Association Between Self-reported Health-Related Social Needs and Acute Care Utilization Among Older Adults Enrolled in Medicare Advantage

Canterberry, Melanie; Figueroa, José F.; Long, Charron; Hagan, Angela; Gondi, Suhas; Bowe, Andy; Franklin, Stephanie M; Renda, Andrew; Shrank, William H.; Powers, Brian

doi:10.1001/jamahealthforum.2022.1874

Cited by 25 publications

(45 citation statements)

References 30 publications

(69 reference statements)

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“…Our search yielded 14,852 citations. After duplicate removal ( n = 3459) and screening, eight studies 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 met the criteria to be reviewed (Figure 1 ). All of the studies were published from 2020 to 2022.…”

Section: Resultsmentioning

confidence: 99%

“…All of the studies were undertaken in the United States. The sample sizes ranged from 226 9 to 56,155 15 participants. Key study findings are summarized in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…[5][6][7] In recent years, several studies have demonstrated the substantial impact of social determinants of health (SDOH) on hospitalization rates. [8][9][10][11][12][13][14][15] The World Health Organization (WHO) 16 defines the SDOH as "the conditions in which people are born, grown, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life." These conditions are influenced by a broader set of factors, including living conditions, economy, social policies, politics, and commercial determinants of health.…”

Section: Introductionmentioning

confidence: 99%

“… 5 , 6 , 7 In recent years, several studies have demonstrated the substantial impact of social determinants of health (SDOH) on hospitalization rates. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 …”

Section: Introductionmentioning

confidence: 99%

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The association of patient‐reported social determinants of health and hospitalization rate: A scoping review

Ardekani

Fereidooni

Heydari

et al. 2023

Health Science Reports

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Introduction The interplay between social determinants of health (SDOH) and hospitalization is significant as targeted interventions can improve the social status of the individuals. This interrelation has been historically overlooked in health care. In the present study, we reviewed studies in which the association between patient‐reported social risks and hospitalization rate was assessed. Method We performed a scoping literature review of articles published until September 1, 2022 without time limit. We searched PubMed, Embase, Web of Science, Scopus, and Google Scholar to find relevant studies using terms representing “social determinants of health” and “hospitalization.” Forward and backward reference checking was done for the included studies. All studies that used patient‐reported data as a proxy of social risks to determine the association between social risks and hospitalization rates were included. The screening and data extraction processes were done independently by two authors. In case of disagreement, senior authors were consulted. Results Our search process retrieved a total of 14,852 records. After the duplicate removal and screening process, eight studies met the eligibility criteria, all of which were published from 2020 to 2022. The sample size of the studies ranged from 226 to 56,155 participants. All eight studies investigated the impact of food security on hospitalization, and six investigated economic status. In three studies, latent class analysis was applied to divide participants based on their social risks. Seven studies found a statistically significant association between social risks and hospitalization rates. Conclusion Individuals with social risk factors are more susceptible to hospitalization. There is a need for a paradigm shift to meet these needs and reduce the number of preventable hospitalizations.

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Section: Resultsmentioning

confidence: 99%

“…All of the studies were undertaken in the United States. The sample sizes ranged from 226 9 to 56,155 15 participants. Key study findings are summarized in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 5 , 6 , 7 In recent years, several studies have demonstrated the substantial impact of social determinants of health (SDOH) on hospitalization rates. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 …”

Section: Introductionmentioning

confidence: 99%

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The association of patient‐reported social determinants of health and hospitalization rate: A scoping review

Ardekani

Fereidooni

Heydari

et al. 2023

Health Science Reports

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“…Finally, ACSCs are limited in their ability to study the quality of care of Medicare Advantage plans, with limitations including associations with nonclinical factors, eg, social vulnerability and economic deprivation. 32 , 33 For this reason, we included county fixed-effects to limit analyses of beneficiaries by Medicare insurance within geographic areas of similar social vulnerability. Furthermore, this study cannot reliably assess which hospitalizations were necessary vs potentially wasteful, nor which encounters were appropriately triaged to observation status or directly treated and discharged from the ED.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Potentially Avoidable Acute Care Utilization Among Patients Insured by Medicare Advantage vs Traditional Medicare

et al. 2023

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ImportanceMedicare Advantage plans have strong incentives to reduce potentially wasteful health care, including costly acute care visits for ambulatory care−sensitive conditions (ACSCs). However, it remains unknown whether Medicare Advantage plans lower acute care use compared with traditional Medicare, or if it shifts patients from hospitalization to observation stays and emergency department (ED) direct discharges.ObjectiveTo determine whether Medicare Advantage is associated with differential utilization of hospitalizations, observations, and ED direct discharges for ACSCs compared with traditional Medicare.Design, Setting, and ParticipantsCross-sectional study of US Medicare Advantage vs traditional Medicare beneficiaries from January 1 to December 31, 2018. Poisson regression models were used to compare risk-adjusted rates of Medicare Advantage vs traditional Medicare, controlling for patient demographic characteristics and clinical risk and including county fixed-effects. Data were analyzed between April 2021 and November 2022.Main Outcomes and MeasuresHospitalizations, observation stays, and ED direct discharges for ACSCs.ResultsThe study sample comprised 2 665 340 Medicare Advantage patients (mean [SD] age, 72.7 [9.8] years; 1 504 519 [56.4%] women; 1 859 067 [69.7%] White individuals) and 7 981 547 traditional Medicare patients (mean [SD] age, 71.2 [11.8] years; 4 232 201 [53.0%] women; 6 176 239 [77.4%] White individuals). Medicare Advantage patients had lower risk of hospitalization for ACSCs compared with traditional Medicare patients (relative risk [RR], 0.94; 95% CI, 0.93-0.95), primarily owing to fewer hospitalizations for acute conditions (eg, pneumonia). Medicare Advantage patients had a higher risk of ED direct discharges (RR, 1.44; 95% CI, 1.43-1.45) and observation stays (RR, 2.38; 95% CI, 2.34-2.41) for ACSCs vs traditional Medicare patients. Overall, Medicare Advantage patients were at higher risk of needing care for an ACSC (hospitalization, ED direct discharge, or observation stay) than traditional Medicare patients (RR, 1.30; 95% CI, 1.30-1.31). Within the Medicare Advantage population, patients in health maintenance organizations (HMOs) were at lower risk of ACSC-related hospitalization compared with patients in its preferred provider organizations (RR, 0.96; 95% CI, 0.95-0.98); however, those in the HMOs had a higher risk of ED direct discharge (RR, 1.08; 95% CI, 1.07-1.09) and observation stay (overall RR, 1.10; 95% CI, 1.02-1.12).Conclusions and RelevanceThe findings of this cross-sectional study of Medicare Advantage and traditional Medicare patients with ACSCs indicate that apparent gains in lowering rates of potentially avoidable acute care have been associated with shifting inpatient care to settings such as ED direct discharges and observation stays.

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Tying Innovation to Evaluation and Accountability in Programs to Address Intersecting Health and Social Needs

Baicker

McConnell

2022

JAMA Health Forum

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Association Between Self-reported Health-Related Social Needs and Acute Care Utilization Among Older Adults Enrolled in Medicare Advantage

Abstract: This cross-sectional study examines the association between self-reported health-related social needs and acute care utilization among older adults enrolled in Medicare Advantage.

Cited by 25 publications

References 30 publications

The association of patient‐reported social determinants of health and hospitalization rate: A scoping review

The association of patient‐reported social determinants of health and hospitalization rate: A scoping review

Evaluation of Potentially Avoidable Acute Care Utilization Among Patients Insured by Medicare Advantage vs Traditional Medicare

Tying Innovation to Evaluation and Accountability in Programs to Address Intersecting Health and Social Needs

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