High social risk, social need increase odds of ED use
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Key takeaways:
- Patients had greater odds of an ED visit if they had high social risk, high social need or both.
- The findings suggest EDs may be an important venue to identify adverse social determinants of health.
Both social risk and social need increased the odds of ED use, according to a study published in JAMA Network Open.
“Primary care providers remain the frontline defense in addressing [adverse social determinants of health (SDoH)],” Katherine Dickerson Mayes, MD, PhD, an emergency medicine resident physician at Mass General Brigham, told Healio. “Our data on the presence of social risk and social need came from PCP visits, which are undoubtedly important opportunities for intervention.”
Mayes and colleagues explained that adverse SDOH “include adverse social conditions associated with poor health (social risk) and an individual’s preferences and priorities regarding assistance (social need).”
They added that many studies on ED services are limited by single-center ascertainment of visits.
To overcome this barrier, the researchers examined data from 77,524 patients who were treated through the Mass General Brigham Medicaid-accountable care organization (ACO). Of these patients, 26,771 received SDOH screening during 29,972 patient encounters across 10 primary care screening sites.
“The Mass General Brigham ACO represents patients covered through MassHealth within the hospital’s network,” Mayes explained. “While those individuals made up the study population, our analysis used all claims across the entire Medicaid system — meaning it captured visits to any hospital, rather than just Mass General Brigham sites.”
Among those screened, 57% were pediatric patients, 41% had one or more ED visits and 16% had at least four ED visits, defined as high-frequency ED use.
The researchers found that social risk (adjusted OR = 1.26; 95% CI, 1.2-1.33) and social need (aOR = 1.29; 95% CI, 1.22-1.38) were both associated with any ED use.
Patients had higher odds of an ED visit if they had:
- high social risk (aOR = 1.39; 95% CI, 1.28-1.5);
- high social need (aOR = 1.4; 95% CI, 1.24-1.57); or
- both (aOR = 1.49; 95% CI, 1.28-1.74).
Both social risk and social need were also associated with high-frequency ED use, with aORs of 1.44 (95% CI, 1.32-1.57) and 1.42 (95% CI, 1.29-1.56), respectively. Patients had greater odds of high-frequency ED use if they possessed:
- high social risk (aOR = 1.6; 95% CI, 1.42-1.8);
- high social need (aOR = 1.68; 95% CI, 1.42-1.98); or
- both (aOR = 1.81; 95% CI, 1.48-2.23).
Mayes and colleagues noted that a single-system analysis would have missed 52% of patients with one or more ED visits and 44% of patients with four or more ED visits, “indicating the importance of using claims data sets.”
There were some limitations in the study. The sample only included those with primary care visits and a SDOH screening, which the researchers said could be biased against those without primary care or insurance.
“Additionally, individuals may have differed by those who attended and did not attend appointments,” they wrote. “Regardless, the frequency of high risk and need among patients presenting to the ED suggests the ED may be an important venue for programs to identify and intervene on adverse SDOH.”
Perspective
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The most interesting thing to me is the approximately 50% of patients who would have been missed by a single-center analysis. That finding likely implies that if services were provided from a system-out model (ie, from a hospital), the services would be less effective and the impact would be challenging to measure. This points to the need for a community-based or governmental approach.
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