A recent Journal of the American Medical Association (JAMA) article (Ryan, J., et.al, 2023) provided some compelling evidence for the confirmation that our hospitalized patients are both socially and medically complex.
This is particularly true for diabetic patients, as their care costs the U.S. more than $200 billion every year, according to the American Diabetes Association.
The study was conducted with Humana Medicare Advantage beneficiaries who were confirmed to be Type II diabetics. The study pulled pharmacy and medical utilization claims data from 2019. From that population, they then conducted a phone survey with the Health-Related Social Needs (HRSN) screening tool. Those who completed at least one question in the HRSN tool were considered to be included in the study, although it should be noted that the response rate for total completion of the HRSN survey was 82.7 percent. The final population for the study was 21,568 individuals, with a mean age of 71.
From this population, 56.9 percent reported having at least one HRSN factor. The positive group for the social determinants of health (SDoH) had a higher mean for the Elixhauser Comorbidity Index scores, and more than twice as many were found to be a part of the Medicare-Medicaid dual-eligible program in Humana. The most frequent overall needs identified, in order, were financial strain (73.6 percent), food insecurity (47.5 percent), poor housing quality (39.1 percent), and utility insecurity (19.1 percent). When comparing the positive factor group of HRSN to those who were negative or did not have social needs, it was found that medication adherence was significantly better among those who did not have the presence of HRSN factors.
In the correlation analysis between those with positive factors and utilization data such as hospitalizations and ED visits, there were some significant factors identified. In particular, higher emergency visit utilization was associated with individuals having the presence of food insecurity, loneliness, and unreliable transportation. Food insecurity was found to be the highest indicator for avoidable hospitalization, all-cause hospitalizations, and ED visits. Finally, individuals experiencing loneliness and unreliable transportation were more likely to have poor medication adherence.
This research continues to demonstrate the value of considering the social complexities of our patient population when delivering care. It also continues the momentum to inform policy decisions at the insurance plan and community level.
Programming note: Listen to Tiffany Ferguson’s live reporting on the social determinants of health every Tuesday, 10 Eastern, on Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer.