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

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  • 1Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.

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|May 7, 2017
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Summary
This summary is machine-generated.

Risk adjustment using social determinants of health (SDH) significantly altered hospital rankings for pediatric readmissions. Including SDH in models improves accuracy and is recommended for performance measures and research.

Keywords:
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Area of Science:

  • Health Services Research
  • Pediatric Healthcare Quality
  • Health Equity

Background:

  • The Pediatric All-Condition Readmission (PACR) measure is crucial for assessing hospital performance.
  • Understanding how social determinants of health (SDH) influence readmission rates is essential for accurate performance evaluation.
  • Current risk adjustment models may not fully capture the impact of SDH on pediatric readmissions.

Purpose of the Study:

  • To evaluate if incorporating social determinants of health (SDH) into risk adjustment modifies hospital performance on the 30-day Pediatric All-Condition Readmission (PACR) measure.
  • To determine if SDH risk adjustment enhances the accuracy and fit of discharge-level predictive models for pediatric readmissions.

Main Methods:

  • A retrospective cohort study analyzed 458,686 pediatric hospital discharges from 2014 across 47 hospitals.
  • Four nested regression models were developed, progressively adding chronic condition indicators, patient factors, and SDH variables (electronic health record-derived and zip code-linked).
  • Changes in hospital decile rank for readmissions and model fit/accuracy were assessed for each model.

Main Results:

  • Factors associated with higher readmission rates included young age, female sex, chronic conditions, Medicaid insurance, higher median household income, and single-parent households.
  • Risk adjustment for SDH resulted in small but significant improvements in the fit and accuracy of discharge-level PACR models.
  • Hospital-level performance rankings changed for 17 out of 47 hospitals after SDH adjustment, indicating a notable impact.

Conclusions:

  • Risk adjustment for social determinants of health (SDH) demonstrably alters hospital readmission rate rankings.
  • The financial implications of these performance changes underscore the importance of accurate risk adjustment.
  • Findings support the inclusion of SDH variables in risk adjustment for pay-for-performance measures and related research in pediatric healthcare.