1. Socioeconomic Status and Health Care Outcomes Jianhui Hu, Ph.D., Research Associate Center for Health Policy & Health Services Research Henry Ford Health System October 16 th, 2014

2.  Introduction  Recent studies on health disparities  Socioeconomic status (SES) and readmissions Agenda

3.  Led by Center Director Dr. David Nerenz  Health policy research: takes on the role of leading and coordinating health policy analysis for Henry Ford Health System since March 2010  Health services research: cancer prevention and control, patient-physician communication, pharmacogenomics and chronic disease, mental health services, and screening and treatment of chronic hepatitis Center for Health Policy & Health Services Research

4.  SES and readmissions  Effects of the ACA’s benefit expansions on preventive service utilizations and disparities in utilizations  Other internal data analyses of disparities in health outcome/performance measures across HFHS hospital/clinics sites serving communities with different SES Recent Studies on Health Disparities

5. Association between SES and HEDIS Scores at the Clinic Site Level

7. Socioeconomic Status and Readmissions

8.  Background: CMS began to reduce payments to hospitals with excess 30-day readmissions. One key debate about the policy revolves around the absence of any adjustment for the patients’ SES. The rationale is that differences in the quality of care received by groups of patients of different SES can contribute to readmissions.  Objectives: Better understand how various SES factors influenced the probability of readmission using data from a single urban teaching hospital. Socioeconomic Status and Readmissions

9. Readmission Penalties in Three Years

10.  Inclusions: Medicare fee-for-service; 65+; discharged from Henry Ford Hospital during 2010  Exclusions: died in the hospital; discharged AMA; admitted for cancer or rehabilitation care; admitted with a primary diagnosis of psychiatric disease  Data Source:  Patient level: Henry Ford Hospital’s Corporate Data Store  Neighborhood level: Census 2000  Readmissions: CMS “dry run report”, including all unplanned 30-day readmissions to any hospital Data

11. Multivariate logistic regressions were used to examine the associations between 30-day readmissions and patients' and their neighborhoods' characteristics. We adjusted both for patients’ discharge conditions and for comorbidities identified from the index and historical admission records. Methods

12. Results: Study Cohort

15.  Socioeconomic disparities in readmission risk exist even after variations in practice patterns across hospitals have been eliminated. The effects of socioeconomic variables were not confounded with variations in hospital resources. Further, the associations reported here occurred in spite of efforts to prevent readmissions in general and to reduce disparities in readmission rates.  The question of whether hospitals should be held accountable for the effects of factors such as poverty, illiteracy, or lack of social support in the patients and communities they serve has not yet been resolved. The present findings underscore the importance of reaching consensus on this issue.  Limitations: 1) limited generalizability; 2) risk adjustment only used inpatient diagnoses from Henry Ford Health System; and 3) unable to include some important post-discharge factors. Discussions & Conclusions

16. Next Steps …