Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes

Abstract

ImportanceRecent research highlights the association of social determinants of health with health outcomes of patients with type 2 diabetes (T2D).ObjectiveTo examine associations between health-related social needs (HRSNs) and health care quality and utilization outcomes in a Medicare Advantage population with T2D.Design, Setting, and ParticipantsThis cross-sectional study used medical and pharmacy claims data from 2019. An HRSN survey was given between October 16, 2019, and February 29, 2020, to Medicare Advantage beneficiaries. Inclusion criteria were diagnosis of T2D, age of 20 to 89 years, continuous Medicare Advantage enrollment in 2019, and response to the HRSN survey. Data were analyzed between June 2021 and January 2022.ExposuresEnrollment in Medicare Advantage, diagnosis of T2D, and completion of a survey on HRSNs.Main Outcomes and MeasuresQuality outcomes included diabetes medication adherence, statin adherence, completion of a glycated hemoglobin (HbA1c) laboratory test in the past 12 months, and controlled HbA1c. Utilization outcomes included all-cause hospitalization, potentially avoidable hospitalization, emergency department discharge, and readmission.ResultsOf the 21 528 Medicare Advantage beneficiaries with T2D included in the study (mean [SD] age, 71.0 [8.3] years; 55.4% women), most (56.9%) had at least 1 HRSN. Among the population with T2D reporting HRSNs, the most prevalent were financial strain (73.6%), food insecurity (47.5%), and poor housing quality (39.1%). In adjusted models, loneliness (odds ratio [OR], 0.85; 95% CI, 0.73-0.99), lack of transportation (OR, 0.80; 95% CI, 0.69-0.92), utility insecurity (OR, 0.86; 95% CI, 0.76-0.98), and housing insecurity (OR, 0.78; 95% CI, 0.67-0.91) were each associated with lower diabetes medication adherence. Loneliness and lack of transportation were associated with increased emergency visits (marginal effects of 173.0 [95% CI, 74.2-271.9] and 244.6 [95% CI, 150.4-338.9] emergency visits per 1000 beneficiaries for loneliness and transportation, respectively). Food insecurity was the HRSN most consistently associated with higher acute care utilization (marginal effects of 84.6 [95% CI, 19.8-149.4] emergency visits, 30.4 [95% CI, 9.5-51.3] inpatient encounters, and 17.1 [95% CI, 4.7-29.5] avoidable hospitalizations per 1000 beneficiaries).Conclusions and RelevanceIn this cross-sectional study of Medicare Advantage beneficiaries with T2D, some HRSNs were associated with care quality and utilization. The results of the study may be used to direct interventions to the social needs most associated with T2D health outcomes and inform policy decisions at the insurance plan and community level.

Health-Care Utilization and Outcomes in Young Adults With Type 1 and Type 2 Diabetes

“…We can extrapolate from adult data the effect of FI on health-care utilization. Adult DM studies demonstrated similar findings of increased health-care utilization, emergency visits, inpatient encounters, avoidable hospitalizations, and significantly higher annual health-care expenditures relative to those who are not food insecure [ 54 ] and increased nonadherence to DM medication with an adjusted odds ratio of 23.92 times higher compared to those who were food secure [ 55 ].…”

Deprescribing medications among patients with multiple prescribers: A socioecological model

“…47,48 Social factors such as limited access to regular care, insurance, or health literacy may increase the propensity for patients to use acute or urgent care services, thereby increasing the number of prescribers. 49 Given the increased number of specialists per patient, deprescribing interventions must carefully consider the complexity of interpersonal and organizational variables that can influence successful deprescribing. Financial pressures to adhere to disease-focused quality metrics and pay-for-performance models can hinder the identification of potentially unnecessary medications and the associated development of deprescribing solutions.…”

“…Furthermore, evidence‐based guidelines often focus on the management of a single disease rather than multiple chronic conditions, which can contribute to undetected harms when patients with coexisting comorbidities are being treated by multiple specialists 47,48 . Social factors such as limited access to regular care, insurance, or health literacy may increase the propensity for patients to use acute or urgent care services, thereby increasing the number of prescribers 49 …”

The Association Between Hospital-Based Food Pantry Use and Subsequent Emergency Department Utilization Among Medicaid Patients With Diabetes

“…Research has shown that having unmet basic needs, such as food insecurity, is associated with adverse diabetes-related clinical outcomes and poorer access to and quality of care (Berkowitz et al, 2015; Cole Nguyen, 2020; Fitzpatrick, Banegas, Kimes, Papajorgji-Taylor, Fuoco, 2021; Gold et al, 2022; Gucciardi, Vahabi, Norris, Del Monte, Farnum, 2014; Ryan et al, 2023). Furthermore, individuals with food insecurity are significantly more likely to have frequent emergency department (ED) utilization than individuals who are food-secure (Estrella et al, 2021).…”