Socioeconomic Status and Health Care Outcomes

Jianhui Hu, Ph.D., Research AssociateCenter for Health Policy & Health Services Research

Henry Ford Health SystemOctober 16th, 2014

Introduction Recent studies on health disparities Socioeconomic status (SES) and

readmissions

Agenda

Led by Center Director Dr. David Nerenz Health policy research: takes on the role of

leading and coordinating health policy analysis for Henry Ford Health System since March 2010

Health services research: cancer prevention and control, patient-physician communication, pharmacogenomics and chronic disease, mental health services, and screening and treatment of chronic hepatitis

Center for Health Policy & Health Services Research

SES and readmissions Effects of the ACA’s benefit expansions on

preventive service utilizations and disparities in utilizations

Other internal data analyses of disparities in health outcome/performance measures across HFHS hospital/clinics sites serving communities with different SES

Recent Studies on Health Disparities

Association between SES and HEDIS Scores at the Clinic Site Level

.65

.7.7

5.8

.85

.9

20000 40000 60000 80000 100000Median HH Income

Breast Cancer Screening Fitted values

.6.6

5.7

.75

.8.8

5

20000 40000 60000 80000 100000Median HH Income

Colorectal Cancer Screening Fitted values

.5.6

.7.8

20000 40000 60000 80000 100000Median HH Income

Comprehensive Diabetes Care -HbA1c < 8% Fitted values

.3.4

.5.6

20000 40000 60000 80000 100000Median HH Income

Comprehensive Diabetes Care - LDL <100mg/dL Fitted values

Socioeconomic Status and Readmissions

Background: CMS began to reduce payments to hospitals with excess 30-day readmissions. One key debate about the policy revolves around the absence of any adjustment for the patients’ SES. The rationale is that differences in the quality of care received by groups of patients of different SES can contribute to readmissions.

Objectives: Better understand how various SES factors influenced the probability of readmission using data from a single urban teaching hospital.

Socioeconomic Status and Readmissions

Readmission Penalties in Three Years

Inclusions: Medicare fee-for-service; 65+; discharged from Henry Ford Hospital during 2010

Exclusions: died in the hospital; discharged AMA; admitted for cancer or rehabilitation care; admitted with a primary diagnosis of psychiatric disease

Data Source: Patient level: Henry Ford Hospital’s Corporate Data

Store Neighborhood level: Census 2000 Readmissions: CMS “dry run report”, including all

unplanned 30-day readmissions to any hospital

Data

Multivariate logistic regressions were used to examine the associations between 30-day readmissions and patients' and their neighborhoods' characteristics. We adjusted both for patients’ discharge conditions and for comorbidities identified from the index and historical admission records.

Methods

Results: Study Cohort

Socioeconomic disparities in readmission risk exist even after variations in practice patterns across hospitals have been eliminated. The effects of socioeconomic variables were not confounded with variations in hospital resources. Further, the associations reported here occurred in spite of efforts to prevent readmissions in general and to reduce disparities in readmission rates.

The question of whether hospitals should be held accountable for the effects of factors such as poverty, illiteracy, or lack of social support in the patients and communities they serve has not yet been resolved. The present findings underscore the importance of reaching consensus on this issue.

Limitations: 1) limited generalizability; 2) risk adjustment only used inpatient diagnoses from Henry Ford Health System; and 3) unable to include some important post-discharge factors.

Discussions & Conclusions

Next Steps …