Donna M. Zulman|Matthew L. Maciejewski|Janet M. Grubber|Hollis J. Weidenbacher|Dan V. Blalock|Leah L. Zullig|Liberty Greene|Heather E. Whitson|S. Nicole Hastings|Valerie A. Smith
Patient-Reported Social and Behavioral Determinants of Health and Estimated Risk of Hospitalization in High-Risk Veterans Affairs Patients
VA Palo Alto Health Care System|Center for Innovation|Stanford University|Durham VA Health Care System|Duke University|Durham VA Health Care System|Durham VA Health Care System|Durham VA Health Care System|Durham VA Health Care System|Duke University|VA Palo Alto Health Care System|Center for Innovation|Stanford University|Duke University|Durham VA Health Care System|Geriatric Research Education and Clinical Center|Geriatric Research Education and Clinical Center|Durham VA Health Care System|Duke University|Durham VA Health Care System|Duke University
h3importanceh3 despite recognition association individual social behavioral determinants health sdh patient outcomes little known regarding value sdh explaining variation outcomes highrisk patients h3objectiveh3 describe sdh factors among veterans high risk hospitalization determine whether adding patientreported sdh measures electronic health record ehr measures improves estimation 90day 180day allcause hospital admission h3design setting participantsh3 survey mailed april 16 june 29 2018 nationally representative sample 10 000 veterans affairs va patients whose 1year risk hospitalization death 75th percentile higher based va ehrderived risk score survey included multiple sdh measures resilience social support health literacy smoking status transportation barriers recent life stressors h3main outcomes measuresh3 ehrbased characteristics survey respondents nonrespondents compared using standardized differences estimation 90day 180day hospital admission risk assessed 3 logistic regression models 1 base model prespecified ehrbased covariates 2 restricted model ehrbased covariates chosen via forward selection based minimizing akaike information criterion aic 3 model ehr surveybased covariates chosen via forward selection based aic minimization h3resultsh3 total 4685 individuals response rate 469 responded survey respondents comparable nonrespondents characteristics survey respondents older eg gt80 years old 881 188 vs 800 151 comprised higher percentage men 4391 937 vs 4794 902 composed white nonhispanic individuals 3366 718 vs 3259 613 based aic regression model surveybased covariates ehrbased covariates better estimated hospital admission 90 days aic 19477 180 days aic 29519 restricted models ehrbased covariates aic 19802 90 days aic 29819 180 days result due inclusion selfreported measures marital partner status healthrelated locus control resilience smoking status health literacy medication insecurity h3conclusions relevanceh3 augmenting ehr data patientreported social information improved estimation 90day 180day hospitalization risk highlighting specific sdh factors might identify individuals high risk hospitalization