggett ◽  
Jennifer Elston Lafata ◽  
Hanna Kelly Sanoff ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Risk Adjustment ◽  
Social Deprivation ◽  
Care Quality ◽  
Determinants Of Health ◽  
Social Risk ◽  
Patient Level ◽  
Provider Quality ◽  
Oncology Care

139 Background: Adjustment for social determinants of health (SDOH) when assessing provider care quality remains limited. The Oncology Care Model (OCM), for example, includes low-income status/dual eligibility (LIS/DE) as a part of the risk adjustment model for some quality measures, but does not account for any social risk variables in the hospice measure. No measures within the OCM account for additional social risk factors beyond LIS/DE such as patients’ race, rurality, and social deprivation. Additional SDOH adjustment could increase the accuracy of provider quality rankings and better align performance-based payments with true provider quality. Methods: North Carolina Medicare claims from 2015-2017 comprised the data for this study. The year 2015 was used to establish baseline covariates. Episodes were attributed to physician practices’ Tax Identification Number (TIN), lasted 6 months, and were divided into performance years beginning 1/1/2016 and 7/1/2016. Three measures were used: 1) all-cause hospital admissions; 2) all-cause emergency department visits or observation stays; and 3) admission to hospice for 3 days or more among patients who died. SDOH included patient-level race as well as county-level rurality and social deprivation, measured using the social deprivation index (SDI). TIN-level scores with and without expanded SDOH variables were divided into quintiles and compared descriptively as well as using weighted kappa statistics. Results: No SDOH were significantly associated with the hospitalization outcome (P = 0.118-0.944). For the ED measure, Black patients and rural patients were significantly more likely to have an ED visit or observation stay during an episode than white patients and urban patients (P < 0.0001). For the hospice measure, greater SDI values were associated with less hospice use (P < 0.05). Accordingly, including SDOH variables for ED visit/observation stay and hospice measures had a greater impact on TIN rankings than for the hospitalization measure (Table). Conclusions: Because quintile rankings in determine potential shared savings under models like the OCM, differences in rankings due to additional SDOH variables could have a meaningful impact on TIN-level revenue. Additional work is needed to expand the scope of patient-level SDOH variables used for risk adjustment and to explore differences across TINs which contribute to SDOH-sensitive changes in rankings.[Table: see text]

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