Considering the Role of Socioeconomic Status in Hospital Outcomes Measures
Authors: Harlan M. Krumholz, Susannah M. Bernheim
Journal: Annals of Internal Medicine (2014)

Editorials2 December 2014Considering the Role of Socioeconomic Status in Hospital Outcomes MeasuresHarlan M. Krumholz, MD, SM and Susannah M. Bernheim, MD, MHSHarlan M. Krumholz, MD, SMFrom Yale University School of Medicine, New Haven, Connecticut, and Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut. and Susannah M. Bernheim, MD, MHSFrom Yale University School of Medicine, New Haven, Connecticut, and Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-2308 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Our team at the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital developed readmission measures for the Centers for Medicare & Medicaid Services with the goal of illuminating hospital performance and stimulating efforts to improve patient care. We believed that such efforts could improve patient recovery and reduce the occurrence of adverse health events after discharge. We developed these measures using data from administrative claims and validated them against measures using medical records data (1). National readmission rates within 30 days of hospital discharge were exceedingly high for common diagnoses, such as acute myocardial infarction, heart failure, and ...References1. Keenan PS, Normand SL, Lin Z, Drye EE, Bhat KR, Ross JS, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2008;1:29-37. [PMID: 20031785] doi:10.1161/CIRCOUTCOMES.108.802686 CrossrefMedlineGoogle Scholar2. Daughtridge GW, Archibald T, Conway PH. Quality improvement of care transitions and the trend of composite hospital care. JAMA. 2014;311:1013-4. [PMID: 24618959] doi:10.1001/jama.2014.509 CrossrefMedlineGoogle Scholar3. Lipstein SH, Dunagan WC. The risks of not adjusting performance measures for sociodemographic factors. Ann Intern Med. 2014;161:594-6. [PMID: 25048401] doi:10.7326/M14-1601 LinkGoogle Scholar4. National Quality Forum. Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors. Technical Report. 2014. Accessed at www.qualityforum.org/Publications/2014/08/Risk_Adjustment_for_Socioeconomic_Status_or_Other_Sociodemographic_Factors.aspx on 23 October 2014. Google Scholar5. Kind AJ, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W, et al. Neighborhood socioeconomic disadvantage and 30-day rehospitalization. A restrospective cohort study. Ann Intern Med. 2014;161:765-74. doi:10.7326/M13-2946 LinkGoogle Scholar6. Bikdeli B, Wayda B, Bao H, Ross JS, Xu X, Chaudhry SI, et al. Place of residence and outcomes of patients with heart failure: analysis from the telemonitoring to improve heart failure outcomes trial. Circ Cardiovasc Qual Outcomes. 2014;7:749-56. [PMID: 25074375] doi:10.1161/CIRCOUTCOMES.113.000911 CrossrefMedlineGoogle Scholar7. Keyhani S, Myers LJ, Cheng E, Hebert P, Williams LS, Bravata DM. Effect of clinical and social risk factors on hospital profiling for stroke readmission.A cohort study. Ann Intern Med. 2014;161:775-84. doi:10.7326/M14-0361 LinkGoogle Scholar8. Smedley BD, Stith AY, Nelson AR; Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Pr; 2003. Google Scholar9. Ross JS, Bernheim SM, Lin Z, Drye EE, Chen J, Normand SL, et al. Based on key measures, care quality for Medicare enrollees at safety-net and non-safety-net hospitals was almost equal. Health Aff (Millwood). 2012;31:1739-48. [PMID: 22869652] doi:10.1377/hlthaff.2011.1028 CrossrefMedlineGoogle Scholar10. Medicare Payment Advisory Commission. Report to the Congress: Medicare and the Health Care Delivery System. 2013. Accessed at www.medpac.gov/documents/reports/jun13_entirereport.pdf on 23 October 2014. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Yale University School of Medicine, New Haven, Connecticut, and Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut.Grant Support: Dr. Krumholz is supported by the National Heart, Lung, and Blood Institute Center for Cardiovascular Outcomes Research at Yale University (grant U01 HL105270-05).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2308.Corresponding Author: Harlan M. Krumholz, MD, SM, Yale University School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510; e-mail, harlan.[email protected]edu.Current Author Addresses: Drs. Krumholz and Bernheim: Yale University School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNeighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization Amy J.H. Kind , Steve Jencks , Jane Brock , Menggang Yu , Christie Bartels , William Ehlenbach , Caprice Greenberg , and Maureen Smith Effect of Clinical and Social Risk Factors on Hospital Profiling for Stroke Readmission Salomeh Keyhani , Laura J. Myers , Eric Cheng , Paul Hebert , Linda S. Williams , and Dawn M. Bravata Effect of Clinical and Social Risk Factors on Hospital Profiling for Stroke Readmission Salomeh Keyhani , Laura J. Myers , Eric Cheng , Paul Hebert , Linda S. Williams , and Dawn M. Bravata Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization Amy J.H. Kind , Steve Jencks , Jane Brock , Menggang Yu , Christie Bartels , William Ehlenbach , Caprice Greenberg , and Maureen Smith The Role of Socioeconomic Status in Hospital Outcomes Measures Alan M. Zaslavsky and Ashish K. Jha The Role of Socioeconomic Status in Hospital Outcomes Measures Harlan M. Krumholz and Susannah M. Bernheim The Role of Socioeconomic Status in Hospital Outcomes Measures Alan M. Zaslavsky and Ashish K. Jha The Role of Socioeconomic Status in Hospital Outcomes Measures Harlan M. Krumholz and Susannah M. Bernheim Metrics Cited byDocumentation and review of social determinants of health data in the EHR: measures and associated insightsAssociation between housing type and accelerated biological aging in different sexes: moderating effects of health behaviorsUsing Consistently Low Performance to Identify Low-Quality Physician GroupsEffect of a Real-Time Risk Score on 30-day Readmission Reduction in SingaporeCommunity factors and hospital wide readmission rates: Does context matter?Association Between Residential Neighborhood Social Conditions and Health Care Utilization and CostsMeasuring the impact of a social programme on healthcare: a 10-year retrospective cohort study in Trieste, ItalyAssessing the impact of social determinants of health on predictive models for potentially avoidable 30-day readmission or deathThe Association Between Structural, Performance, and Community Factors and the Likelihood of Receiving a Penalty Under the Hospital Readmissions Reduction Program (Fiscal Year 2013–2019)Assessment of variation in 30‐day mortality following cancer surgeries among older adults across US hospitalsAdopting best practices in post-operative analgesia prescribing in a safety-net hospital: Residents as a conduit to changeFactors associated with emergency room visits and hospitalisation amongst low-income public rental flat dwellers in SingaporeAssociation of Patient Social, Cognitive, and Functional Risk Factors with Preventable Hospitalizations: Implications for Physician Value-Based PaymentSafety-Net Hospitals, Neighborhood Disadvantage, and Readmissions Under Maryland's All-Payer Program An Observational StudyStephen F. Jencks, MD, MPH, Alyson Schuster, PhD, MPH, MBA, Geoff B. Dougherty, PhD, MPH, Sule Gerovich, PhD, Jane E. Brock, MD, MSPH, and Amy J.H. Kind, MD, PhDHospital Variation in 30‐Day Mortality for Patients With Stroke; The Impact of Individual and Municipal Socio‐Demographic StatusAssociation of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction ProgramAdjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction programThe Role Of Social, Cognitive, And Functional Risk Factors In Medicare Spending For Dual And Nondual EnrolleesSocial Risk Adjustment of Quality Measures for Diabetes and Cardiovascular Disease in a Commercially Insured US PopulationA Quality Framework for Emergency Department Treatment of Opioid Use DisorderPublic rental housing and its association with mortality – a retrospective, cohort studyChanges to Racial Disparities in Readmission Rates After Medicare's Hospital Readmissions Reduction Program Within Safety-Net and Non–Safety-Net HospitalsAssessment of the Effect of Adjustment for Patient Characteristics on Hospital Readmission RatesTime for Value-Based Payment Models to Adopt a Disparities-Sensitive Frame ShiftKrisda H. Chaiyachati, MD, MPH, MSHP, Jay Bhatt, DO, MPH, MPA, and Jane M. Zhu, MD, MPPDoes Medicare Advantage Reduce Racial Disparity in 30-Day Rehospitalization for Medicare Beneficiaries?Associations Between Community Sociodemographics and Performance in HEDIS Quality Measures: A Study of 22 Medical Centers in a Primary Care NetworkDually Enrolled Beneficiaries Have Higher Episode Costs On The Medicare Spending Per Beneficiary MeasureWhat is the impact of a clinically related readmission measure on the assessment of hospital performance?Area-level poverty, race/ethnicity & dialysis star ratingsImpact of Frailty and Sociodemographic Factors on Hospital Admission From an Emergency Department Observation UnitPredicting Readmission at Early Hospitalization Using Electronic Clinical DataHousing as a Social Determinant of Health in Singapore and Its Association with Readmission Risk and Increased Utilization of Hospital ServicesRisk-standardized Acute Admission Rates Among Patients With Diabetes and Heart Failure as a Measure of Quality of Accountable Care OrganizationsThe Financial Effect of Value-Based Purchasing and the Hospital Readmissions Reduction Program on Safety-Net Hospitals in 2014 A Cohort StudyMatlin Gilman, BA, Jason M. Hockenberry, PhD, E. Kathleen Adams, PhD, Arnold S. Milstein, MD, Ira B. Wilson, MD, MSc, and Edmund R. Becker, PhDThe Role of Socioeconomic Status in Hospital Outcomes MeasuresAlan M. Zaslavsky, PhD and Ashish K. Jha, MD, MPH 2 December 2014Volume 161, Issue 11Page: 833-834KeywordsDisclosureHealth careHealth care qualityHealth care quality assessmentLegislationMedicarePatientsPopulation statistics ePublished: 2 December 2014 Issue Published: 2 December 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...