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]

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.

Using a Social Determinants of Health Summary Measure to Predict General Health Status in the BRFSS

2021 ◽  
pp. 089011712110449
Author(s):  
Candace C. Nelson
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
General Health ◽  
Poor Mental Health ◽  
Determinants Of Health ◽  
Social Risk ◽  
Summary Measure ◽  
Cross Sectional

Purpose This study aims to assess the relationship between social determinants of health (SDoH) burden and overall health. Design Three years of Behavioral Risk Factor Surveillance System (BRFSS) data (2017–2019) were combined for this cross-sectional study. Setting Massachusetts. Subjects Out of a possible 21,312 respondents, 16,929 (79%) were eligible for inclusion. Measures To create the SDoH summary measure, items assessing social risk experiences including financial instability (1 item), housing instability (2 items), perceptions of neighborhood crime (1 item), and food insecurity (2 items) were summed to create a count of risk experiences. Outcome measures included self-rated general health, days of poor physical health, and days of poor mental health. Analysis Multivariable logistic regression was used to evaluate the association between each outcome and the SDoH summary measure, adjusting for demographic confounders. Results In adjusted analyses, respondents who reported experiencing 1, 2, 3, or 4+ SDoH had a 1.6 (95% CI: 1.3–2.0), 2.9 (95% CI: 2.3–3.7), 3.2 (95% CI: 2.4–4.3), or 5.3 (95% CI: 4.0–7.0) increased odds (respectively) of self-rated fair/poor health, compared to those who reported zero SDoH. The adjusted relationship between the SDoH summary measure and physical health and mental health was similar in magnitude and statistically significant. Conclusions These results demonstrate that the overall burden of risk due to SDoH is an important predictor of health.

Social Determinants of Health and Patient-level Mortality Prediction after Trauma

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Heather M. Phelos ◽  
Nicolas M. Kass ◽  
Andrew-Paul Deeb ◽  
Joshua B. Brown
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Mortality Prediction ◽  
Determinants Of Health ◽  
Patient Level

scholarly journals Clinical Hypertension Guidelines and Social Determinants of Health: A Systematic Scoping Review

2020 ◽  
Author(s):  
Na'amah Razon ◽  
Danielle Hessler-Jones ◽  
Kirsten Bibbins-Domingo ◽  
Laura Gottlieb
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Scoping Review ◽  
Social Care ◽  
Determinants Of Health ◽  
Care Practice ◽  
Hypertension Management ◽  
Social Risk ◽  
Management Guidelines ◽  
Hypertension Guidelines

Abstract Background Social and economic factors impact hypertension risk and control. We examined the integration of social determinants of health (SDH) guidance into adult US hypertension guidelines to explore how existing hypertension guidelines reference social care activities. Objective To explore how existing hypertension management guidelines reference social care activities. Methods Systematic scoping review of clinical guidelines (guidelines, protocols, and professional organization statements) for adult hypertension management. We employed a PubMed search strategy to identify all hypertension guidelines and protocols published in the US between 1977 and 2019. We reviewed all titles to identify the most updated versions focused on non-pregnant adults with essential hypertension. We extracted instances where included guidelines referred to social determinants of health or social care. The primary outcome was how guidelines covered topics related to social care, defined using a framework adapted from the National Academies of Sciences, Engineering and Medicine (NASEM). Results Search terms yielded 126 guidelines. Thirty-six guidelines met inclusion criteria. Of those 72% (26/36) recommended social care activities as part of hypertension management; 58% recommended clinicians change clinical care practice based on social risk information. These recommendations often lacked specific guidance around how to address SDH. When guidelines referred to specific social factors, patient financial security was the most common social determinant highlighted (n = 101). Ten guidelines (28%) did not reference social care activities. Conclusion Information about social determinants of health is included in many adult hypertension management guidelines, but few guidelines provide clear guidance for clinicians on how to identify and address actionable social risk factors in the context of care delivery.

scholarly journals The terminology of social emergency medicine: Measuring social determinants of health, social risk, and social need

2020 ◽  
Vol 1 (5) ◽  
pp. 852-856
Author(s):  
Margaret E. Samuels‐Kalow ◽  
Gia E. Ciccolo ◽  
Michelle P. Lin ◽  
Elizabeth M. Schoenfeld ◽  
Carlos A. Camargo
Keyword(s):  
Emergency Medicine ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Social Risk

scholarly journals On the Association Between Social Determinants of Health and Disability in Stroke-Free Older Adults Living in Rural Settings. The Three Villages Study

2020 ◽  
Vol 11 ◽  
pp. 215013272096126
Author(s):  
Oscar H. Del Brutto ◽  
Robertino M. Mera ◽  
Bettsy Y. Recalde ◽  
Victor J. Del Brutto
Keyword(s):  
Older Adults ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Determinants Of Health ◽  
Study Cohort ◽  
Social Risk ◽  
Multivariate Models ◽  
Rural Settings

Background High social risk, as quantified by the social determinants of health (SDH), may lead to disability. This association has not been well explored in remote settings. Using the three Villages Study cohort, we assessed the association between SDH and disability among stroke-free older adults living in a rural Ecuadorian community. Methods SDH were measured by the use of the Gijon Scale and disability by the Functional Activities Questionnaire. All participants had a brain MRI to assess subclinical biomarkers of cerebral small vessel disease. Multivariate models were fitted to assess the association between components of SDH and disability, after adjusting for covariates of interest. Results The mean age of 478 enrolled individuals was 70.1 ± 8 years (59% women). High social risk was observed in 220 (46%) individuals and disability in 222 (46%). There was an almost direct linear relationship between SDH and disability, after taking into account the effect of age. A generalized linear model, adjusted for all included covariates, showed an independent association between social risk and disability ( P < .001). In addition, multivariate models showed that independent SDH components more strongly associated with disability were worse support networks and social relationships. In contrast, the single SDH component not associated with disability was the economic status. Conclusions This study showed a robust association between SDH and disability. Economic needs were surpassed by other components of SDH. This knowledge will help to develop strategies for the control of factors that may be in the path for disability among older adults living in rural settings.

Sign in / Sign up

Export Citation Format

Share Document