Using social risks to predict unplanned hospital readmission and emergency care among hospitalized Veterans

Author:

Cornell Portia Y.12ORCID,Hua Cassandra L.3,Buchalksi Zachary M.1,Chmelka Gina R.45,Cohen Alicia J.67,Daus Marguerite M.8ORCID,Halladay Christopher W.1,Harmon Alita49,Silva Jennifer W.4,Rudolph James L.167

Affiliation:

1. Center of Innovation for Long Term Services and Supports Providence VA Medical Center Providence Rhode Island USA

2. Centre for the Digital Transformation of Health University of Melbourne Melbourne Victoria Australia

3. Department of Public Health, Zuckerberg College of Health Sciences University of Massachusetts Lowell Massachusetts USA

4. National Social Work Program, Care Management and Social Work, Patient Care Services Department of Veterans Affairs Washington DC USA

5. Tomah VA Medical Center Tomah Wisconsin USA

6. Department of Health Services, Policy and Practice Brown University Providence Rhode Island USA

7. Department of Family Medicine Alpert Medical School of Brown University Providence Rhode Island USA

8. Rocky Mountain Regional Medical Center Aurora Colorado USA

9. Gulf Coast Veterans Health Care System Biloxi Mississippi USA

Abstract

AbstractObjectives(1) To estimate the association of social risk factors with unplanned readmission and emergency care after a hospital stay. (2) To create a social risk scoring index.Data Sources and SettingWe analyzed administrative data from the Department of Veterans Affairs (VA) Corporate Data Warehouse. Settings were VA medical centers that participated in a national social work staffing program.Study DesignWe grouped socially relevant diagnoses, screenings, assessments, and procedure codes into nine social risk domains. We used logistic regression to examine the extent to which domains predicted unplanned hospital readmission and emergency department (ED) use in 30 days after hospital discharge. Covariates were age, sex, and medical readmission risk score. We used model estimates to create a percentile score signaling Veterans' health‐related social risk.Data ExtractionWe included 156,690 Veterans' admissions to a VA hospital with discharged to home from 1 October, 2016 to 30 September, 2022.Principal FindingsThe 30‐day rate of unplanned readmission was 0.074 and of ED use was 0.240. After adjustment, the social risks with greatest probability of readmission were food insecurity (adjusted probability = 0.091 [95% confidence interval: 0.082, 0.101]), legal need (0.090 [0.079, 0.102]), and neighborhood deprivation (0.081 [0.081, 0.108]); versus no social risk (0.052). The greatest adjusted probabilities of ED use were among those who had experienced food insecurity (adjusted probability 0.28 [0.26, 0.30]), legal problems (0.28 [0.26, 0.30]), and violence (0.27 [0.25, 0.29]), versus no social risk (0.21). Veterans with social risk scores in the 95th percentile had greater rates of unplanned care than those with 95th percentile Care Assessment Needs score, a clinical prediction tool used in the VA.ConclusionsVeterans with social risks may need specialized interventions and targeted resources after a hospital stay. We propose a scoring method to rate social risk for use in clinical practice and future research.

Funder

U.S. Department of Veterans Affairs

Publisher

Wiley

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