Journal article
Care Fragmentation, Social Determinants of Health, and Postoperative Mortality in Older Veterans
The Journal of surgical research, Vol.300, pp.514-525
08/2024
DOI: 10.1016/j.jss.2024.04.082
PMCID: PMC11837767
PMID: 38875950
Abstract
Veterans Affairs Surgical Quality Improvement Program (VASQIP) benchmarking algorithms helped the Veterans Health Administration (VHA) reduce postoperative mortality. Despite calls to consider social risk factors, these algorithms do not adjust for social determinants of health (SDoH) or account for services fragmented between the VHA and the private sector. This investigation examines how the addition of SDoH change model performance and quantifies associations between SDoH and 30-d postoperative mortality.
VASQIP (2013-2019) cohort study in patients ≥65 y old with 2-30-d inpatient stays. VASQIP was linked to other VHA and Medicare/Medicaid data. 30-d postoperative mortality was examined using multivariable logistic regression models, adjusting first for clinical variables, then adding SDoH.
In adjusted analyses of 93,644 inpatient cases (97.7% male, 79.7% non-Hispanic White), higher proportions of non-veterans affairs care (adjusted odds ratio [aOR] = 1.02, 95% CI = 1.01-1.04) and living in highly deprived areas (aOR = 1.15, 95% CI = 1.02-1.29) were associated with increased postoperative mortality. Black race (aOR = 0.77, CI = 0.68-0.88) and rurality (aOR = 0.87, CI = 0.79-0.96) were associated with lower postoperative mortality. Adding SDoH to models with only clinical variables did not improve discrimination (c = 0.836 versus c = 0.835).
Postoperative mortality is worse among Veterans receiving more health care outside the VA and living in highly deprived neighborhoods. However, adjusting for SDoH is unlikely to improve existing mortality-benchmarking models. Reduction efforts for postoperative mortality could focus on alleviating care fragmentation and designing care pathways that consider area deprivation. The adjusted survival advantage for rural and Black Veterans may be of interest to private sector hospitals as they attempt to alleviate enduring health-care disparities.
Details
- Title: Subtitle
- Care Fragmentation, Social Determinants of Health, and Postoperative Mortality in Older Veterans
- Creators
- Carly A. Duncan - VA Pittsburgh Healthcare SystemMichael A. Jacobs - VA Pittsburgh Healthcare SystemYubo Gao - University of IowaMichael Mader - South Texas Veterans Health Care SystemSusanne Schmidt - The University of Texas Health Science Center at San AntonioHeather Davila - University of IowaKatherine Hadlandsmyth - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IowaPaula K. Shireman - Texas A&M Health Science CenterLeslie R.M. Hausmann - VA Pittsburgh Healthcare SystemRobert A. Tessler - VA Pittsburgh Healthcare SystemAndrea Strayer - VA Quality Scholar, Iowa City Veterans Affairs Medical Center, Iowa City, IowaMary Vaughan Sarrazin - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IowaDaniel E. Hall - VA Pittsburgh Healthcare System
- Resource Type
- Journal article
- Publication Details
- The Journal of surgical research, Vol.300, pp.514-525
- DOI
- 10.1016/j.jss.2024.04.082
- PMID
- 38875950
- PMCID
- PMC11837767
- NLM abbreviation
- J Surg Res
- ISSN
- 0022-4804
- eISSN
- 1095-8673
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 08/2024
- Academic Unit
- Psychiatry; Health Management and Policy; Anesthesia; General Internal Medicine; Neurosurgery; Internal Medicine
- Record Identifier
- 9984696657402771
Metrics
12 Record Views