Social Determinants of Health May Predict End of Life Portable Orders for Life Sustaining Treatment Form Completion and Treatment Selections

2021 ◽  
pp. 104990912110415
Author(s):  
Ladawna Gievers ◽  
Sheevaun Khaki ◽  
Abby Dotson ◽  
Zunqiu Chen ◽  
Robert C. Macauley ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
End Of Life ◽  
Social Determinants ◽  
Private Insurance ◽  
Determinants Of Health ◽  
Insurance Status ◽  
Completion Rates ◽  
Full Treatment ◽  
Life Sustaining Treatment ◽  
Eol Care

Background: End of life (EOL) care planning is important for aging adults given the growing prevalence of chronic medical conditions in the US. The Portable Orders for Life Sustaining Treatment (POLST) program promotes communication between clinicians and patients with advanced illness about EOL treatment preferences. Despite growing resources for EOL care, utilization remains unequal based on social determinants of health (SDOH), including race, language, urbanization, and education. We evaluated the relationship between POLST form selections and completion rates and SDOH. Methods: Oregon POLST Registry and American Community Survey data from 2013 to 2017 were analyzed retrospectively. POLST form completion rates and selections, and various SDOH, including age, income, insurance status, urbanization, etc. were recorded. Data were merged based on ZIP codes and analyzed using χ2 or Wilcoxon-Mann-Whitney tests. Logistic regression was performed. Results: 127,588 POLST forms from 319 ZIP codes were included. POLST form completion rates were highest among urban ZIP codes, and urban registrants more often selected CPR and full treatment. ZIP codes with higher incomes tended to select CPR. ZIP codes with higher rates of private insurance completed POLST forms, and selected CPR and full treatment more frequently. ZIP codes with higher rates of Bachelor’s degrees (or higher) completed POLST forms and selected full treatment more frequently. Conclusions: Various SDOH-specifically, urbanization, insurance status, income level and educational level achieved-may influence POLST form completion rates and selections. The expanding socioeconomic diversity and growth of urban communities, highlight the need for broader access to EOL planning and POLST.

scholarly journals The Relationship between Social Determinants of Health and Utilization of Tertiary Rhinology Care

2017 ◽  
Vol 31 (6) ◽  
pp. 376-381 ◽  
Author(s):  
Madeleine B. Samuelson ◽  
Rakesh K. Chandra ◽  
Justin H. Turner ◽  
Paul T. Russell ◽  
David O. Francis
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Tertiary Care ◽  
College Education ◽  
Determinants Of Health ◽  
Insurance Status ◽  
Median Income ◽  
Care Hospital ◽  
Davidson County

Background Chronic rhinosinusitis (CRS) has a high prevalence and significant cost and quality of life implications. Many types of practitioners care for patients with rhinosinusitis; however, patients with chronic or complicated conditions are often referred for tertiary rhinology services. It is unclear how social determinants of health affect access and utilization of these services. A better understanding of social barriers to tertiary rhinology care is needed to reduce health care disparities and improve health outcomes. The aim of the present study was to measure whether income, insurance status, race, and education affect utilization of tertiary rhinology care. Methods All adult patients diagnosed with CRS by rhinologists at a single tertiary care hospital were identified (2010–2014). Patient characteristics (age, gender, race, insurance status) were compared with population-level data from the hospital and from Davidson County, Tennessee, which includes Nashville. Rhinology utilization rates were calculated for each ZIP code within the county. The association between determinants of health (race, insurance status, education, median income) and tertiary rhinology utilization were measured by using multivariable regression analyses. Results A total of 1341 unique patients with CRS (median age, 50 years; 55% women, 80%> white, 82%> with private insurance) from Davidson County used tertiary rhinology services. These patients were significantly older and more likely to be female, white, and privately insured than patients seen hospital-wide or among the population of Davidson County (p <0.001). Utilization rates were higher in ZIP codes with a lower proportion of minorities, a higher median income, and higher rates of private insurance and college education. However, in adjusted analysis, only attainment of a college education was independently associated with utilization of tertiary rhinology services. Utilization was 4%> higher for every V/o increase in college-educated population (coefficient 0.04 [95%o CI, 0.01–0.07]; p = 0.01). Conclusion Results of this study indicated that some social determinants of health (race, income, educational level, insurance status) do affect utilization of tertiary rhinology services. Higher utilization among those with higher income and educational attainment are contradictory to the data, which indicated that lower socioeconomic status was associated with a higher CRS rate. Further study is required to understand the disparities in rhinology utilization rates.

Disparities in NOSE Scores and Surgical Approaches among Patients Undergoing Functional Rhinoplasty

2018 ◽  
Vol 35 (01) ◽  
pp. 090-095 ◽  
Author(s):  
Mingyang Gray ◽  
Joseph Rousso ◽  
Matthew Hirsch ◽  
Joshua Rosenberg ◽  
Collin Rozanski
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Surgical Techniques ◽  
Determinants Of Health ◽  
Surgical Approaches ◽  
Delivery Of Care ◽  
Score Improvement ◽  
Significant Difference ◽  
Patient Reported

AbstractSocial determinants of health have been widely studied throughout medicine; however, their role relating to functional rhinoplasty has not been previously evaluated. The records of 178 patients who underwent functional rhinoplasty in a single health network from 2013 to 2016 were reviewed. The Nasal Obstruction Symptom Evaluation (NOSE) score was used to assess patient-reported symptoms, and patients with both preoperative and postoperative NOSE scores were included in this study. Basic demographics and surgical techniques were also collected. Differences between NOSE scores and surgical approaches to functional rhinoplasty on the basis of insurance type were measured. One hundred and sixteen patients were included for analysis, the mean age was 34.7 years (standard deviation [SD] = 16.2) and 57 (49.1%) were female. Twenty-one (18.1%) patients had public insurance and, of these, 18 patients had Medicaid. Patients (mean, SD) with Medicaid insurance (56.39, 15.6) had a slightly greater improvement in NOSE scores compared with patients with non-Medicaid insurance (47.90, 25.6) (p = 0.067). There was no statistically significant difference in preoperative NOSE scores or postoperative improvement in NOSE scores between patients with different health insurance. Furthermore, there was no statistically significant difference in surgical approaches. The majority of patients receiving functional rhinoplasty had private insurance. Medicaid patients trended toward a greater NOSE score improvement after functional rhinoplasty, but also had a closer association with a history of nasal trauma and prior surgery. Future study is needed to better understand the association between socioeconomic status and disparities in care. Understanding how social determinants of health affect patients may reveal potential inherent biases, improve delivery of care, and translate to better patient outcomes.

Social determinants of health are associated with physical therapy use: a systematic review

2021 ◽  
pp. bjsports-2020-103475
Author(s):  
Amanda Day Braaten ◽  
Cannon Hanebuth ◽  
Holt McPherson ◽  
Dashae Smallwood ◽  
Samantha Kaplan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Physical Therapy ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Determinants Of Health ◽  
Future Research ◽  
Eligibility Criteria ◽  
Therapy Services ◽  
Physical Therapy Services

ObjectiveThe purpose of this systematic review is to identify and summarise the social determinants of health (SDH) cited in the literature and evaluate their association with individuals using physical therapy services.DesignA systematic review using qualitatively synthesised information to describe the association between SDH and physical therapy use.Data sourcesThe electronic databases Medline, Embase and Scopus were searched from inception to February 2021, identifying observational and qualitative studies.Eligibility criteriaPublished studies included all adults, aged 18 or older, who independently sought to use physical therapy, in all practice settings from all geographical locations.ResultsOf the 9248 studies screened, 36 met the inclusion criteria for the review. The participants represented 8 countries and totaled 2 699 437. The majority of the papers reported moderate strength of association for each SDH. Female gender, non-Hispanic white race/ethnicity, increased education attainment, urban environment, access to transportation, employment, high socioeconomic status and private insurance were associated with higher likelihood of physical therapy use.ConclusionThis systematic review identifies predisposing and enabling factors impacting physical therapy usage among adults in different countries and across physical therapy settings. The results of this study have implications for policy and future research regarding populations that have been shown to be using physical therapy services less, such as those with lower levels of education, those in a rural area, or those in a low socioeconomic class.

Hospice use at end of life in children with cancer: The effect of insurance.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10558-10558
Author(s):  
Emily E. Johnston ◽  
Elizabeth Davis ◽  
Smita Bhatia ◽  
Kelly Kenzik
Keyword(s):  
End Of Life ◽  
Hospice Care ◽  
Private Insurance ◽  
Hematologic Malignancies ◽  
Insurance Status ◽  
Children With Cancer ◽  
Location Of Death ◽  
National Quality ◽  
Eol Care ◽  
Privately Insured

10558 Background: The National Quality Forum has endorsed hospice care as a metric of high quality end-of-life (EOL) care for adults with cancer. Specific hospice-related quality metrics include hospice enrollment, hospice enrollment for ≥3d, and death outside of the acute care setting. These metrics have been examined extensively in adults and disparities related to a number of clinical and sociodemographic factors, including insurance, have been identified. However, for children with cancer, hospice utilization data is lacking. We addressed this gap by examining location of death and hospice utilization at EOL for children with cancer and determining whether these metrics varied with insurance status. Methods: We used national insurance claims data (Truven) to conduct a population-based analysis of patients with cancer who died between 2011 and 2017 at age 0-21y. The dataset was queried for hospice claims, inpatient claims, and location of death. The association between insurance (private vs. Medicaid) and 1) location of death, 2) hospice enrollment, and 3) days between first hospice claim and death was examined using multivariable regression analysis, adjusting for age at death, gender, and cancer diagnosis (hematologic malignancies vs. solid tumor). Results: A total of 1,492 children died at a mean age of 11y (SD: 6y); 56% were privately-insured, 56% were male, and 30% had hematologic malignancies. Overall, 58% died in the hospital (privately-insured: 54% vs. Medicaid: 63%). Forty-five percent enrolled in hospice (privately-insured: 46% vs. Medicaid: 43%) with 2% returning to the hospital to die after enrolling in hospice. The average time between first hospice claim and death was 3d (privately-insured: 10d vs. Medicaid: 2d, p = < 0.001). When compared to privately-insured children, children on Medicaid had similar likelihood of hospice enrollment (RR = 1.0, 95%Cl = 0.6-1.8). However, children on Medicaid were more likely to die in the hospital (RR = 1.3, 95%CI = 1.1-1.4) and have fewer days between hospice enrollment and death if enrolled in hospice (IRR: 0.5, 95%CI = 0.3-0.8). Conclusions: In this first study to examine national hospice utilization in children with cancer, care varies significantly with insurance status. Children on Medicaid are more likely to die in the hospital and have shorter hospice enrollment duration than children with private insurance. Whether this variation represents EOL care preferences, provider biases, differences in quality and availability of hospice or home care to different insurers, or other barriers needs to be examined.

Disparities in Obstetric Readmissions: A Multistate Analysis, 2007–2014

2021 ◽  
Author(s):  
Kathy C. Matthews ◽  
Virginia E. Tangel ◽  
Sharon E. Abramovitz ◽  
Laura E. Riley ◽  
Robert S. White
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Hospital Readmissions ◽  
Determinants Of Health ◽  
Median Income ◽  
Black Patients ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
White Patients

Background Hospital readmissions are generally higher among racial-ethnic minorities and patients of lower socioeconomic status. However, this has not been widely studied in obstetrics. Objective The aim of the study is to determine 30-day postpartum readmission rates by patient-level social determinants of health: race ethnicity, primary insurance payer, and median income, independently and as effect modifiers. Study Design Using state inpatient databases from the health care cost and utilization project from 2007 to 2014, we queried all deliveries. To produce accurate estimates of the effects of parturients' social determinants of health on readmission odds while controlling for confounders, generalized linear mixed models (GLMMs) were used. Additional models were generated with interaction terms to highlight any associations and their effect on the outcome. Adjusted odds ratios (aOR) with 95% confidence intervals are reported. Results There were 5,129,867 deliveries with 79,260 (1.5%) 30-day readmissions. Of these, 947 (1.2%) were missing race ethnicity. Black and Hispanic patients were more likely to be readmitted within 30 days of delivery, as compared with White patients (p < 0.001 and p < 0.05, respectively). Patients with government insurance were more likely to be readmitted than those with private insurance (p < 0.001). Patients living in the second quartile of median income were also more likely to be readmitted than those living in other quartiles (p < 0.05). Using GLMMs, we observed that Black patients with Medicare were significantly more likely to get readmitted as compared with White patients with private insurance (aOR 2.78, 95% CI 2.50–3.09, p < 0.001). Similarly, Black patients living in the fourth (richest) quartile of median income were more likely to get readmitted, even when compared with White patients living in the first (poorest) quartile of median income (aOR 1.48, 95% CI 1.40–1.57, p < 0.001). Conclusion Significant racial-ethnic disparities in obstetric readmissions were observed, particularly in Black patients with government insurance and even in Black patients living in the richest quartile of median income. Key Points

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.

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