Adding Social Determinant Data Changes Children's Hospitals' Readmissions Performance

Marion R. Sills, Matthew Hall, Gretchen J. Cutler, Jeffrey D. Colvin, Laura M. Gottlieb, Michelle L. Macy, Jessica L. Bettenhausen, Rustin B. Morse, Evan S. Fieldston, Jean L. Raphael, Katherine A. Auger, Samir S. Shah

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives To determine whether social determinants of health (SDH) risk adjustment changes hospital-level performance on the 30-day Pediatric All-Condition Readmission (PACR) measure and improves fit and accuracy of discharge-level models. Study design We performed a retrospective cohort study of all hospital discharges meeting criteria for the PACR from 47 hospitals in the Pediatric Health Information database from January to December 2014. We built four nested regression models by sequentially adding risk adjustment factors as follows: chronic condition indicators (CCIs); PACR patient factors (age and sex); electronic health record-derived SDH (race, ethnicity, payer), and zip code-linked SDH (families below poverty level, vacant housing units, adults without a high school diploma, single-parent households, median household income, unemployment rate). For each model, we measured the change in hospitals' readmission decile-rank and assessed model fit and accuracy. Results For the 458 686 discharges meeting PACR inclusion criteria, in multivariable models, factors associated with higher discharge-level PACR measure included age <1 year, female sex, 1 of 17 CCIs, higher CCI count, Medicaid insurance, higher median household income, and higher percentage of single-parent households. Adjustment for SDH made small but significant improvements in fit and accuracy of discharge-level PACR models, with larger effect at the hospital level, changing decile-rank for 17 of 47 hospitals. Conclusions We found that risk adjustment for SDH changed hospitals' readmissions rate rank order. Hospital-level changes in relative readmissions performance can have considerable financial implications; thus, for pay for performance measures calculated at the hospital level, and for research associated therewith, our findings support the inclusion of SDH variables in risk adjustment.

Original languageEnglish (US)
Pages (from-to)150-157.e1
JournalJournal of Pediatrics
Volume186
DOIs
StatePublished - Jul 1 2017

Fingerprint

Social Determinants of Health
Patient Readmission
Risk Adjustment
Pediatrics
Single Parent
Incentive Reimbursement
Sex Factors
Pediatric Hospitals
Unemployment
Electronic Health Records
Age Factors
Medicaid
Poverty
Insurance
Cohort Studies
Retrospective Studies
Databases
Health
Research

Keywords

  • healthcare quality measurement
  • pay for performance
  • performance measure
  • predictive model
  • public reporting
  • risk adjustment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Sills, M. R., Hall, M., Cutler, G. J., Colvin, J. D., Gottlieb, L. M., Macy, M. L., ... Shah, S. S. (2017). Adding Social Determinant Data Changes Children's Hospitals' Readmissions Performance. Journal of Pediatrics, 186, 150-157.e1. https://doi.org/10.1016/j.jpeds.2017.03.056

Adding Social Determinant Data Changes Children's Hospitals' Readmissions Performance. / Sills, Marion R.; Hall, Matthew; Cutler, Gretchen J.; Colvin, Jeffrey D.; Gottlieb, Laura M.; Macy, Michelle L.; Bettenhausen, Jessica L.; Morse, Rustin B.; Fieldston, Evan S.; Raphael, Jean L.; Auger, Katherine A.; Shah, Samir S.

In: Journal of Pediatrics, Vol. 186, 01.07.2017, p. 150-157.e1.

Research output: Contribution to journalArticle

Sills, MR, Hall, M, Cutler, GJ, Colvin, JD, Gottlieb, LM, Macy, ML, Bettenhausen, JL, Morse, RB, Fieldston, ES, Raphael, JL, Auger, KA & Shah, SS 2017, 'Adding Social Determinant Data Changes Children's Hospitals' Readmissions Performance', Journal of Pediatrics, vol. 186, pp. 150-157.e1. https://doi.org/10.1016/j.jpeds.2017.03.056
Sills, Marion R. ; Hall, Matthew ; Cutler, Gretchen J. ; Colvin, Jeffrey D. ; Gottlieb, Laura M. ; Macy, Michelle L. ; Bettenhausen, Jessica L. ; Morse, Rustin B. ; Fieldston, Evan S. ; Raphael, Jean L. ; Auger, Katherine A. ; Shah, Samir S. / Adding Social Determinant Data Changes Children's Hospitals' Readmissions Performance. In: Journal of Pediatrics. 2017 ; Vol. 186. pp. 150-157.e1.
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abstract = "Objectives To determine whether social determinants of health (SDH) risk adjustment changes hospital-level performance on the 30-day Pediatric All-Condition Readmission (PACR) measure and improves fit and accuracy of discharge-level models. Study design We performed a retrospective cohort study of all hospital discharges meeting criteria for the PACR from 47 hospitals in the Pediatric Health Information database from January to December 2014. We built four nested regression models by sequentially adding risk adjustment factors as follows: chronic condition indicators (CCIs); PACR patient factors (age and sex); electronic health record-derived SDH (race, ethnicity, payer), and zip code-linked SDH (families below poverty level, vacant housing units, adults without a high school diploma, single-parent households, median household income, unemployment rate). For each model, we measured the change in hospitals' readmission decile-rank and assessed model fit and accuracy. Results For the 458 686 discharges meeting PACR inclusion criteria, in multivariable models, factors associated with higher discharge-level PACR measure included age <1 year, female sex, 1 of 17 CCIs, higher CCI count, Medicaid insurance, higher median household income, and higher percentage of single-parent households. Adjustment for SDH made small but significant improvements in fit and accuracy of discharge-level PACR models, with larger effect at the hospital level, changing decile-rank for 17 of 47 hospitals. Conclusions We found that risk adjustment for SDH changed hospitals' readmissions rate rank order. Hospital-level changes in relative readmissions performance can have considerable financial implications; thus, for pay for performance measures calculated at the hospital level, and for research associated therewith, our findings support the inclusion of SDH variables in risk adjustment.",
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N2 - Objectives To determine whether social determinants of health (SDH) risk adjustment changes hospital-level performance on the 30-day Pediatric All-Condition Readmission (PACR) measure and improves fit and accuracy of discharge-level models. Study design We performed a retrospective cohort study of all hospital discharges meeting criteria for the PACR from 47 hospitals in the Pediatric Health Information database from January to December 2014. We built four nested regression models by sequentially adding risk adjustment factors as follows: chronic condition indicators (CCIs); PACR patient factors (age and sex); electronic health record-derived SDH (race, ethnicity, payer), and zip code-linked SDH (families below poverty level, vacant housing units, adults without a high school diploma, single-parent households, median household income, unemployment rate). For each model, we measured the change in hospitals' readmission decile-rank and assessed model fit and accuracy. Results For the 458 686 discharges meeting PACR inclusion criteria, in multivariable models, factors associated with higher discharge-level PACR measure included age <1 year, female sex, 1 of 17 CCIs, higher CCI count, Medicaid insurance, higher median household income, and higher percentage of single-parent households. Adjustment for SDH made small but significant improvements in fit and accuracy of discharge-level PACR models, with larger effect at the hospital level, changing decile-rank for 17 of 47 hospitals. Conclusions We found that risk adjustment for SDH changed hospitals' readmissions rate rank order. Hospital-level changes in relative readmissions performance can have considerable financial implications; thus, for pay for performance measures calculated at the hospital level, and for research associated therewith, our findings support the inclusion of SDH variables in risk adjustment.

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