Sociodemographic data adjustments help hospitals predict readmissions

Healthcare experts have long warned that financial penalties and rewards for hospitals fail to account for sociodemographic risk factors, but a Missouri effort to incorporate data on such risks may serve as a national model.

The Missouri Hospital Association’s (MHA) Focus on Hospitals website in February became the first in the nation to report data readjusted for sociodemographic aspects, according to a blog post on NEJM Catalyst from MHA’s Mat Reidhead and Herb B. Kuhn. The MHA worked to develop models that take several factors into account, including the socioeconomic status of the patient’s census tract, whether the patient is a Medicaid beneficiary and local access to services such as nutrition, transportation and post-acute care.

They next analyzed the impact that considering those factors played in outcomes for patients with six conditions: congestive heart failure, pneumonia, chronic obstructive pulmonary disease, total-hip and total-knee arthroplasty and acute myocardial infarction. The MHA also examined the impact on hospital-wide readmissions. The adjusted model showed significant relative reductions in readmission ratios for patients with each condition, with figures ranging from 35 percent reduction in readmissions for acute myocardial infarction to 80 percent for total-hip and total-knee replacement. Moreover, the adjustment improved hospitals’ ability to predict readmission risks.

The model also accounted for the concern that adjusting for sociodemographic factors may inadvertently hide actual differences in care quality. However, the researchers found their model showed more hospitals with higher or lower than expected risk-adjusted ratios compared to prior research by Yale and the Centers for Medicare & Medicaid Services.

“If hospitals’ ability to mediate these factors is limited, or if structural barriers prevent hospitals from addressing the upstream effects of social factors on health outcomes, it is common sense to account for them in determining penalties under the HRRP [Hospital Readmission Reduction Program],” the authors wrote. “Without such change, the disease of poverty will fester.”