Social determinants of health Archives - Page 2 of 2 - Safety-Net Association of Pennsylvania

Journal Looks at Health Disparities

The journal Health Affairs looks at health disparities and social determinants of health in its Augusts 2016 issue.
The article “Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health” looks at interventions that focus on social determinants of health, addresses how such interventions can reduce health disparities and improve population health, and considers the challenges to implementing such approaches. Find it here.
The article “Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research” also looks at health care disparities and how to address them, focusing on cardiovascular disease and cancer. Find it here.
Communities served by Pennsylvania’s safety-net hospitals usually suffer from the very health disparities policy-makers are currently working to address.

PA Safety Net Admin2016-09-01T06:00:22+00:00September 1st, 2016|Pennsylvania safety-net hospitals|Comments Off

Socio-Economic Factors Leading Cause in Pediatric Asthma Readmissions

African-American children suffering from asthma are readmitted to hospitals more often than other children primarily because of socio-economic factors, a new study published in JAMA Pediatrics has concluded.
In a study conducted in Cincinnati, according to the report, “Socioeconomic hardship variables explained 53% of the observed disparity” in readmissions among African-American children with asthma. The study also found that

A total of 80% of the observed readmission disparity between African American and white children could be explained after statistically balancing available biologic, environmental, disease management, access to care, and socioeconomic and hardship variables across racial groups.

These findings are especially relevant to Pennsylvania safety-net hospitals because the communities they serve often have especially large numbers of low-income and low-income African-American children.
Read more about the study, its findings, and its implications in the JAMA Pediatrics article “Explaining Racial Disparities in Child Asthma Readmission Using a Causal Inference Approach, “which can be found here.

PA Safety Net Admin2016-05-19T06:00:21+00:00May 19th, 2016|Uncategorized|Comments Off

Academy Offers Practices to Improve Care for Disadvantaged Patients

The National Academies of Science, Engineering, and Medicine has published a new report that acknowledges the challenges faced by hospitals that care for socio-economically challenged patients and offers suggestions for how to serve those patients more effectively.
The report, Systems Practices for the Care of Socially At-Risk Populations, is the second in a projected series of five reports on the subject.
The study notes that

Emerging evidence suggests that providers disproportionately serving patients with social risk factors for poor health outcomes may be more likely to fare poorly on quality rankings and to receive financial penalties, and less likely to receive financial rewards.

Because the study did not include any original empirical research and is based instead on literature reviews and case studies, the Academy declined to suggest best practices for serving this challenging population but did offer six recommendations for improving care to socio-economically disadvantaged communities:

Commitment to health equity. Value and promote health equity and hold yourself accountable.
Data and measurement. Understand your population’s health, risk factors, and patterns of care.
Comprehensive needs assessment. Identify, anticipate, and respond to clinical and social needs.
Collaborative partnerships. Collaborate within and across provider teams and service sectors to deliver care.
Care continuity. Plan care and transitions in care to prepare for patients’ changing clinical and social needs.
Engaging patients in their care. Design individualized care to promote the health of individuals in the community setting.

The study also acknowledged the importance of adequate provider (primarily Medicare) payments in serving such a challenging population:

Both the availability of resources and alignment of financial incentives are prerequisites for the adoption and sustainability of these practices…Resources can provide the incentives to reduce disparities by targeting interventions at socially at-risk populations and incorporating equitable care and outcomes into accountability processes. Interventions that improve health and quality of care or reduce utilization and cost are only sustainable if the provider’s profits are higher with the intervention than without. Most of the efforts presented by the committee involve fixed costs and potentially shared benefits across multiple payers, so their economic feasibility depends on Medicare’s payment system and that of other payers. Environments in which a greater share of a provider’s revenue derives from payments related to health outcomes will make it more sustainable for them to invest in programs that improve quality and reduce cost.

The communities described in the report are the very types of communities Pennsylvania’s safety-net hospitals serve.
To learn more about what the Academy learned and what it has recommended, go here to see its news release accompanying publication of the report and go here to see the report itself.

PA Safety Net Admin2016-04-12T06:00:50+00:00April 12th, 2016|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

New Approaches to Readmissions Reduction Program?

While Medicare’s readmissions reduction program has produced a decline in the number of Medicare readmissions within 30 days of discharge, critics – among them many safety-net hospitals – argue that the program is unfair to hospitals that serve especially large numbers of low-income patients whose distinct needs pose a greater risk of requiring readmission to address.
In a new report, the journal Health Affairs notes that such arguments have given rise to a number of proposals for possible changes in the readmissions reduction program. Among them, the Medicare Payment Advisory Commission

…has proposed a revision to the method for calculating readmissions. Rather than including patient SES [note: socio-economic status] in the risk-adjustment step, which MedPAC argues would take years to develop empirically and could mask true quality disparities, MedPAC suggests grouping hospitals into peer groups based on their share of low-income Medicare patients and then set readmissions targets for each peer group. Put another way, hospitals with similar shares of low-income patients would be compared with each other instead of all hospitals.

Other suggestions for modifying the readmissions reduction program include shortening the window on readmissions, which might better reflect the quality of care a hospital provides rather than the nature of the patients it serves; changing the quality measures on which hospitals are judged, choosing new measures that might be less sensitive to socio-economic factors; and providing additional financial or other support to hospitals that serve especially large numbers of low-income patients.
To learn more about the kinds of challenges Medicare’s hospital readmissions reduction program pose and what might be done to address them without discarding the program entirely, go here for the Health Affairs article “The Challenges Of Rewarding Value Over Volume Without Penalizing Safety-Net Hospitals.”

PA Safety Net Admin2016-04-07T06:00:04+00:00April 7th, 2016|Affordable Care Act, Medicare|Comments Off

Safety-Net Hospitals’ Readmissions Challenge

The March edition of the journal Health Affairs offers a compelling snapshot of a type of patient many safety-net hospitals serve on an almost daily basis: the “superutilizer” who lacks the ability and resources to address his own medical needs.
The article “Mr. G And The Revolving Door: Breaking The Readmission Cycle At A Safety-Net Hospital” tells the story of a patient who

…had been using drugs and alcohol since his teenage years, and he was addicted to crack cocaine and alcohol…He had been released from prison six months before we first met him, without any basic resources to help him transition back into society – not even a state ID. Lacking this fundamental necessity, he could not apply for state health insurance or a Supplemental Nutrition Assistance Program card to receive food stamps. As an ex-felon with no income, he couldn’t find a place to live. He told us he was living on the streets, where he spent his days panhandling and using the money he got to buy tacos from street vendors and hash browns from McDonald’s.

Mr. G’s first several admissions to our hospital were similar. He would walk into the emergency department, unable to breathe, and would be admitted to the hospital for treatment related to heart failure. He had a complex medical history including diabetes and extremely poor heart function – which was complicated by a clot in his heart that required the chronic use of blood thinners. Furthermore, he suffered from schizophrenia.

The hospital faced a problem in addition to caring for Mr. G.

The problem with Mr. G’s admissions, aside from their drain on hospital resources, is that to motivate hospitals to improve care, Medicare penalizes hospitals for certain patients who are readmitted within thirty days. This policy assumes that all patients have the means and internal resources to care for themselves effectively and that hospitals, by simply adhering to best practices of medical management, can avoid redundant care. Medicare fails to consider the complications imposed by poverty and the significant burden safety-net hospitals face in trying to address overwhelming social issues.

A typical admission was set in motion by Mr. G’s nonadherence to his medications, poor diet, substance abuse, or a combination of the three. With each admission, additional problems and complications cropped up that extended his stay.

The problems continue, and the article explains that

Patients like Mr. G frustrate health care providers. These patients are often dismissed as being nonadherent, and their psychosocial needs go unrecognized. Their daily challenges are compounded by poverty, mental illness, substance abuse, lack of social support, lack of transportation, and unstable housing. These factors – and other social determinants of health – set the stage for poor health outcomes in patients with low socioeconomic status.

The article concludes by noting that

Current health care policy emphasizes the reduction of readmissions but does not support the time and resources needed to achieve this goal. As the basis for payment shifts from volume to value, it will become exceedingly expensive to continue ignoring the social determinants of health.

To learn more about Mr. G, the hospital that served him, and the challenges Pennsylvania’s safety-net hospitals face when serving patients CMS has labeled “superutilizers,” go here, to the web site of the journal Health Affairs, to see the complete article “Mr. G And The Revolving Door: Breaking The Readmission Cycle At A Safety-Net Hospital.”

PA Safety Net Admin2016-04-06T06:00:21+00:00April 6th, 2016|Affordable Care Act, Medicare, Pennsylvania safety-net hospitals|Comments Off

IOM Weighs in on Social Determinants Training

If patients’ symptoms and conditions are the product of who they are, where they are from, and how they have lived, can better understanding those circumstances help providers serve those patients more effectively?
Increasingly the answer to that question has been yes, it can, and now, the National Academies of Science, Engineering, and Medicine and the Institute of Medicine have proposed an approach to training caregivers on the social determinants of health. Their new publication, A Framework for Educating Health Professionals to Address the Social Determinants of Health, notes that

The World Health Organization (WHO) defines social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” These forces and systems include economic policies, development agendas, cultural and social norms, social policies, and political systems. Health inequities, “the unfair and avoidable differences in health between groups of people within countries and between countries” (WHO, 2015b), stem from the social determinants of health and result in stark differences in health and health outcomes.

SNAP has long maintained that the socio-economic challenges their patients face – all important social determinants of health – make serving their low-income communities more challenging and more complex than the patients served by the typical community hospital in Pennsylvania today.
The report’s framework addresses such issues as diversity and inclusion, the importance of a diverse workforce, community participation, health professions education, and more. To learn more about how understanding the social determinants of health might lead to better care and healthier populations, go here to see the National Academies of Science, Engineering, and Medicine and the Institute of Medicine publication A Framework for Educating Health Professionals to Address the Social Determinants of Health.

PA Safety Net Admin2016-03-15T06:00:32+00:00March 15th, 2016|Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

Study Looks at Social Determinants of Health

A new issue brief from the Kaiser Family Foundation looks at the social determinants of health and health outcomes.
The issue brief “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity” reports that

Social determinants have a significant impact on health outcomes. Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age.” They include factors like socioeconomic status, education, the physical environment, employment, and social support networks, as well as access to health care (Figure 2). Based on a meta-analysis of nearly 50 studies, researchers found that social factors, including education, racial segregation, social supports, and poverty accounted for over a third of total deaths in the United States in a year. In the United States, the likelihood of premature death increases as income goes down. Similarly, lower education levels are directly correlated with lower income, higher likelihood of smoking, and shorter life expectancy. Children born to parents who have not completed high school are more likely to live in an environment that poses barriers to health. Their neighborhoods are more likely to be unsafe, have exposed garbage or litter, and have poor or dilapidated housing and vandalism. They also are less likely to have sidewalks, parks or playgrounds, recreation centers, or a library.

The issue brief also looks at different steps that are being pursued to address such challenges through the State Innovation Models Initiative (SIM), state Medicaid programs, community health centers, health insurers, local groups, and more.
The Safety-Net Association of Pennsylvania (SNAP) has long maintained that the patients it serves are fundamentally more challenging to treat than those served by the typical community hospital because of the very factors identified in this study.
To learn more, find the Kaiser Foundation issue brief here.

PA Safety Net Admin2015-11-17T06:00:21+00:00November 17th, 2015|Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

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