The Impact of Social Determinants of Health on Hospitalization in the Veterans Health Administration
The Impact of Social Determinants of Health on Hospitalization in the Veterans Health Administration
复制标题
DOI：
10.1016/j.amepre.2018.12.012
复制
发表时间：
2019-06-01
影响因子：
5.5
通讯作者：
Weiner, Jonathan P.
中科院分区：
文献类型：
--
作者：
Hatef, Elham;Searle, Kelly M.;Weiner, Jonathan P.
简介：本研究旨在评估个人和地理层面的社会健康决定因素对退伍军人健康管理局初级保健诊所住院风险的影响，该诊所被称为患者对齐护理团队。对于在初级保健诊所登记的退伍军人人群，研究小组从2015年退伍军人健康管理局电子健康记录数据中提取了患者水平的特征和医疗保健利用记录。他们还收集了美国所有人口普查区健康因素社会决定因素的普查数据。他们使用广义估计方程模型和基于空间的GIS分析来评估健康的关键社会决定因素对住院的作用。数据分析于2018年完成。结果：2015年，退伍军人健康管理局人口中共有6.63%住院。大部分住院患者为男性（93.40%）和白色（68.80%）;平均年龄为64.5岁。在广义估计方程模型中，与非白色退伍军人相比，白色退伍军人的住院几率降低了15%。在控制了患者水平的特征后，居住在具有较高社区SES指数的人口普查区的退伍军人住院的几率降低。一项基于空间的分析显示了退伍军人健康管理局初级保健诊所住院率的变化，并确定了住院风险升高的诊所（热点）与全国其他诊所相比。通过在地理水平上将患者和人口水平的数据联系起来，健康评估的社会决定因素有助于设计人口健康干预措施，并确定导致某些人可能不必要住院的特征。地理区域似乎是异常值。(C)2019年美国预防医学杂志。爱思唯尔公司出版All rights reserved.
Introduction: This study aims to assess the effect of individual and geographic-level social determinants of health on risk of hospitalization in the Veterans Health Administration primary care clinics known as the Patient Aligned Care Team.Methods: For a population of Veterans enrolled in the primary care clinics, the study team extracted patient-level characteristics and healthcare utilization records from 2015 Veterans Health Administration electronic health record data. They also collected census data on social determinants of health factors for all U.S. census tracts. They used generalized estimating equation modeling and a spatial-based GIS analysis to assess the role of key social determinants of health on hospitalization. Data analysis was completed in 2018.Results: A total of 6.63% of the Veterans Health Administration population was hospitalized during 2015. Most of the hospitalized patients were male (93.40%) and white (68.80%); the mean age was 64.5 years. In the generalized estimating equation model, white Veterans had a 15% decreased odds of hospitalization compared with non-white Veterans. After controlling for patient-level characteristics, Veterans residing in census tracts with the higher neighborhood SES index experienced decreased odds of hospitalization. A spatial-based analysis presented variations in the hospitalization rate across the Veterans Health Administration primary care clinics and identified the clinic sites with an elevated risk of hospitalization (hotspots) compared with other clinics across the country.Conclusions: By linking patient and population-level data at a geographic level, social determinants of health assessments can help with designing population health interventions and identifying features leading to potentially unnecessary hospitalization in selected geographic areas that appear to be outliers. (C) 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.