Patient-Level Determinants of Care

A second definitional focus of my research has studied approaches to defining patient-level characteristics that are relevant to the quality of care, either as indicators of healthcare disparities, as case-mix-adjustment variables, or as potential confounders of the association between a healthcare delivery system and asthma outcomes.  Our most important findings have demonstrated the importance of using risk-adjustment that extends beyond adjustment for the severity of the acute condition to encompass chronic medical complexity and social determinants of health.

In my ongoing role as a co-Investigator on the SAFTINet project, I have guided the design of the data infrastructure to include (among other measures) the patient-level characteristics needed for risk-adjustment and/or for study of disparities in healthcare delivery and outcomes, including patient socio-demographics and ZIP-code-based links to regional determinants of patient health.  I have also included condition-specific patient information in the dataset, using stakeholder-engagement methods to develop and implement patient-reported outcomes measures of asthma symptom severity and medication adherence.  Building these patient-level characteristics into the SAFTINet data infrastructure has directly supported the mission and research aims of SAFTINet.

As an active member of a research group at the Children’s Hospital Association, I have authored and co-authored 10 publications and publications-in-progress developing and implementing risk-adjustment methods that include severity of the acute condition, chronic medical complexity and social determinants of health. Two more manuscripts (one first-author, listed here) are in press.

  • Sills MR, Hall M, Colvin JD, Macy ML, Cutler GJ, Bettenhausen JL, Morse RB, Auger KA, Raphael JL, Gottlieb LM, Fieldston ES, Shah SS. Impact of social determinants on children’s hospitals’ preventable readmissions performance. JAMA Pediatrics. In press.

I have also published a multicenter study of acute and chronic measures of asthma severity among children in the emergency department for an asthma exacerbation: