In an article released by JAMA Pediatrics today, my co-authors and I show that social determinants of health (patient factors such as health insurance, poverty and other sociodemographic measures) are risk factors for readmissions-related penalties for children’s hospitals. Without adjusting pay-for-performance (P4P) measures for social determinants of health (SDH), hospitals may receive penalties partially related to patient SDH factors beyond the quality of hospital care.
Risk adjustment for SDH may reduce penalizing hospitals for patient factors beyond their control. When we calculated hospital rates on a readmissions-based P4P measure, we found that risk adjusting the readmissions measure for SDH changed the penalty status of 7.0% and 11.6% of hospitals using 15-day and 30-day readmission windows, respectively.
For more on readmissions-related research and policy, see my recent post. A great post on readmissions risk-adjustment is here.
I am reposting a post by Garret Johnson and Zoe Lyon, both research assistants for Dr. Ashish Jha at the Harvard T.H. Chan School of Public Health (who also has a great post on risk-adjustment for readmissions. The post eloquently explores an issue I’ve visited in a recent post: the importance of understanding the diverse factors that drive the health outcomes that have become performance metrics. Performance metrics–in this case, hospital readmissions–are intended to reward or penalize providers (hospitals) for the quality of care they deliver. However, these measures are often strongly driven by factors beyond the hospital’s care–patient factors often called “social determinants of health”. The authors state “there is now substantialevidence that high readmission rates — especially for medical conditions, as opposed to surgical ones — are driven more by patient factors outside of hospitals’ control (e.g. poverty, lack of social supports) than by hospitals’ quality of care and discharge planning.”