Impact of Social Determents on Heart Failure Readmission At York Hospital

Abstract

Heart failure readmissions cost over $30.7 billion in 2012. Our institution in the past identified medical co-morbities as a major factor of heart failure (HF) readmissions however we did not evaluate external factors effecting readmission. Socioecnomic status has been shown to be a predictor of increased HF readmissions. Hospitals serving economically disadvantaged communities may also be experiencing higher readmission rates due to social determinants of health care (1). We aimed to identify social determents that impacted 30-day HF readmissions at York Hospital. We identified 1294 patients that were admitted to York hospital from September 2018 through February 2019 with an index admission of HF. We then identified a total of 213 patients that were readmitted within 30 days of their discharge and compared them to the 1081 that did not require re-hospitailzation. We compared social factors, which included race, gender, age group, median household income, education, and insurance coverage. We also compared living disparities, such as ability to obtain food, pay bills, availability of stable housing, routine medical care, transportation, and concern for harm. Readmitted patients were found to have significantly higher rates of home health care at initial discharge (39.4% vs. 30.6%, P=0.001), higher fear of being hurt at home (2% vs. 0.1%, P= P=0.003), and higher Charlson comorbidity index (4.78 vs 4.46, P=0.049). The readmitted group also had higher rates of lack of food availability (2.9% vs. 2%), loss of electricity (2.0% vs. 1.8%), and unstable housing (4.4% vs. 2.8%), within the last 12 months. The readmitted group also had significantly more disparities. There was no significant difference between race, insurance coverage, marital status, age group, median household income or level of education. Socioeconomic status is associated with health care, environmental exposure, and health behaviors- all being major determinants of health. We found a discrepancy in social factors including food, electricity, housing, and medical resources between the two groups. Despite having more home health resources at discharge, the readmitted group still required additional medical care. Future work should focus on the quality of home health services and to investigate if the services being offered are allowing for patient optimization. Our data supports that sicker patients have a higher chance of being readmitted as per the difference in the Charlson scoring however we feel that the quality of resources both at discharge and during the rehabilitation phase can positively impact readmission rates. Heart failure readmissions are multi-disciplinary and are impacted by bother medical and social factor. Our prior work has showed the impact of medical comorbidities on HF readmissions. We have now also found that social factors such as living conditions, and post-discharge medical resources significantly influence HF readmissions. Creating health care model that integrates both medical and social factors specific to a patient population should be considered going forward.