Integrating Social Determinants of Health Into Risk Adjustment Models: An Opportunity to Improve Care Coordination Strategies For Medicaid Beneficiaries

将健康的社会决定因素纳入风险调整模型：改善医疗补助受益人护理协调策略的机会

• 批准号: 9919325
• 负责人: MELISSA L MCCARTHY
• 金额: $ 35.61万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-14 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9919325
• 关键词: Acute; Address; Adult; Age; Ambulatory Care; Caring; Chronic; Clinical; Country; Data; Diabetes Mellitus; Diagnosis; Disadvantaged; Disease; Drug Prescriptions; Emergency department visit; Enrollment; Equation; Expenditure; Female; Financial Hardship; Food; Future; Gender; Health; Health Care Costs; Health Services; Health behavior; Healthcare; Healthcare Systems; Hospitalization; Housing; Infection; Injury; Interview; Linear Models; Link; Measures; Medicaid; Medical; Mental Health; Modeling; Occupations; Onset of illness; Outcome; Population; Prospective cohort study; Reporting; Research; Risk; Risk Adjustment; Risk stratification; Role; Sampling; Sampling Studies; Services; Social Processes; Social support; Socioeconomic Status; Stress; System; Telephone; Telephone Interviews; Vulnerable Populations; Washington; Work; acute care; beneficiary; care coordination; care delivery; care systems; clinical risk; cost; disability payment; effective intervention; experience; follow-up; health assessment; health care service utilization; health disparity; health inequalities; improved; information model; inpatient service; patient subsets; population health; predictive modeling; programs; respiratory; social; social health determinants; social inclusion; socioeconomics

PROJECT SUMMARY The purpose of this project is to provide evidence of the value of measuring social determinants of health (SDH) in the Medicaid population. This project will demonstrate that risk stratification using traditional risk adjustment models (RAMs) can be improved significantly with the inclusion of SDH information in addition to the information these models typically rely on: age, gender, and medical diagnoses. In addition, this project will quantify incident and cumulative risk of various SDH factors on the onset of incident disease within a one year period, highlighting the need to address social and environmental disadvantages that drive health inequities so that Medicaid can achieve the triple aim: improved care and population health at lower cost. To accomplish our objectives, we will conduct a prospective cohort study that will enroll 9,600 adult Medicaid beneficiaries treated at two medical facilities located in Washington, DC. The study sample will be predominately black (i.e. 90%) with a slightly higher percentage of females (60%). Medicaid beneficiaries who participate will complete a comprehensive SDH assessment during their initial medical encounter that will include validated SDH questions that measure housing stability, food availability, financial strain, health behaviors, social support, etc. Six and 12 months after enrollment, we will conduct a telephone follow-up interview with subjects to determine if there have been any major changes to their social and environmental circumstances. We will merge the interview data with DC Medicaid claims data (two years pre and one year post enrollment date). We will use the prior claims data to characterize health care utilization and expenditures by: (1) different types of service (i.e., inpatient care, outpatient care, prescription drugs, etc); (2) acute versus chronic treatments; and (3) preventable versus non preventable. We will risk stratify the study sample using three RAMs (i.e., Chronic Disability and Payment System, The Johns Hopkins Adjusted Clinical Groups (ACG) System, and 3M Clinical Risk Groups (CRGs). We will compare predictions of next year's health care utilization and expenditures for each RAM using generalized linear models that include or exclude SDH variables. We will also quantify the incident and cumulative risk associated with different SDH factors on disease onset during a one year follow-up period using generalized estimating equation models. To reduce the large health inequities that exist in the Medicaid population, this project aims to demonstrate the critical need to measure and address SDH in our care delivery strategies.

项目概要 该项目的目的是提供衡量健康社会决定因素价值的证据 (SDH) 医疗补助人群。该项目将证明使用传统风险进行风险分层 调整模型（RAM）可以通过包含 SDH 信息以及 这些模型通常依赖的信息：年龄、性别和医疗诊断。另外，这个项目 将量化一年内各种 SDH 因素对疾病发生的事件和累积风险 年期间，强调需要解决促进健康的社会和环境不利因素 不平等现象，以便医疗补助能够实现三重目标：以更低的成本改善护理和人口健康。 为了实现我们的目标，我们将进行一项前瞻性队列研究，将招募 9,600 名成人医疗补助 受益人在华盛顿特区的两家医疗机构接受治疗。研究样本将是 以黑人为主（即 90%），女性比例稍高（60%）。医疗补助受益人 参与者将在初次医疗接触期间完成全面的 SDH 评估，这将 包括经过验证的 SDH 问题，用于衡量住房稳定性、食品供应、财务压力、健康状况 行为、社会支持等。入学后6个月和12个月，我们将进行电话随访 采访对象以确定他们的社会和环境是否发生了重大变化 情况。 我们将把访谈数据与 DC Medicaid 索赔数据合并（注册前两年和注册后一年） 日期）。我们将使用先前的索赔数据通过以下方式来描述医疗保健的利用和支出：(1) 不同类型的服务（即住院护理、门诊护理、处方药等）； (2) 急性与慢性 治疗； (3) 可预防与不可预防。我们将使用三个风险对研究样本进行分层 RAM（即慢性残疾和支付系统、约翰霍普金斯大学调整临床组 (ACG) 系统和 3M 临床风险组 (CRG)。我们将比较明年医疗保健的预测 使用包含或不包含 SDH 的广义线性模型计算每个 RAM 的利用率和支出 变量。我们还将量化与不同 SDH 因素相关的事件和累积风险 使用广义估计方程模型在一年的随访期内疾病发作。 为了减少医疗补助人群中存在的巨大健康不平等，该项目旨在证明 在我们的护理服务战略中衡量和解决 SDH 的迫切需要。

项目成果

The Influence of Social Determinants of Health on Emergency Departments Visits in a Medicaid Sample.

健康决定因素对医疗补助样本中急诊室访问的影响。

• DOI: 10.1016/j.annemergmed.2020.11.010
• 发表时间: 2021-05
• 期刊: ANNALS OF EMERGENCY MEDICINE
• 影响因子: 6.2
• 作者: McCarthy, Melissa L.;Zheng, Zhaonian;Wilder, Marcee E.;Elmi, Angelo;Li, Yixuan;Zeger, Scott L.
• 通讯作者: Zeger, Scott L.

Relationship Between Social Determinants of Health and Antihypertensive Medication Adherence in a Medicaid Cohort.

• DOI: 10.1161/circoutcomes.121.008150
• 发表时间: 2022-03
• 期刊: Circulation. Cardiovascular quality and outcomes
• 作者: Wilder ME;Zheng Z;Zeger SL;Elmi A;Katz RJ;Li Y;Mccarthy ML
• 通讯作者: Mccarthy ML

Latent Class Analysis to Represent Social Determinant of Health Risk Groups in the Medicaid Cohort of the District of Columbia.

• DOI: 10.1097/mlr.0000000000001468
• 发表时间: 2021-03-01
• 期刊: Medical care
• 影响因子: 3
• 作者: McCarthy ML;Zheng Z;Wilder ME;Elmi A;Kulie P;Johnson S;Zeger SL
• 通讯作者: Zeger SL

Social Determinants of Health Influence Future Health Care Costs in the Medicaid Cohort of the District of Columbia Study.

哥伦比亚特区研究的医疗补助队列中健康的社会决定因素影响未来的医疗保健费用。

• DOI: 10.1111/1468-0009.12582
• 发表时间: 2022
• 期刊: The Milbank quarterly
• 作者: McCarthy,MelissaL;Li,Yixuan;Elmi,Angelo;Wilder,MarceeE;Zheng,Zhaonian;Zeger,ScottL
• 通讯作者: Zeger,ScottL

Social determinants of health impacting adherence to diabetic retinopathy examinations.

• DOI: 10.1136/bmjdrc-2021-002374
• 发表时间: 2021-09
• 期刊: BMJ open diabetes research & care
• 影响因子: 4.1
• 作者: Cai CX;Li Y;Zeger SL;McCarthy ML
• 通讯作者: McCarthy ML