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Socioeconomic Status and Health Care Outcomes
Jianhui Hu, Ph.D., Research AssociateCenter for Health Policy & Health Services Research
Henry Ford Health SystemOctober 16th, 2014
Introduction Recent studies on health disparities Socioeconomic status (SES) and
readmissions
Agenda
Led by Center Director Dr. David Nerenz Health policy research: takes on the role of
leading and coordinating health policy analysis for Henry Ford Health System since March 2010
Health services research: cancer prevention and control, patient-physician communication, pharmacogenomics and chronic disease, mental health services, and screening and treatment of chronic hepatitis
Center for Health Policy & Health Services Research
SES and readmissions Effects of the ACA’s benefit expansions on
preventive service utilizations and disparities in utilizations
Other internal data analyses of disparities in health outcome/performance measures across HFHS hospital/clinics sites serving communities with different SES
Recent Studies on Health Disparities
Association between SES and HEDIS Scores at the Clinic Site Level
.65
.7.7
5.8
.85
.9
20000 40000 60000 80000 100000Median HH Income
Breast Cancer Screening Fitted values
.6.6
5.7
.75
.8.8
5
20000 40000 60000 80000 100000Median HH Income
Colorectal Cancer Screening Fitted values
.5.6
.7.8
20000 40000 60000 80000 100000Median HH Income
Comprehensive Diabetes Care -HbA1c < 8% Fitted values
.3.4
.5.6
20000 40000 60000 80000 100000Median HH Income
Comprehensive Diabetes Care - LDL <100mg/dL Fitted values
Socioeconomic Status and Readmissions
Background: CMS began to reduce payments to hospitals with excess 30-day readmissions. One key debate about the policy revolves around the absence of any adjustment for the patients’ SES. The rationale is that differences in the quality of care received by groups of patients of different SES can contribute to readmissions.
Objectives: Better understand how various SES factors influenced the probability of readmission using data from a single urban teaching hospital.
Socioeconomic Status and Readmissions
Readmission Penalties in Three Years
Inclusions: Medicare fee-for-service; 65+; discharged from Henry Ford Hospital during 2010
Exclusions: died in the hospital; discharged AMA; admitted for cancer or rehabilitation care; admitted with a primary diagnosis of psychiatric disease
Data Source: Patient level: Henry Ford Hospital’s Corporate Data
Store Neighborhood level: Census 2000 Readmissions: CMS “dry run report”, including all
unplanned 30-day readmissions to any hospital
Data
Multivariate logistic regressions were used to examine the associations between 30-day readmissions and patients' and their neighborhoods' characteristics. We adjusted both for patients’ discharge conditions and for comorbidities identified from the index and historical admission records.
Methods
Results: Study Cohort
Socioeconomic disparities in readmission risk exist even after variations in practice patterns across hospitals have been eliminated. The effects of socioeconomic variables were not confounded with variations in hospital resources. Further, the associations reported here occurred in spite of efforts to prevent readmissions in general and to reduce disparities in readmission rates.
The question of whether hospitals should be held accountable for the effects of factors such as poverty, illiteracy, or lack of social support in the patients and communities they serve has not yet been resolved. The present findings underscore the importance of reaching consensus on this issue.
Limitations: 1) limited generalizability; 2) risk adjustment only used inpatient diagnoses from Henry Ford Health System; and 3) unable to include some important post-discharge factors.
Discussions & Conclusions
Next Steps …