The Association between Social Vulnerability and Fragmented Readmissions: An Analysis of the Florida State Inpatient Database Público

Abstract

Research Objective: Fragmented readmissions, when a patient is readmitted to a different hospital than they were originally discharged from, are associated with lower quality of care. The goal of this analysis was to measure the association between the Social Vulnerability Index (SVI), a proxy for social determinants of health, and interhospital care fragmentation.

Study Design: This was a cross-sectional study of the Healthcare Cost and Utilization Project’s State Inpatient Database for Florida in 2018. We fit unadjusted and adjusted logistic regressions to determine the association between SVI quartiles and the odds of a fragmented readmission.

Population Studied: All patients 18 years and older with one or more readmissions in the year.

Principal Findings: There were 759,371 readmissions, of which 34% were fragmented. Compared with patients who were the least socially vulnerable (SVI in the lowest quartile), patients who were the most socially vulnerable were 7.0% more likely to have a fragmented readmission (AOR 1.07, 95% CI 1.06, 1.09) after adjusting for patient demographics and social characteristics. Patients in the second most vulnerable group had a 16% increased odds of a fragmented readmission (AOR 1.16, 95% CI 1.14, 1.18), and patients in the second least vulnerable group had a 25% increased odds (AOR 1.25, 95% CI 1.23, 1.26). When readmissions limited to those diagnosed for sepsis, the most socially vulnerable group had the highest increase in the odds of fragmented readmissions (AOR 1.23, 95% CI 1.16-1.31). Sensitivity analyses using sub-components of the CDC's SVI as the exposure variables, such as minority status, language proficiency, and access to transportation being significant factors, revealed that the most socially vulnerable group had the highest increase in the odds of a fragmented readmission. When “speaks English ‘less than well’” was used as the exposure, a 24% increase in the odds of a fragmented readmission was observed in the most socially vulnerable group (AOR 1.24, 95% CI 1.22-1.26) compared to the least socially vulnerable group.

Conclusions:  The results indicated that, when using the composite SVI score as the exposure, the second least socially vulnerable group had the largest increase in the odds of a fragmented readmission, followed by the second most socially vulnerable group. Sensitivity analyses showed that specific social vulnerability components, such as minority status, language, and transportation had the linear effects on the odds of fragmented readmissions.

Implications for Policy or Practice: Further examination of which social determinants of health and components of the SVI score are associated with fragmented readmissions are necessary to optimize care for all.

Table of Contents

Introduction ....................................................................................................................................1

Methods ..........................................................................................................................................2

Results ............................................................................................................................................9 Discussion......................................................................................................................................14

References .....................................................................................................................................18

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Health Care Management Health Sciences, Public Health Health Sciences, Epidemiology
Palavra-chave	Health policy Population health Care fragmentation Healthcare access Healthcare cost Social determinants of health Social vulnerability Socioeconomic status Health disparity
Committee Chair / Thesis Advisor	Turbow, Sara, Emory University
Committee Members	Ali, Mohammed, Emory University

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Supplemental Files

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	Figures and Tables (Data Summary of the Analysis )	2023-04-18 12:33:17 -0400	Press to Select an action Download
	Figure 1: Social Vulnerability Index and Quantile Groups (Data Summary of the Analysis )	2023-04-18 12:33:28 -0400	Press to Select an action Download
	Figure 2: Sample Admission-Readmission Pair Selection (Data Summary of the Analysis )	2023-04-18 12:33:41 -0400	Press to Select an action Download