By: Penny Cook, MSW
Senior Quality Improvement Facilitator
There have been many factors studied as we search for answers as to the causes of hospital readmissions. Obviously there are planned readmissions, some that are unavoidable and then there are all the rest. It is this last category that leaves us with the most questions. Research has attempted to understand avoidable readmissions by looking at variables such as hospital or other provider specific practices, discharge location, diagnosis, age, sex, patient activation and individual socioeconomic status among many others. Some of these are hard to measure and some give an incomplete picture.
That’s why a new study, Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization1, recently published in the Annals of Internal Medicine not only helps to explain rehospitalizations, but also provides potentially useful information to explain and influence many aspects of health policy. The study uses a measure for socioeconomic disadvantage, the Area Deprivation Index (ADI)2, which was developed by Gopal Singh in 2003. The ADI measures the level of socioeconomic disadvantage of a neighborhood and includes 17 variables such as median income, median rent, percent of households without a motor vehicle and percent of single parent households with a child under the age of 18. The census-tract level information is then separated and presented by 9-digit zip code. This means you can enter your zip code, your patient’s or those zip codes feeding into your hospital or organization and see whether there is a risk of negative health outcomes based on where people live.
The results of the study showed a strong correlation between living in a disadvantaged neighborhood and the risk of rehospitalization even after accounting for patient and hospital level factors. So what can we do with this information? It can assist in risk stratification, direct resource allocation and support policy development. Ultimately, it contributes to the dialogue that health care isn’t confined within the walls of a medical office or facility. Communities matter. Partnerships matter. Shared responsibility matters.
ADI is yet another tool we have to look at the relationship between socioeconomic factors and health whether we are seeking information on a state or national level, or own organization or an individual’s personal health care. It also influences how we view hospital readmissions and why Healthy Transitions Colorado is such an important initiative as it brings people and organizations together across the state to improve population health, provide person-centered care and improve cost and efficiency.
- Kind, Amy et al. “Neighborhood Socioeconomic Disadvantage and 3-Day Rehospitalization.” Annals of Internal Medicine. Volume 161 Number 11 (2014)
- HIPxChange (2014). Area Deprivation Index. http://www.hipxchange.org/ADI