The impact of non-medical determinants of health on hospital readmission rates

Jan. 13, 2017 / By L. Gordon Moore, MD

The Missouri Hospital Association’s exploration of the impact of poverty on readmission rates leads them to suggest, “Before Penalizing Hospitals, Account for the Social Determinants of Health.”[1]

Here’s an example:

Dave and Bob are both 53 years old. They each have diabetes, hypertension, high cholesterol and COPD and an equal chance of readmission following discharge.

Dave has a master’s degree, is fully employed, has health insurance, lives with his spouse and family, can afford his deductibles and co-payments.

Bob graduated from high school, is occasionally employed, lives alone and, when he does have health insurance, he cannot afford the deductibles and co-payments.

Non-medical factors have an impact on outcomes:[2]  Poverty, family and social support, individual behaviors and other factors play a role.[3]

A hospital serving a higher proportion of people disadvantaged by non-medical determinants will have a higher rate of readmissions than one serving people with fewer.  We can enhance our understanding of the variation in results across hospitals and further use this enhanced understanding to develop interventions that mitigate the effects of these factors.

Bottom line: Outcomes such as hospital readmission rates will vary based on the variability in social and other non-medical determinants of health (MDoH).  It is possible to layer MDoH on top of age, sex and illness burden ato gain further insight into variation as well as to plan interventions to mitigate these factors and improve outcomes.

L. Gordon Moore, MD, is senior medical director for Populations and Payment Solutions at 3M Health Information Systems.

[1] “Before Penalizing Hospitals, Account for the Social Determinants of Health.” NEJM Catalyst, October 24, 2016. http://catalyst.nejm.org/penalizing-hospitals-account-social-determinants-of-health/.

[2] Kindig, David A., Yukiko Asada, and Bridget Booske. “A Population Health Framework for Setting National and State Health Goals.” JAMA 299, no. 17 (May 7, 2008): 2081–83. doi:10.1001/jama.299.17.2081.

[3] Evans, R G, and G L Stoddart. “Producing Health, Consuming Health Care.” Social Science & Medicine (1982) 31, no. 12 (1990): 1347–63.