Association of Socioeconomic Area Deprivation Index with Hospital Readmissions After Colon and Rectal Surgery.

Autor: Ghirimoldi FM; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA., Schmidt S; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA., Simon RC; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA., Wang CP; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA.; South Texas Veterans Health Care System, San Antonio, TX, USA., Wang Z; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA., Brimhall BB; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA.; University Health System, San Antonio, TX, USA., Damien P; McCombs School of Business, Department of Information, Risk, & Operations Management, University of Texas, Austin, TX, USA., Moffett EE; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA., Manuel LS; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA., Sarwar ZU; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA., Shireman PK; Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA. Shireman@uthscsa.edu.; South Texas Veterans Health Care System, San Antonio, TX, USA. Shireman@uthscsa.edu.; University Health System, San Antonio, TX, USA. Shireman@uthscsa.edu.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2021 Mar; Vol. 25 (3), pp. 795-808. Date of Electronic Publication: 2020 Sep 08.
DOI: 10.1007/s11605-020-04754-9
Abstrakt: Background: Risk adjustment for reimbursement and quality measures omits social risk factors despite adversely affecting health outcomes. Social risk factors are not usually available in electronic health records (EHR) or administrative data. Socioeconomic status can be assessed by using US Census data. Distressed Communities Index (DCI) is based upon zip codes, and the Area Deprivation Index (ADI) provides more granular estimates at the block group level. We examined the association of neighborhood disadvantage using the ADI, DCI, and patient-level insurance status on 30-day readmission risk after colorectal surgery.
Methods: Our 677 patient cohort was derived from the 2013-2017 National Surgical Quality Improvement Program at a safety net hospital augmented with EHR data to determine insurance status and 30-day readmissions. Patients' home addresses were linked to the ADI and DCI.
Results: Our cohort consisted of 53.9% males and 63.8% Hispanics with a 22.9% 30-day readmission rate from the date of discharge; > 50% lived in highly deprived neighborhoods. Controlling for medical comorbidities and complications, ADI was associated with increased risk of 30 days from the date of discharge readmissions among patients living in medium (OR = 2.15, p = .02) or high (OR = 1.88, p = .03) deprived areas compared to less-deprived neighborhoods, but not insurance status or DCI.
Conclusions: The ADI identified patients living in deprived communities with increased readmission risk. Our results show that block-group level ADI can potentially be used in risk adjustment, to identify high-risk patients and to design better care pathways that improve health outcomes.
Databáze: MEDLINE
Externí odkaz: