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.

scholarly journals Influence of social determinants of health and county vaccination rates on machine learning models to predict COVID-19 case growth in Tennessee

2021 ◽  
Vol 28 (1) ◽  
pp. e100439
Author(s):  
Lukasz S Wylezinski ◽  
Coleman R Harris ◽  
Cody N Heiser ◽  
Jamieson D Gray ◽  
Charles F Spurlock
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Learning Models ◽  
Vaccination Rates ◽  
Data Framework ◽  
The Impact ◽  
Machine Learning Models

IntroductionThe SARS-CoV-2 (COVID-19) pandemic has exposed health disparities throughout the USA, particularly among racial and ethnic minorities. As a result, there is a need for data-driven approaches to pinpoint the unique constellation of clinical and social determinants of health (SDOH) risk factors that give rise to poor patient outcomes following infection in US communities.MethodsWe combined county-level COVID-19 testing data, COVID-19 vaccination rates and SDOH information in Tennessee. Between February and May 2021, we trained machine learning models on a semimonthly basis using these datasets to predict COVID-19 incidence in Tennessee counties. We then analyzed SDOH data features at each time point to rank the impact of each feature on model performance.ResultsOur results indicate that COVID-19 vaccination rates play a crucial role in determining future COVID-19 disease risk. Beginning in mid-March 2021, higher vaccination rates significantly correlated with lower COVID-19 case growth predictions. Further, as the relative importance of COVID-19 vaccination data features grew, demographic SDOH features such as age, race and ethnicity decreased while the impact of socioeconomic and environmental factors, including access to healthcare and transportation, increased.ConclusionIncorporating a data framework to track the evolving patterns of community-level SDOH risk factors could provide policy-makers with additional data resources to improve health equity and resilience to future public health emergencies.

Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

2021 ◽  
pp. 104990912110578
Author(s):  
Hyunjin Noh ◽  
Hee Y. Lee ◽  
Lewis H. Lee ◽  
Yan Luo
Keyword(s):  
Health Literacy ◽  
Social Determinants Of Health ◽  
Social Isolation ◽  
Social Determinants ◽  
Hospice Care ◽  
Demographic Characteristics ◽  
Black Belt ◽  
Determinants Of Health ◽  
Black Belt Region ◽  
Alabama's Black Belt

Background: Despite the need for hospice care as our society ages, adults in the U.S.’s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama’s Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama’s Black Belt region (N = 179, age = 18-91). Participants’ awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care ( OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care ( OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it ( OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama’s Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.

scholarly journals SOCIAL DETERMINANTS OF HEALTH DRIVE EMERGENCY ROOM AND HOSPITAL USE BY DUAL ELIGIBLE AND DISABLED PENNSYLVANIANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S964-S964
Author(s):  
Sih-Ting Cai ◽  
Howard Degenholtz ◽  
Hayley Germack
Keyword(s):  
Risk Factors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Physical Dependence ◽  
Health Hazards ◽  
Determinants Of Health ◽  
Economic Insecurity ◽  
Potential Health ◽  
Icd 10 ◽  
Dual Eligible

Abstract The study examined correlates and consequences of social determinants of health risk factors (SDoH) among dual eligible aged and disabled individuals; Pennsylvania is transitioning this population into a managed care plan with responsibility for care coordination and incentives to prevent hospitalization and nursing home placement. Medicaid and Medicare claims were used to identify people with SDoH based on ICD-10 codes in 2016 in four domains: economic insecurity, life stressors, physical dependence, and potential health hazards. Of 281,918 people, 38.6% had one or more SDoH. Among people with severe mental illnesses (SMI; schizophrenia, psychosis, major depressive disorder, or bipolar disorder), the prevalence of SDoH was 57.9%. Of people with one or more SDoH, 42% visited the ED, compared to only 32% of people with no SDoH. Economic insecurity (OR 1.68; CI 1.59-1.78), life stressors (OR 1.39; CI 1.29-1.48), physical dependence, (OR 2.01; CI 1.97-2.06), and potential health hazards (OR 1.52; CI 1.47-1.56) were independently associated with risk of hospitalization, controlling for age, gender, race, SMI, chronic conditions and disability. The introduction of diagnosis codes for SDoH under ICD-10 has facilitated identifying individuals with deficits that might increase health care use above and beyond their underlying health status. Although the prevalence of these risk factors as captured in diagnosis data is likely an underestimate, the strong association with subsequent ED use and hospitalization lends credence to these indicators. Medicare and Medicaid claims data can be used to identify people with SDoH and target interventions to prevent downstream health services use.

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 as Potential Influencers of a Collaborative Care Intervention for Patients with Hypertension

2021 ◽  
Vol 31 (1) ◽  
pp. 47-56
Author(s):  
Chidinma A. Ibe ◽  
Carmen Alvarez ◽  
Kathryn A. Carson ◽  
Jill A. Marsteller ◽  
Deidra C. Crews ◽  
...  
Keyword(s):  
Health Literacy ◽  
Community Health ◽  
Social Determinants Of Health ◽  
Community Health Workers ◽  
Social Determinants ◽  
Collaborative Care ◽  
Health Workers ◽  
Determinants Of Health ◽  
Nurse Care ◽  
Care Intervention

Objectives: The use of collaborative care teams, comprising nurse care managers and community health workers, has emerged as a promising strategy to tackle hyperten­sion disparities by addressing patients’ social determinants of health. We sought to identify which social determinants of health are associated with a patient’s likelihood of engaging with collaborative care team members and with the nurse care manager’s likelihood of enlisting community health workers (CHW) to provide additional sup­port to patients.Methods: We conducted a within-group longitudinal analysis of patients assigned to receive a collaborative care intervention in a pragmatic, cluster randomized trial that aims to reduce disparities in hypertension control (N=888). Generalized estimating equations were used to identify which social deter­minants of health, reported on the study’s baseline survey, were associated with the odds of patients engaging with the col­laborative care intervention, and of nurses deploying community health workers.Results: Patients who were unable to work and those with higher health literacy were less likely to engage with the collaborative care team than those who were employed full time or had lower health literacy, respectively. Patients had a greater likeli­hood of being referred to a community health worker by their care manager if they reported higher health literacy, perceived stress, or food insecurity, while those report­ing higher numeracy had lower odds of receiving a CHW referral.Implications/Conclusions: A patient’s social determinants of health influence the extent of engagement in a collaborative care intervention and nurse care manager appraisals of the need for supplementary support provided by community health workers.Ethn Dis. 2021;31(1):47-56; doi:10.18865/ed.31.1.47

scholarly journals Childhood obesity in Mexico: social determinants of health and other risk factors

2018 ◽  
pp. bcr-2017-223862
Author(s):  
David Avelar Rodriguez ◽  
Erick Manuel Toro Monjaraz ◽  
Karen Rubi Ignorosa Arellano ◽  
Jaime Ramirez Mayans
Keyword(s):  
Risk Factors ◽  
Childhood Obesity ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health
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