Association of Socioeconomic Area Deprivation Index with Hospital Readmissions After Colon and Rectal Surgery
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ORIGINAL ARTICLE
Association of Socioeconomic Area Deprivation Index with Hospital Readmissions After Colon and Rectal Surgery Federico M. Ghirimoldi 1 & Susanne Schmidt 1 & Richard C. Simon 1 & Chen-Pin Wang 1,2 & Zhu Wang 1 & Bradley B. Brimhall 1,3 & Paul Damien 4 & Eric E. Moffett 1 & Laura S. Manuel 1 & Zaheer U. Sarwar 1 & Paula K. Shireman 1,2,3 Received: 24 April 2020 / Accepted: 19 July 2020 # 2020 The Society for Surgery of the Alimentary Tract (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply)
Abstract Background Risk adjustment for reimbursement and quality measures omits social risk factors despite adversely affecting health outcomes. Social risk factors are not usually available in electronic health records (EHR) or administrative data. Socioeconomic status can be assessed by using US Census data. Distressed Communities Index (DCI) is based upon zip codes, and the Area Deprivation Index (ADI) provides more granular estimates at the block group level. We examined the association of neighborhood disadvantage using the ADI, DCI, and patient-level insurance status on 30-day readmission risk after colorectal surgery. Methods Our 677 patient cohort was derived from the 2013–2017 National Surgical Quality Improvement Program at a safety net hospital augmented with EHR data to determine insurance status and 30-day readmissions. Patients’ home addresses were linked to the ADI and DCI. Results Our cohort consisted of 53.9% males and 63.8% Hispanics with a 22.9% 30-day readmission rate from the date of discharge; > 50% lived in highly deprived neighborhoods. Controlling for medical comorbidities and complications, ADI was associated with increased risk of 30 days from the date of discharge readmissions among patients living in medium (OR = 2.15, p = .02) or high (OR = 1.88, p = .03) deprived areas compared to less-deprived neighborhoods, but not insurance status or DCI. Conclusions The ADI identified patients living in deprived communities with increased readmission risk. Our results show that block-group level ADI can potentially be used in risk adjustment, to identify high-risk patients and to design better care pathways that improve health outcomes. Keywords Colectomy . Social risk factors . Outcomes . Distressed communities index . National Surgical Quality Improvement Program
Introduction
Meeting Presentation: Presented at the Academic Surgical Congress, Orlando, FL, February 2020 * Paula K. Shireman [email protected] 1
Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX 78229-3900, USA
2
South Texas Veterans Health Care System, San Antonio, TX, USA
3
University Health System, San Antonio, TX, USA
4
McCombs School of Business, Department of Information, Risk, & Operations Management, University of Texas, Austin, TX, USA
Colorectal operations are among the most common surgeries performed in the USA an
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