Measuring health disparities using a continuous social risk factor.

Area of Science:

• Health Services Research
• Health Disparities
• Social Determinants of Health

Background:

• Measuring hospital-level disparities is crucial for equitable healthcare.
• Existing methods often use dichotomous social risk factors (SRFs), which may oversimplify complex social realities.
• A continuous approach to SRFs could provide a more nuanced understanding of disparities.

Purpose of the Study:

• To propose and evaluate a novel method for measuring hospital-level disparities.
• To assess the effect of continuous, polysocial risk factors on patient outcomes.
• To compare a continuous SRF approach with existing dichotomous methods.

Main Methods:

• Adapted existing methodologies for reporting hospital-level disparities.
• Utilized the Agency for Healthcare Research and Quality (AHRQ) Socioeconomic Status (SES) Index as a continuous SRF.
• Applied methods to six 30-day hospital readmission measures using Medicare Fee-for-Service (FFS) administrative claims data.

Main Results:

• The continuous SRF approach identified disparity results for more facilities compared to existing methods.
• Disparity measures showed moderate to high correlation with dichotomous SRF methods but reflected a fuller spectrum of risk.
• The novel approach aligns provider-level results more closely with underlying social risk.

Conclusions:

• Demonstrated the feasibility and utility of estimating hospital disparities using continuous, polysocial risk factors.
• This expanded approach enhances the reporting of hospital-level disparities.
• The method better accounts for the multifactorial nature of social risk on hospital outcomes.