Residents of Disadvantaged Neighborhoods At Increased Risk of Hospital Readmission

Amy Jo Haavisto Kind, M.D., Ph.D. Assistant Professor, Division of Geriatrics University of Wisconsin School of Medicine and Public Health William S Middleton VA- GRECC Madison, WI 53705MedicalResearch.com Interview with:
Amy Jo Haavisto Kind, M.D., Ph.D.

Assistant Professor, Division of Geriatrics
University of Wisconsin School of Medicine and Public Health
William S Middleton VA- GRECC Madison, WI 53705

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Kind: By way of background:

Socioeconomic disadvantage is a complex theoretical concept which describes the state of being challenged by low income, limited education and substandard living conditions for both the person and his or her neighborhood or social network.

It is plausible that disadvantage would influence rehospitalization because vulnerable patients depend upon their neighborhood supports for stability, generally, and these needs are likely to be increased after a hospitalization.

Yet, it is difficult to assess socioeconomic disadvantage during clinical encounters, yet the ADI provides an option for beginning such a discussion.

ADI or Area Deprivation Index is a composite measure of neighborhood disadvantage, similar to other geographic measures of disadvantage employed in other countries for resource planning and health policy development.

Dr. Kind: The results demonstrated:

Residence within the most disadvantaged 15% of neighborhoods was associated with an increased risk for 30-day rehospitalization, increasing from 22-27% with worsening ADI.

When comparing 2 patients who are otherwise the same but differ by reason of neighborhood deprivation index and arrive at the same hospital, the association of deprivation and readmission remains.

Patients in the most disadvantaged neighborhoods were more apt to be black, be on Medicaid and have greater rates of comorbid conditions. Most patients in the most disadvantaged 5% of neighborhoods lived in urban core areas, however those in the second- and third- most disadvantage 5% groups were most likely to live in rural areas or large towns.

Prevalence of disadvantaged neighborhoods vary by geographic region.

Nearly 1/3 of eligible patients residing in rural areas lived in neighborhoods that were among the most disadvantaged.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Kind: The main message of this study is:

Residence within a disadvantaged neighborhood is a rehospitalization predictor of magnitude similar to chronic pulmonary disease.

Living in a severely disadvantaged neighborhood predicts rehospitalization as powerfully as the presence of serious illnesses, like chronic pulmonary disease.

Patients from disadvantaged neighborhoods are at greater risk for rehospitalization regardless of their treating hospital.

Residence within a disadvantaged US neighborhood is a rehospitalization predictor of magnitude similar to important chronic diseases (that we would not dream of ignoring).

Measure of neighborhood disadvantage, such as the ADI, are easily created using data already routinely collected by the US government and freely available to the public. These may be useful in targeting patient- and community-based initiatives designed to lower unwanted rehospitalizations.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Kind: Our findings suggest that neighborhood disadvantage is associated with a threshold effect, with strong and increasing risk for rehospitalization for residents of the most disadvantaged 15%. It is clear that social support and a patient’s environment can influence clinical outcomes, including rehospitalization.

Unfortunately, however, issues of social disadvantage are often overlooked.  The use of a measure like the ADI could enable early targeting of transitional care services, prompt discussions of social supports, and activate additional community resources.  It could also help in refining characterizations of hospital service regions, and be used to identify neighborhoods that could most benefit from additional outreach and services, or innovative programs, funding.

Future research is needed to explore use of the ADI as an adjuster for the current Medicare hospital-based readmissions measures/penalties.

Citation:

Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization
Amy J.H. Kind, MD, PhD; Steve Jencks, MD, MPH; Jane Brock, MD, MSPH; Menggang Yu, PhD; Christie Bartels, MD; William Ehlenbach, MD, Msc; Caprice Greenberg, MD; and Maureen Smith, MD, MPH, PhD

Ann Intern Med. 2014;161(11):765-774. doi:10.7326/M13-2946

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