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Evaluating Social Determinants of Health in a Mobile Integrated Healthcare-Community Paramedicine Program

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Abstract

In 2018, the University of Maryland Medical Center and the Baltimore City Fire Department implemented a community paramedicine program to help medically or socially complex patients transition from hospital to home and avoid hospital utilization. This study describes how patients’ social determinants of health (SDoH) needs were identified, and measures the association between needs and hospital utilization. SDoH needs were categorized into ten domains. Multinomial logistic regression was used to measure association between identified SDoH domains and predicted risk of readmission. Poisson regression was used to measure association between SDoH domains and actual 30-day hospital utilization. The most frequently identified SDoH needs were in the Coordination of Healthcare (37.7%), Durable Medical Equipment (18.8%), and Medication (16.3%) domains. Compared with low-risk patients, patients with an intermediate risk of readmission were more likely to have needs within the Coordination of Healthcare (RRR [95% CI] 1.12 [1.01, 1.24], p = 0.032) and Durable Medical Equipment (RRR = 1.13 [1.00, 1.27], p = 0.046) domains. Patients with the highest risk for readmission were more likely to have needs in the Utilities domain (RRR = 1.76 [0.97, 3.19], p = 0.063). Miscellaneous domain needs, such as requiring a social security card, were associated with increased 30-day hospital utilization (IRR = 1.23 [0.96, 1.57], p = 0.095). SDoH needs within the Coordination of Healthcare, Durable Medical Equipment, and Utilities domains were associated with higher predicted 30-day readmission, while identification documentation and social services needs were associated with actual readmission. These results suggest where to allocate resources to effectively diminish hospital utilization.

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Data Availability

The data that support the findings of this study are available upon reasonable request.

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Acknowledgements

We acknowledge the support of the Baltimore City Fire Department (BCFD), the Maryland Health Services Cost Review Commission (MHSCRC), the University of Maryland, Baltimore, Institute for Clinical & Translational Research (ICTR), and the National Center for Advancing Translational Sciences (NCATS) Clinical Translational Science Award (CTSA) grant number 1UL1TR003098. We also thank Eileen O’Brien for her editorial assistance.

Funding

We received funding internally from the University of Maryland, Baltimore, which came from the Institute for Clinical & Translational Research Accelerated Translational Incubator Pilot grant program (ID number 70), which in turn is funded by the National Center for Advancing Translational Sciences (NCATS) Clinical Translational Science Award (CTSA), grant number UL1TR003098. In addition, we acknowledge the support of the Maryland Health Services Cost Review Commission (HSCRC), which funded the MIH-CP program. This was not an award; it was a reimbursement rate adjustment from the HSCRC, then the Maryland State Hospital Funding Commission, to the University of Maryland Medical Center for piloting a two-year MIH-CP program. We declare no other financial relationships with any organizations that might have an interest in the submitted work and no other relationships or activities that could appear to have influenced the submitted work.

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Authors and Affiliations

  1. University of Maryland School of Medicine, 620 W Lexington St, Baltimore, MD, 21201, USA

    Sean Naimi

  2. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Benoit Stryckman, David Marcozzi & Daniel B. Gingold

  3. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Yuanyuan Liang

  4. Department of Quality and Safety, University of Maryland Medical Center, Baltimore, USA

    Kristin Seidl

  5. Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, 21201, USA

    Kristin Seidl

  6. Baltimore City Fire Department, Baltimore, MD, 21201, USA

    Erinn Harris & Jessica Thomas

  7. Mobile Integrated Health Community Paramedicine, University of Maryland Medical Center, Baltimore, MD, 21201, USA

    Colleen Landi

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  1. Sean Naimi
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  2. Benoit Stryckman
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  3. Yuanyuan Liang
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  4. Kristin Seidl
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  7. Jessica Thomas
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  8. David Marcozzi
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  9. Daniel B. Gingold
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Contributions

SN: conceptualization (support); data curation (support); writing—original draft (lead); writing—review and editing (lead). BS: conceptualization (support); data curation (lead); formal analysis (support); project administration (lead); software (lead); writing—review and editing (support). YL: formal analysis (lead); methodology (lead); writing--review and editing (support). KS: data curation (lead); software (support); writing--review and editing (support). EH: investigation (equal). CL: data curation (support); software (support). JT: investigation (equal). DM: funding acquisition (equal). DBG: conceptualization (lead); funding acquisition (equal); project administration (support); supervision (lead); writing—review and editing (support).

Corresponding author

Correspondence to Sean Naimi.

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Conflict of interest

The authors have no relevant financial or non-financial conflicts of interest to disclose.

Ethical Approval

This study was exempt by University of Maryland, Baltimore IRB HP-00086403.

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Appendix

Appendix

See Table 6.

Table 6 Average HOSPITAL score and 30-day post-enrollment hospital utilization for patients enrolled in the program, stratified by social determinant of health needs
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Naimi, S., Stryckman, B., Liang, Y. et al. Evaluating Social Determinants of Health in a Mobile Integrated Healthcare-Community Paramedicine Program. J Community Health 48, 79–88 (2023). https://doi.org/10.1007/s10900-022-01148-7

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