Association of Socioeconomic Area Deprivation Index with Hospital Readmissions After Colon and Rectal Surgery.
Association of Socioeconomic Area Deprivation Index with Hospital Readmissions After Colon and Rectal Surgery.
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DOI：
10.1007/s11605-020-04754-9
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Shireman PK
中科院分区：
文献类型：
--
作者：
Ghirimoldi FM;Schmidt S;Simon RC;Wang CP;Wang Z;Brimhall BB;Damien P;Moffett EE;Manuel LS;Sarwar ZU;Shireman PK
风险调整补偿和质量措施忽略了社会风险因素，尽管对健康结果产生了不利影响。社会风险因素通常在电子健康记录（EHR）或行政数据中不可用。社会经济地位可以通过使用美国人口普查数据进行评估。贫困社区指数（DCI）基于邮政编码，而地区贫困指数（ADI）则在街区组级别提供更详细的估计。我们使用ADI、DCI和患者水平的保险状况对结直肠手术后30天再入院风险进行了研究。我们的677例患者队列来自2013-2017年国家手术质量改进计划，该计划在一家安全网医院进行，并使用EHR数据来确定保险状态和30天再入院率。患者的家庭地址与ADI和DCI相关联。我们的队列包括53.9%的男性和63.8%的西班牙裔，从出院之日起30天再入院率为22.9%; >50%的人生活在高度贫困的社区。控制医疗合并症和并发症，ADI与生活在中等（OR = 2.15，p= 0.02）或高度（OR = 1.88，p= 0.03）贫困地区的患者自出院之日起30天再入院的风险增加相关，但与保险状况或DCI无关。ADI确定了生活在贫困社区的患者，其再入院风险增加。我们的研究结果表明，块组水平ADI可能用于风险调整，以识别高风险患者，并设计更好的护理途径，改善健康结果。
Risk-adjustment for reimbursement and quality measures omits social risk factors despite adversely affecting health outcomes. Social risk factors are not usually available in electronic health records (EHR) or administrative data. Socioeconomic status can be assessed by using United States Census data. Distressed Communities Index (DCI) is based upon zip codes and the Area Deprivation Index (ADI) provides more granular estimates at the block group level. We examined the association of neighborhood disadvantage using the ADI, DCI and patient-level insurance status on 30-day readmission risk after colorectal surgery. Our 677 patient cohort was derived from the 2013–2017 National Surgical Quality Improvement Program at a safety net hospital augmented with EHR data to determine insurance status and 30-day readmissions. Patients’ home addresses were linked to the ADI and DCI. Our cohort consisted of 53.9% males and 63.8% Hispanics with a 22.9% 30-day readmission rate from the date of discharge; >50% lived in highly deprived neighborhoods. Controlling for medical comorbidities and complications, ADI was associated with increased risk of 30-day from the date of discharge readmissions among patients living in medium (OR = 2.15, p= .02) or high (OR = 1.88, p= .03) deprived areas compared to less deprived neighborhoods; but not insurance status or DCI. The ADI identified patients living in deprived communities with increased readmission risk. Our results show that block-group level ADI can potentially be used in risk-adjustment, to identify high-risk patients and to design better care pathways that improve health outcomes.
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影响因子：
39.2
作者：
Kind AJ;Jencks S;Brock J;Yu M;Bartels C;Ehlenbach W;Greenberg C;Smith M
通讯作者：
Smith M
DOI：
10.1016/j.jamcollsurg.2014.12.007
发表时间：
2015-03-01
影响因子：
5.2
作者：
Cologne, Kyle G.;Keller, Deborah S.;Senagore, Anthony J.
通讯作者：
Senagore, Anthony J.
DOI：
10.1016/j.jamcollsurg.2018.10.010
发表时间：
2019-01-01
影响因子：
5.2
作者：
Graham, Laura A.;Wagner, Todd H.;Hawn, Mary T.
通讯作者：
Hawn, Mary T.
影响因子：
2.2
作者：
Kelley, Katherine A.;Young, J. Isaac;Tsikitis, V. Liana
通讯作者：
Tsikitis, V. Liana
DOI：
10.1016/j.jamcollsurg.2016.12.034
发表时间：
2017-04-01
影响因子：
5.2
作者：
Hollis, Robert H.;Graham, Laura A.;Hawn, Mary T.
通讯作者：
Hawn, Mary T.