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- Title
Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes.
- Authors
Ryan, Jessica L.; Franklin, Stephanie M.; Canterberry, Melanie; Long, Charron L.; Bowe, Andy; Roy, Brandy D.; Hessler, Danielle; Aceves, Benjamin; Gottlieb, Laura M.
- Abstract
This cross-sectional study examines associations between health-related social needs and health care quality and utilization outcomes among Medicare Advantage beneficiaries with type 2 diabetes. Key Points: Question: Which health-related social needs (HRSNs) are associated with health care quality and utilization outcomes in a Medicare Advantage population with type 2 diabetes? Findings: Of 21 528 beneficiaries in this cross-sectional study, 56.9% had at least 1 HRSN; the most prevalent were financial strain, food insecurity, and poor housing quality. Loneliness and lack of transportation were associated with lower care quality and increased acute care utilization; financial strain, utility insecurity, and housing insecurity with lower care quality; and food insecurity with increased acute care utilization. Meaning: The findings suggest that some self-reported HRSNs are associated with diabetes-specific health and utilization outcomes; patient-level information may be relevant to diabetes interventions. Importance: Recent research highlights the association of social determinants of health with health outcomes of patients with type 2 diabetes (T2D). Objective: To examine associations between health-related social needs (HRSNs) and health care quality and utilization outcomes in a Medicare Advantage population with T2D. Design, Setting, and Participants: This cross-sectional study used medical and pharmacy claims data from 2019. An HRSN survey was given between October 16, 2019, and February 29, 2020, to Medicare Advantage beneficiaries. Inclusion criteria were diagnosis of T2D, age of 20 to 89 years, continuous Medicare Advantage enrollment in 2019, and response to the HRSN survey. Data were analyzed between June 2021 and January 2022. Exposures: Enrollment in Medicare Advantage, diagnosis of T2D, and completion of a survey on HRSNs. Main Outcomes and Measures: Quality outcomes included diabetes medication adherence, statin adherence, completion of a glycated hemoglobin (HbA1c) laboratory test in the past 12 months, and controlled HbA1c. Utilization outcomes included all-cause hospitalization, potentially avoidable hospitalization, emergency department discharge, and readmission. Results: Of the 21 528 Medicare Advantage beneficiaries with T2D included in the study (mean [SD] age, 71.0 [8.3] years; 55.4% women), most (56.9%) had at least 1 HRSN. Among the population with T2D reporting HRSNs, the most prevalent were financial strain (73.6%), food insecurity (47.5%), and poor housing quality (39.1%). In adjusted models, loneliness (odds ratio [OR], 0.85; 95% CI, 0.73-0.99), lack of transportation (OR, 0.80; 95% CI, 0.69-0.92), utility insecurity (OR, 0.86; 95% CI, 0.76-0.98), and housing insecurity (OR, 0.78; 95% CI, 0.67-0.91) were each associated with lower diabetes medication adherence. Loneliness and lack of transportation were associated with increased emergency visits (marginal effects of 173.0 [95% CI, 74.2-271.9] and 244.6 [95% CI, 150.4-338.9] emergency visits per 1000 beneficiaries for loneliness and transportation, respectively). Food insecurity was the HRSN most consistently associated with higher acute care utilization (marginal effects of 84.6 [95% CI, 19.8-149.4] emergency visits, 30.4 [95% CI, 9.5-51.3] inpatient encounters, and 17.1 [95% CI, 4.7-29.5] avoidable hospitalizations per 1000 beneficiaries). Conclusions and Relevance: In this cross-sectional study of Medicare Advantage beneficiaries with T2D, some HRSNs were associated with care quality and utilization. The results of the study may be used to direct interventions to the social needs most associated with T2D health outcomes and inform policy decisions at the insurance plan and community level.
- Subjects
MEDICAL quality control; GLYCOSYLATED hemoglobin; SOCIAL determinants of health; CONFIDENCE intervals; CROSS-sectional method; FOOD security; AGE distribution; SELF-evaluation; PATIENT readmissions; TYPE 2 diabetes; MEDICAL care use; SEVERITY of illness index; SEX distribution; COMPARATIVE studies; T-test (Statistics); CRITICAL care medicine; QUALITY assurance; DRUGS; DESCRIPTIVE statistics; FINANCIAL stress; CHI-squared test; NEEDS assessment; PATIENT compliance; ODDS ratio; HOUSING; LOGISTIC regression analysis; DATA analysis software; MEDICARE
- Publication
JAMA Network Open, 2023, Vol 6, Issue 4, pe239316
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.9316