Evidence map›Paper›PMID 34445974›Full record

ArticleBMC health services research2021

Examining the association of social risk with heart failure readmission in the Veterans Health Administration.

Charlie M Wray, Marzieh Vali, Louise C Walter, Lee Christensen, Wendy Chapman, Peter C Austin, Amy L Byers, Salomeh Keyhani

Abstract read
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In one paragraph

Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Charlie M WrayDepartment of Medicine, University of California, San Francisco, USA. Charlie.Wray@ucsf.edu.
Marzieh ValiNorthern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, San Francisco, USA.
Louise C WalterDepartment of Medicine, University of California, San Francisco, USA.
Lee ChristensenDepartment of Biomedical Informatics, University of Utah, Salt Lake City, USA.
Wendy ChapmanCentre for Digital Transformation of Health, University of Melbourne, Melbourne, Victoria, Australia.
Peter C AustinInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Amy L ByersDepartment of Psychiatry, University of California, San Francisco, USA.
Salomeh KeyhaniDivision of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, USA.

Funding

An Evaluation of Novel Domains for Predicting 30-Day ReadmissionR01HL116522 · NHLBI · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI KEYHANI, SALOMEH · 2013 to 2017
$3.3M
HSRD VA SDR 02-237NHLBI NIH HHS R01 HL116522NIH HHS RO1 HL116522-01A1
6 · The paper itself

Abstract

backgroundPrevious research has found that social risk factors are associated with an increased risk of 30-day readmission. We aimed to assess the association of 5 social risk factors (living alone, lack of social support, marginal housing, substance abuse, and low income) with 30-day Heart Failure (HF) hospital readmissions within the Veterans Health Affairs (VA) and the impact of their inclusion on hospital readmission model performance.

methodsWe performed a retrospective cohort study using chart review and VA and Centers for Medicare and Medicaid Services (CMS) administrative data from a random sample of 1,500 elderly (≥ 65 years) Veterans hospitalized for HF in 2012. Using logistic regression, we examined whether any of the social risk factors were associated with 30-day readmission after adjusting for age alone and clinical variables used by CMS in its 30-day risk stratified readmission model. The impact of these five social risk factors on readmission model performance was assessed by comparing c-statistics, likelihood ratio tests, and the Hosmer-Lemeshow goodness-of-fit statistic.

resultsThe prevalence varied among the 5 risk factors; low income (47 % vs. 47 %), lives alone (18 % vs. 19 %), substance abuse (14 % vs. 16 %), lacks social support (2 % vs. <1 %), and marginal housing (< 1 % vs. 3 %) among readmitted and non-readmitted patients, respectively. Controlling for clinical factors contained in CMS readmission models, a lack of social support was found to be associated with an increased risk of 30-day readmission (OR 4.8, 95 %CI 1.35-17.88), while marginal housing was noted to decrease readmission risk (OR 0.21, 95 %CI 0.03-0.87). Living alone (OR: 0.9, 95 %CI 0.64-1.26), substance abuse (OR 0.91, 95 %CI 0.67-1.22), and having low income (OR 1.01, 95 %CI 0.77-1.31) had no association with HF readmissions. Adding the five social risk factors to a CMS-based model (age and comorbid conditions; c-statistic 0.62) did not improve model performance (c-statistic: 0.62).

conclusionsWhile a lack of social support was associated with 30-day readmission in the VA, its prevalence was low. Moreover, the inclusion of some social risk factors did not improve readmission model performance. In an integrated healthcare system like the VA, social risk factors may have a limited effect on 30-day readmission outcomes.

Indexed as

Heart FailurePneumoniaAgedHumansMedicarePatient ReadmissionRetrospective StudiesRisk FactorsUnited StatesVeterans HealthHeart FailureReadmissionsSocial Risk FactorsVeterans Affairs

Identifiers

PMID34445974
PMCPMC8393433

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.