Abstract
Introduction
Higher Area Deprivation Index (ADI) scores, indicating higher social deprivation, have been associated with more frequent emergency department (ED) utilization. Access to clinical and social services can help prevent inappropriate ED use. A community-based medical school administering a primary and preventive care program focused on the social determinants of health (SDOH) tracks annual ED utilization by its households. This retrospective study determined household ADI scores and evaluated for associations with ED use.
Methods
The ADI uses 17 publicly available variables to assign composite scores of social deprivation at the block group level. The Green Family Foundation Neighborhood Health Education Learning Program at Florida International University provides outreach, clinical, and educational services to > 850 disadvantaged households. We conducted Poisson regression to evaluate the association between households’ ADI scores and self-reported ED utilization over 2 calendar years.
Results
For both the 2018 and 2019 cohorts, independent Poisson regression results indicate that ED visit count is significantly and inversely associated with ADI raw scores and deciles (p < 0.001).
Discussion
Based on findings from earlier studies, we had hypothesized a positive, yet reduced association between annual ED utilization and ADI level but surprisingly, we found an inverse association. The combination of providing primary care and connecting with social and behavioral health services as needed appeared to reverse the expected higher ED use at higher ADI scores.
Conclusion
Tracking of ED utilization in association with composite, area-based indices such as the ADI may prove useful for other clinical and community health endeavors focused on SDOH.
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Data availability
The data that support the findings of this study are available from the corresponding author upon request.
Code availability
Not applicable
References
About the Area Deprivation Index (2022) Neighborhood Atlas 2022. Applied Population Lab, UW-Madison, Madison, WI, USA. https://www.neighborhoodatlas.medicine.wisc.edu/#faq-anchor. Accessed 1 Nov 2022
Accountable Health Communities (AHC) (2020) Model evaluation: first evaluation report centers for Medicare and Medicaid Services. RTI International, Research Triangle Park, NC, USA. https://innovation.cms.gov/data-and-reports/2020/ahc-first-eval-rpt. Accessed 21 Feb 2023
ASPE Reports (2021) Trends in the utilization of emergency department services, 2009–2018. U.S. Department of Health and Human Services, Washington, DC. https://aspe.hhs.gov/pdf-report/utilization-emergency-department-services. Accessed 21 Feb 2023
Barbadoro P, Di Tondo E, Menditto VG, Pennacchietti L, Regnicoli F, Di Stanislao F, D’Errico MM, Prospero E (2015) Emergency department non-urgent visits and hospital readmissions are associated with different socio-economic variables in Italy. PLoS One 10(6):e0127823. https://doi.org/10.1371/journal.pone.0127823
Carlson LC, Kim J, Samuels-Kalow ME, Yun BJ, Terry DF, Weilburg JB, Lee J (2021) Comparing neighborhood-based indices of socioeconomic risk factors and potentially preventable emergency department utilization. Am J Emerg Med 44:213–219. https://doi.org/10.1016/j.ajem.2020.03.035
Coster JE, Turner JK, Bradbury D, Cantrell A (2017) Why do people choose emergency and urgent care services? a rapid review utilizing a systematic literature search and narrative synthesis. Acad Emerg Med 24(9):1137–1149. https://doi.org/10.1111/acem.13220
Daniel H, Bornstein SS, Kane GC, Health and Public Policy Committee of the American College of Physicians (2018) Addressing social determinants to improve patient care and promote health equity: an American College of Physicians position paper. Ann Intern Med 168(8):577. https://doi.org/10.7326/M17-2441
Davies S, Schultz E, Raven M, Wang NE, Stocks CL, Delgado MK, McDonald KM (2017) Development and validation of the Agency for Healthcare Research and Quality measures of potentially preventable emergency department (ED) visits: the ED prevention quality indicators for general health conditions. Health Serv Res 52(5):1667–1684. https://doi.org/10.1111/1475-6773.12687
Durfey SNM, Kind AJH, Buckingham WR, DuGoff EH, Trivedi AN (2019) Neighborhood disadvantage and chronic disease management. Health Serv Res 54:206–216. https://doi.org/10.1111/1475-6773.13092
Fahrenbach J, Chin MH, Huang ES, Springman MK, Weber SG, Tung EL (2020) Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program. Med Care 58(4):376–383. https://doi.org/10.1097/MLR.0000000000001283
Fleury MJ, Rochette L, Grenier G, Huỳnh C, Vasiliadis HM, Pelletier É, Lesage A (2019) Factors associated with emergency department use for mental health reasons among low, moderate and high users. Gen Hosp Psychiatry 60:111–119. https://doi.org/10.1016/j.genhosppsych.2019.07.006
Garba NA, Anderson F, Schneider GW, Bisschops J, Bhoite P, Lage OG, Sackstein R, Brown DR (2021) Caring for vulnerable communities in Miami Dade County during the COVID-19 pandemic. J Health Care Poor Underserved 32(2):598–606. https://doi.org/10.1353/hpu.2021.0088
Gentil L, Huỳnh C, Grenier G, Fleury MJ (2020) Predictors of emergency department visits for suicidal ideation and suicide attempt. Psychiatry Res 285:112805. https://doi.org/10.1016/j.psychres.2020.112805
Greer PJ, Brown DR, Brewster LG, Lage OG, Esposito KF, Whisenant EB, Anderson FW, Castellanos NK, Stefano TA, Rock JA (2018) Socially accountable medical education: an innovative approach at Florida International University Herbert Wertheim College of Medicine. Acad Med 93(1):60–65. https://doi.org/10.1097/ACM.0000000000001811
Hu J, Kind AJH, Nerenz D (2018) Area Deprivation Index predicts readmission risk at an urban teaching hospital. Am J Med Qual 33(5):493–501. https://doi.org/10.1177/1062860617753063
Hull SA, Homer K, Boomla K, Robson J, Ashworth M (2018) Population and patient factors affecting emergency department attendance in London: retrospective cohort analysis of linked primary and secondary care records. Br J Gen Pract 68(668):e157–e167. https://doi.org/10.3399/bjgp18X694397
Jencks SF, Schuster A, Dougherty GB, Gerovich S, Brock JE, Kind AJH (2019) Safety-net hospitals, neighborhood disadvantage, and readmissions under Maryland’s All-Payer Program: an observational study. Ann Intern Med 171(2):91. https://doi.org/10.7326/M16-2671
Kangovi S, Barg FK, Carter T, Long JA, Shannon R, Grande D (2013) Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care. Health Aff 32(7):1196–1203. https://doi.org/10.1377/hlthaff.2012.0825
Kind AJH, Buckingham WR (2018) Making neighborhood-dsadvantage metrics accessible—the Neighborhood Atlas. N Engl J Med 378(26):2456–2458. https://doi.org/10.1056/NEJMp1802313
Kind AJH, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W, Greenberg C, Smith M (2014) Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med 161(11):765. https://doi.org/10.7326/M13-2946
Knighton AJ, Savitz L, Belnap T, Stephenson B, VanDerslice J (2016) Introduction of an Area Deprivation Index measuring patient socio-economic status in an integrated health system: implications for population health. eGEMs: J Electronic Health Data Methods 4(3):9. https://doi.org/10.13063/2327-9214.1238
Krieg C, Hudon C, Chouinard MC, Dufour I (2016) Individual predictors of frequent emergency department use: a scoping review. BMC Health Serv Res 16(1):594. https://doi.org/10.1186/s12913-016-1852-1
Lantos PM, Hoffman K, Permar SR, Jackson P, Hughes BL, Kind A, Swamy G (2018) Neighborhood disadvantage is associated with high cytomegalovirus seroprevalence in pregnancy. J Racial Ethn Health Disparities 5(4):782–786. https://doi.org/10.1007/s40615-017-0423-4
Maroko AR, Doan TM, Arno PS, Hubel M, Yi S, Viola D (2016) Integrating social determinants of health with treatment and prevention: a new tool to assess local area deprivation. Prev Chronic Dis 13:160221. https://doi.org/10.5888/pcd13.160221
Martin LJ, Chen Y, Serrano-Lomelin J, Talbot J, Yasui Y (2020) Higher levels of social and material deprivation are associated with higher rates of influenza-like illness–related emergency department visits: Edmonton, Alberta, 2004–2014. Public Health 189:117–122. https://doi.org/10.1016/j.puhe.2020.06.039
Mensah GA, Riley WT (2021) Social determinants of health and implementation research: three decades of progress and a need for convergence. Ethn Dis 31(1):1–4. https://doi.org/10.18865/ed.31.1.1
Rahman M, Meyers DJ, Wright B (2020) Unintended consequences of observation stay use may disproportionately burden Medicare beneficiaries in disadvantaged neighborhoods. Mayo Clin Proc 95(12):2589–2591. https://doi.org/10.1016/j.mayocp.2020.10.014
Sheehy AM, Powell WR, Kaiksow FA, Buckingham WR, Bartels CM, Birstler J, Yu M, Bykovskyi AG, Shi F, Kind AJH (2020) Thirty-day re-observation, chronic re-observation, and neighborhood disadvantage. Mayo Clin Proc 95(12):2644–2654. https://doi.org/10.1016/j.mayocp.2020.06.059
Singh GK (2003) Area deprivation and widening inequalities in US mortality, 1969–1998. Am J Public Health 93(7):1137–1143. https://doi.org/10.2105/AJPH.93.7.1137
Smith-Campbell B (2005) Emergency department and community health center visits and costs in an uninsured population. J Nurs Scholarsh 37(1):80–86. https://doi.org/10.1111/j.1547-5069.2005.00011.x
Soto Mas F, Iriart C, Pedroncelli R, Binder DS, Qualls CR, Price B (2019) Impact of health care and socioeconomic needs on health care utilization and disease management: the University of New Mexico Hospital Care One Program. Population Health Manag 22(2):113–119. https://doi.org/10.1089/pop.2018.0048
Stumbar SE, Garba NA, Bhoite P, Ravelo N, Shringarpure N (2020) Pilot Study of a free long-acting reversible contraception program on a mobile health center in Miami Dade County, Florida. J Immigr Minor Health 22(2):421–425. https://doi.org/10.1007/s10903-019-00937-y
Sun BC, Burstin HR, Brennan TA (2003) Predictors and outcomes of frequent emergency department users. Acad Emerg Med 10(4):320–328. https://doi.org/10.1111/j.1553-2712.2003.tb01344.x
Theriault KM, Rosenheck RA, Rhee TG (2020) Increasing emergency department visits for mental health conditions in the United States. J Clin Psych 81(5):20m13241. https://doi.org/10.4088/JCP.20m13241
Weinick RM, Burns RM, Mehrotra A (2010) Many emergency department visits could be managed at urgent care centers and retail clinics. Health Aff 29(9):1630–1636. https://doi.org/10.1377/hlthaff.2009.0748
Wesson D, Kitzman H, Halloran KH, Tecson K (2018) Innovative population health model associated with reduced emergency department use and inpatient hospitalizations. Health Aff 37(4):543–550. https://doi.org/10.1377/hlthaff.2017.1099
Yan D, Wang S, Temkin-Greener H, Cai S (2021) The use patterns of Medicaid home and community based services among Medicare/Medicaid beneficiaries with dementia. Front Public Health 9:708402. https://doi.org/10.3389/fpubh.2021.708402
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All authors contributed to the study conception and design. Data collection and analysis were performed by Jamie Fairclough, Anuj Ojha, Prasad Bhoite, and Gregory W. Schneider. Background research and material preparation were performed by Mackenzie Mayhew, Alexa Denton, Anna Kenney, Matthew Hey, Shahab Shaffiey, Rupa Seetharamaiah, and Gregory W. Schneider. The first draft of the manuscript was written by Mackenzie Mayhew. The final draft of the manuscript was written by Gregory W. Schneider, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The study received IRB approval through expedited review from the Florida International University Institutional Review Board, protocol number IRB-20-0351.
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Mayhew, M., Denton, A., Kenney, A. et al. Social deprivation, the Area Deprivation Index, and emergency department utilization within a community-based primary and preventive care program at a Florida medical school. J Public Health (Berl.) 32, 827–835 (2024). https://doi.org/10.1007/s10389-023-01871-y
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DOI: https://doi.org/10.1007/s10389-023-01871-y