Observational studyJournal of general internal medicine2019
Association of Patient Social, Cognitive, and Functional Risk Factors with Preventable Hospitalizations: Implications for Physician Value-Based Payment.
Observational study in Journal of general internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 33 citations in OpenAlex.
- Association of Geriatric Emergency Department Care With Hospitalization and Mortality in Older Adults.Journal of the American Geriatrics Society · 2026Article
- Association between governmental spending on social services and health care use among low-income older adults.Health affairs scholar · 2025Article
- Functional Impairments, Phenotypic Frailty, and Sector-Specific Incremental Healthcare Costs in Older Adults.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Article
- Association Between Community-Level Social Risk and Spending Among Medicare Beneficiaries: Implications for Social Risk Adjustment and Health Equity.JAMA health forum · 2023Article
- Association of Function, Symptoms, and Social Support Reported in Standardized Outpatient Clinic Questionnaires With Subsequent Hospital Discharge Disposition and 30-Day Readmissions.Archives of physical medicine and rehabilitation · 2022Article
- Association of Social Determinants of Health and Their Cumulative Impact on Hospitalization Among a National Sample of Community-Dwelling US Adults.Journal of general internal medicine · 2022Article
- Clinical risk calculators informing the decision to admit: A methodologic evaluation and assessment of applicability.PloS one · 2022Article
- Article
- National profile of the growing population of older adults who access community health centers.Journal of the American Geriatrics Society · 2021Article
- Evaluation of Hospital Performance Using the Excess Days in Acute Care Measure in the Hospital Readmissions Reduction Program.Annals of internal medicine · 2021Article
- Utilization of Social Determinants of Health ICD-10 Z-Codes Among Hospitalized Patients in the United States, 2016-2017.Medical care · 2020Article
- Hospitalization and Mortality among Black Patients and White Patients with Covid-19.The New England journal of medicine · 2020Observational
- Patient social risk factors and continuity of care for Medicare beneficiaries.Health services research · 2020Observational
- Social Determinants of Health and 90-Day Mortality After Hospitalization for Heart Failure in the REGARDS Study.Journal of the American Heart Association · 2020Observational
- Switching Between Medicare Advantage And Traditional Medicare Before And After The Onset Of Functional Disability.Health affairs (Project Hope) · 2020Article
- Article
- Paying for Performance Improvement in Quality and Outcomes of Cardiovascular Care: Challenges and Prospects.Methodist DeBakey cardiovascular journalReview
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundAmbulatory care-sensitive condition (ACSC) hospitalizations are used to evaluate physicians' performance in Medicare value-based payment programs. However, these measures may disadvantage physicians caring for vulnerable populations because they omit social, cognitive, and functional factors that may be important determinants of hospitalization.
objectiveTo determine whether social, cognitive, and functional risk factors are associated with ACSC hospitalization rates and whether adjusting for them changes outpatient safety-net providers' performance.
designUsing data from the Medicare Current Beneficiary Survey, we conducted patient-level multivariable regression to estimate the association (as incidence rate ratios (IRRs)) between patient-reported social, cognitive, and functional risk factors and ACSC hospitalizations. We compared outpatient safety-net and non-safety-net providers' performance after adjusting for clinical comorbidities alone and after additional adjustment for social, cognitive, and functional factors captured in survey data.
settingSafety-net and non-safety-net clinics.
participantsCommunity-dwelling Medicare beneficiaries contributing 38,616 person-years from 2006 to 2013. MEASUREMENTS: Acute and chronic ACSC hospitalizations.
resultsAfter adjusting for clinical comorbidities, Alzheimer's/dementia (IRR 1.30, 95% CI 1.02-1.65), difficulty with 3-6 activities of daily living (ADLs) (IRR 1.43, 95% CI 1.05-1.94), difficulty with 1-2 instrumental ADLs (IADLs, IRR 1.54, 95% CI 1.26-1.90), and 3-6 IADLs (IRR 1.90, 95% CI 1.49-2.43) were associated with acute ACSC hospitalization. Low income (IRR 1.28, 95% CI 1.03-1.58), lack of educational attainment (IRR 1.33, 95% CI 1.04-1.69), being unmarried (IRR 1.18, 95% CI 1.01-1.36), difficulty with 1-2 IADLs (IRR 1.30, 95% CI 1.05-1.60), and 3-6 IADLs (IRR 1.44, 95% CI 1.16-1.80) were associated with chronic ACSC hospitalization. Adding these factors to standard Medicare risk adjustment eliminated outpatient safety-net providers' performance gap (p < .05) on ACSC hospitalization rates relative to non-safety-net providers.
conclusionsSocial, cognitive, and functional risk factors are independently associated with ACSC hospitalizations. Failure to account for them may penalize outpatient safety-net providers for factors that are beyond their control.
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