Examining the Association of Social Needs with Future Health Care Utilization in an Older Adult Population: Which Needs Are Most Important?
Examining the Association of Social Needs with Future Health Care Utilization in an Older Adult Population: Which Needs Are Most Important?
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DOI：
10.1089/pop.2023.0171
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发表时间：
2023-12-01
影响因子：
2.5
通讯作者：
Dickerson，John F.
中科院分区：
文献类型：
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作者：
Mosen，David M.;Banegas，Matthew P.;Dickerson，John F.
社会隔离和粮食不安全等社会需求是个人层面健康的重要社会决定因素，对65岁及以上的成年人来说尤其如此。这些需求可能与未来的医疗保健利用有关，但这一研究领域尚未得到广泛研究。本研究的目的是检验5个个体社会需求与未来(1)急诊就诊（ED）和(2)住院的独立关联。本观察性研究包括9649名Kaiser Permanente Northwest （KPNW）医疗保险成员，他们在2020年8月17日至2022年1月31日期间完成了医疗保险总健康评估（MTHA）质量改进调查。MTHA评估的5种社会需求，定义为二元措施（是/否），包括(1)财政压力，(2)粮食不安全，(3)住房不稳定，(4)社会隔离，(5)交通需求。在MTHA评估后的12个月内测量ED利用率（是/否）和住院率（是/否），这是当前研究的结果指标。在多变量分析中，5种社会需求中有3种与较高的ED利用率显著相关：经济压力（优势比[OR] = 1.40, 95%可信区间[CI] = 1.11-1.76，P< 0.05）、住房不稳定（OR = 1.43, 95% CI = 1.02-1.99，P< 0.05）、社会隔离（OR = 1.19, 95% CI = 1.05-1.34，P< 0.05），以及经济压力与住院率显著相关（OR = 1.66, 95% CI = 1.23-2.23，P< 0.05）。研究结果确定了哪些社会需求与未来ED的使用和住院率最密切相关。需要进一步的研究来更好地了解解决社会需求是否与改善患者水平的健康结果有关。
Social needs, such as social isolation and food insecurity, are important individual-level social determinants of health, especially for adults ages 65 years and older. These needs may be associated with future health care utilization, but this research area has not been studied extensively. The objective of this study was to examine theindependent associationof 5 individual social needs with future (1) emergency department (ED) visits and (2) hospital admissions. This observational study included 9649 Kaiser Permanente Northwest (KPNW) Medicare members who completed the Medicare Total Health Assessment (MTHA) quality improvement survey between August 17, 2020 and January 31, 2022. The 5 social needs assessed by the MTHA, defined as binary measures (yes/no), included (1) financial strain, (2) food insecurity, (3) housing instability, (4) social isolation, and (5) transportation needs. ED utilization (yes/no) and hospitalization (yes/no), the current study outcome measures, were measured in the 12 months after MTHA assessment. In multivariable analyses, 3 of the 5 social needs were significantly associated with higher ED utilization: financial strain (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.11–1.76,P< 0.05), housing instability (OR = 1.43, 95% CI = 1.02–1.99,P< 0.05), and social isolation (OR = 1.19, 95% CI = 1.05–1.34,P< 0.05), and 1, financial strain, was significantly associated with hospital admissions (OR = 1.66, 95% CI = 1.23–2.23,P< 0.05). The study results identified which social needs are most strongly associated with future ED utilization and hospital admissions. Further research is needed to better understand whether addressing social needs is associated with improved patient-level health outcomes over time.