Association of Home Based Primary Care Enrollment with Social Determinants of Health for Older Veterans

Dextiny Mccain,Regina Wright,Adrienne Aiken Morgan

doi:10.1093/geroni/igab046.3301

Abstract

The Veterans Administration (VA) Home-based Primary Care (HBPC) program provides comprehensive primary care to older Veterans with multiple chronic conditions who may be at risk of adverse health outcomes due to their social determinants of health. Area Deprivation Index (ADI) can be used as a surrogate measure of a Veteran’s social needs. The objective of this study was to estimate the effect of neighborhood disadvantage, as measured by ADI, on HBPC enrollment for a sample of older Veterans. We estimated a linear multivariate model in which the exposure was ADI and the outcome was enrollment in HBPC. Controls included clinical and demographic characteristics. In a final sample of 12,005,453 observations (total Veteran months) on 353,485 individual Veterans, 18.4% lived in high-deprivation neighborhoods (ADI greater than or equal to 80). Mean monthly probability of new HBPC enrollment was 0.0061. Controlling for clinical characteristics, housing instability, and distance from the medical center, Veterans residing in high-deprivation neighborhoods were 1.4% to 14.8% less likely to enroll in HBPC, though the association was not statistically significant. The VA HBPC program provides beneficial comprehensive, primary care services to Veterans at risk of poor health outcomes. However, a Veteran’s social determinants of health could prevent enrollment. More research is needed to determine the relationship between Veterans’ social needs and HBPC enrollment.

Highlights

Medicare’s Hospital Readmissions Reduction Program (HRRP) places disproportionate penalties on hospitals serving populations with complex medical and social needs
We found that compared to Black participants, White participants were significantly less likely to be in mostly Non-White schools
Without measures to identify the social need intensity of populations cared for by these hospitals, the HRRP cannot account for these risk factors, leading to burdensome penalties that may inadvertently hinder the ability of such hospitals to care for vulnerable populations

Summary

Introduction

Medicare’s Hospital Readmissions Reduction Program (HRRP) places disproportionate penalties on hospitals serving populations with complex medical and social needs. RACIAL/ ETHNIC AND GENDER DIFFERENCES IN OLDER ADULTS’ CHRONIC STRESS PATTERNS Kun Wang, and Zainab Suntai, University of Alabama, Tuscaloosa, Alabama, United States This study aimed to examine the association between chronic stress and cognition among older adults, using the intersectionality of race and sex.

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