Accounting for Social Risk Factors in Medicare Payment (2017) / Chapter Skim
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A2: Social Risk Factors
A2: Social Risk Factors
Pages 159-206
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Residential and community context. The five social risk factors may influence health care and health through a number of potential pathways.
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The five social risk factors may also influence health literacy, the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (NASEM, 2015)
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Several review articles examined the influence of SEP on health care use and health care outcomes, but each found only a small number of studies. Two reviews examined the effect of SEP on readmissions, one of which found no association between education and readmissions after acute myocardial infarction (AMI)
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. Fewer articles examined health care outcomes, including health outcomes and patient experiences.
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. In terms of patient experience, one study found that excellent ratings of care were significantly lower among colorectal cancer patients, but not among lung cancer patients, and also reported no differences in experiences of interpersonal care by income (Ayanian et al., 2010)
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. The committee made the following findings: • The committee identified literature indicating that income may influence health care utilization, clinical processes of care, costs, health outcomes, and patient experience.
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. The committee made the following finding: • The committee identified literature indicating that education may influence health care utilization, health outcomes, and patient experience.
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. The committee made the following finding: • The committee identified literature indicating that occupation may influence health care utilization, health outcomes, and patient experience.
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. Several review articles examined race and ethnicity effects on health care use and health care outcomes.
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. Of three review articles examining effects of race and ethnicity on readmissions, one reported that non-whites had higher readmission rates for both pneumonia and heart failure (Calvillo-King et al., 2013)
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. In terms of other utilization outcomes, one study found that blacks had significantly increased all-cause hospitalization over 2.5 year follow up of heart failure patients (Mentz et al., 2013)
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and another found no differences between blacks and whites in 2.5-year follow up after ischemic heart disease treatment (Cromwell et al., 2005) , while one found that blacks had significantly increased mortality over 2.5-year follow up of heart failure patients (Mentz et al., 2013)
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In terms of post-acute outcomes, one study reported that blacks, Hispanics, and other non-whites had significantly worse functional outcomes after stroke (Ottenbacher et al., 2008) , but another study found no significant differences in functional status at discharge between black and whites after a moderate or severe stroke (Putman et al., 2010)
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. With respect to ambulatory care outcomes, two studies found that blacks had worse control of cardiovascular disease risk factors (Rooks et al., 2008; Wendel et al., 2006)
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. The committee made the following finding: • The committee identified literature indicating that race and ethnic ity may influence health care utilization, clinical processes of care, costs, health outcomes, patient safety, and patient experience.
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. Several studies examined language and patient experiences of care.
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. The committee made the following finding: • The committee identified literature indicating that language may influence health care utilization, clinical processes of care, health outcomes, and patient experience.
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The committee made the following finding: • The committee identified literature indicating that nativity may influence clinical processes of care and patient experience.
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. A small number of articles examined effects of gender on patient experience.
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. The committee made the following finding: • The committee identified literature indicating that gender may influence clinical processes of care and patient experience.
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. The committee made the following finding: • The committee identified literature indicating that marital status may influence health care utilization, clinical processes of care, costs, health outcomes, and patient experience.
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The committee made the following finding: • The committee identified literature indicating that living alone may influence health care utilization, clinical processes of care, and health outcomes. Social Support Social support is a key function of social relationships and includes the provision of emotional and appraisal support through caring and concern, as well as more tangible instrumental and informational support such as the provision of material or other practical support (House et al., 1988b)
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found that among breast cancer patients some types of social support but not others were associated with satisfaction with their physician and problems interacting with their medical team. The committee made the following findings: • The committee identified literature indicating that social support may influence heath care utilization, clinical processes of care, health outcomes, and patient experience.
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Community composition has been shown to affect health behaviors and other risk factors, morbidity, and mortality (Diez Roux and Mair, 2010; IOM, 2014a)
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. Education Few studies examined the influence of neighborhood educational attainment as a proxy for individual education on health care utilization and health care outcomes.
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. Community composition as a measure of group-level effects Income A number of studies examined the effects of area-level income, measured using median household income, and poverty, measured as relative to the federal poverty level, on health care utilization and health care outcomes.
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Two studies found that low area-level SEP was associated with increased readmissions from heart failure (Bikdeli et al., 2014) from all
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Other compositional factors Two studies examined the effect of other compositional factors on health care use. One article found that the percent of residents never married, the number of Medicare beneficiaries per capita, the number of nursing home residents with pressure sores, and the number of nursing home residents with increased need for help were associated with increased readmissions for AMI, heart failure, and pneumonia, whereas the number of nursing home patients who were depressed or anxious was associated with decreased risk of readmission (Herrin et al., 2015)
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. Transportation Transportation can be a barrier to health care access and may include both availability of public transportation and travel distance; identified studies examining the influence of transport on health care utilization and health care outcomes focused on the latter.
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. Another study reported that towns closer to a hospital had significantly higher hospitalization rates for heart failure (Harris et al., 2008)
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• The committee identified literature indicating that urbanization may influence health care utilization, clinical processes of care, costs, and patient experience.
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It does so also because it is affected by social risk factors, and the literature supports a role for health literacy in health care outcomes and quality measures. The committee also included numeracy as a related concept.
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The committee made the following finding: • The committee identified literature indicating that health literacy may influence health care utilization, clinical processes of care, cost, and patient experience. CONCLUDING REMARKS It is important to note that although often correlated (e.g., SEP is correlated with race/ethnicity and both race/ethnicity and income are correlated with community context)
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2013. Health literacy and health outcomes in diabetes: A systematic review.
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2015. Health literacy and 30-day hospital readmission after acute myocardial infarction.
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2015. Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: Evidence from a systematic review.
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2011. Socioeconomic status, Medicaid coverage, clinical comorbidity, and rehospitalization or death after an incident heart failure hospitalization atherosclerosis risk in communities cohort (1987 to 2004)
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2008. Myocardial infarction and heart failure hospitalization rates in Maine, USA -- variability along the urban–rural continuum.
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2014. Risk factors for early hospital readmission in low-income elderly adults.
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2011. Gender, race, and socioeconomic status affects out i comes after lung cancer resections in the United States.
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2005. The importance and impact of social support on outcomes in patients with heart failure: An overview of the literature.
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2004. Social support and its relationship to morbidity and mortality after acute myocardial infarction: Systematic overview.
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2011. Readmission rates for Hispanic Medicare beneficiaries with heart failure and acute myocardial infarction.
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2007. Factors underlying racial dispari ties in hospital care of congestive heart failure.
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2002. Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans.
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2006. Racial and ethnic disparities in the control of cardiovascular disease risk factors in southwest American veterans with type 2 diabetes: The diabetes outcomes in veterans study.
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2013. An examination of racial differences in process and outcome of colorectal cancer care quality among users of the Veterans Affairs health care system.
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