Overlap in Social Risk Factors

2019 Measure Reporting Year

Measurement Period: April 2015 - June 2018

There are challenges to reliably identifying populations with social risk factors. Research has shown that various markers of populations with social risk factors capture different aspects of patient disparities. It is often assumed, however, that these markers consistently identify the same group of hospitals. This data visualization examines the overlap in the identification and geographic location of hospitals using seven different social risk factors.

To begin exploring the data:

  1. Select a measure from the drop down menu

  2. Select social risk factors from the drop down menu

The map displays all hospitals captured by the selected characteristics. The colored boxes display the overlap of hospitals captured by the selected characteristics.

Choose a condition/procedure

Choose a condition/procedure

Choose a Condition:

Then, choose an outcome:

Add a Sociodemographic Characteristic(s)

Add a Characterstic

Current Characteristics:

  • {[{characteristic.name}]}

Years:

2023 2021 2020 2019 2018

{[{ selectedMeasure.condition }]}: {[{ selectedMeasure.description }]} Hospitals with the highest proportion of patients with the following characteristic: {[{selectedVariables[0].name}]} Select at least one sociodemographic characteristic above to begin.

{[{filteredHospitals[0].length}]} out of {[{ allHospitals.length }]} total hospitals in measure

{[{variable.length}]} {[{ $index > 0 ? "and" : ""}]} {[{ selectedVariables[$index].name }]}{[{ $index === filteredHospitals.length - 1 ? "" : "..."}]}

Table View

Sociodemographic Characteristic(s)
{[{ selectedMeasure.condition }]}: {[{selectedMeasure.description}]}
Hospitals with the highest proportion of patients with the following characteristic: {[{selectedVariables[0].name}]}
{[{filteredHospitals[0].length}]} out of {[{ allHospitals.length }]} hospitals
{[{variable.name}]}
Checkmark
--
Number of Hospitals that Meet Criteria:
{[{variable.length}]}

Notes

Hospitals were identified as caring for disproportionate volume of patients with social risk factors if they were in the highest decile for that definition.

The measurement period for all condition-specific mortality, readmission, and payment measures, and the hip/knee readmission measure went from July 2015 through June 2018. The hip/knee complication measure uses data from April 2015 through March 2018. The hospital-wide readmission measure uses data from July 2017 through June 2018.

Social risk factors were derived from the American Community Survey (ACS) 5-year estimate: 2013 - 2017, the American Hospital Association (AHA) Survey 2016, and the Medicare Part A Inpatient Claims 2017.

Only hospitals with at least 25 qualifying hospitalizations for a given measure are included in the visualization.

Beginning with the 2019 reporting year, the stroke readmission measure was removed from this data visualization because this measure is no longer reported in the Inpatient Quality Reporting Program (IQR). This measure’s results are still available in reporting years prior to 2019.

Table 1. Key Definitions

Social Risk Factor

Definition

Below U.S. poverty line
  • Patients residing in zip codes where more than 18.6% of the residents are below the United States (U.S.) poverty line.

Educational attainment below high school
  • Patients from zip codes where more than 16.0% of residents aged 25 or older have less than a 12th grade education.

Unemployed
  • Patients from zip codes where more than 8.7% of the residents aged 16 years or older are in the labor force who are unemployed and actively seeking work.

Crowded households
  • Patients from zip codes where more than 3.2% of residents live in households containing one or more person per room.

African-American
  • Patients who self-identify as African-American

Medicaid
  • Patients who receive Medicaid coverage

AHRQ Index of SES score
  • Patients from zip codes with an Agency for Healthcare Research & Quality (AHRQ) socioeconomic status (SES) index score below 48.2

Methodology Sources

Hospital-Wide Readmission Measure Methodology: Lori Wallace, Jacqueline N. Grady, Darinka Djordjevic, et al. 2019 All-Cause Hospital-Wide Measure Updates and Specifications Report: Hospital-Level 30-Day Risk-Standardized Readmission Measure – Version 8.0. https://qualitynet.org/inpatient/measures/readmission/methodology. Available as of April 23, 2019.

AMI, COPD, Heart Failure, and Pneumonia Readmission Measures Methodology: Lori Wallace, Jacqueline N. Grady, Darinka Djordjevic, et al. 2019 Condition-Specific Measures Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Readmission Measures: Acute Myocardial Infarction – Version 12.0, Chronic Obstructive Pulmonary Disease – Version 8.0, Heart Failure – Version 12.0, Pneumonia – Version 12.0. https://qualitynet.org/inpatient/measures/readmission. Available as of April 23, 2019.

CABG and Hip/Knee Arthroplasty Readmission Measures Methodology: Lori Wallace, Jacqueline N. Grady, Darinka Djordjevic, et al. 2019 Procedure-Specific Measures Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Readmission Measures: Isolated Coronary Artery Bypass Graft (CABG) Surgery – Version 6.0, Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) – Version 8.0. https://qualitynet.org/inpatient/measures/readmission. Available as of April 23, 2019.

AMI, COPD, Heart Failure, Pneumonia, and Stroke Mortality Measures Methodology: Lori Wallace, Jacqueline N. Grady, Darinka Djordjevic, et al. 2019 Condition-Specific Measures Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Mortality Measures: Acute Myocardial Infarction – Version 13.0, Chronic Obstructive Pulmonary Disease – Version 8.0, Heart Failure – Version 13.0, Pneumonia – Version 13.0, Stroke – Version 8.0. https://qualitynet.org/inpatient/measures/mortality/methodology. Available as of April 23, 2019.

CABG Mortality Measure Methodology: Lori Wallace, Jacqueline N. Grady, Darinka Djordjevic, et al. 2019 Procedure-Specific Measure Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Mortality Measure: Isolated Coronary Artery Bypass Graft (CABG) Surgery – Version 6.0. https://qualitynet.org/inpatient/measures/mortality/methodology. Available as of April 23, 2019.

Hip/Knee Arthroplasty Complication Measure Methodology: Lori Wallace, Jacqueline N. Grady, Darinka Djordjevic, et al. 2019 Procedure-Specific Measure Updates and Specifications Report Hospital-Level Risk-Standardized Complication Measure: Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) – Version 8.0. https://qualitynet.org/inpatient/measures/complication/methodology. Available as of April 23, 2019.

AMI, Heart Failure, Pneumonia, and Hip/Knee Arthroplasty Payment Measures Methodology: Lori Wallace, Jacqueline N. Grady, Darinka Djordjevic, et al. 2019 Measure Updates and Specifications Report Hospital-Level Risk-Standardized Payment Measures: Acute Myocardial Infarction – Version 8.0, Heart Failure – Version 6.0, Pneumonia – Version 6.0, Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) – Version 5.0. https://qualitynet.org/inpatient/measures/payment/methodology. Available as of April 23, 2019.

AMI, Heart Failure, Pneumonia Excess Days in Acute Care Measure Methodology: Lori Wallace, Jacqueline N. Grady, Darinka Djordjevic, et al. 2019 Condition-Specific Measures Updates and Specification Report Hospital-Level 30-Day Risk-Standardized Excess Days in Acute Care Measures: Acute Myocardial Infarction – Version 4.0, Heart Failure – Version 4.0, Pneumonia – Version 3.0. https://www.qualitynet.org/inpatient/measures/edac/methodology. Available as of April 23, 2019.

American Hospital Association (AHA) Annual Survey Database. Fiscal Year 2016. http://www.ahadataviewer.com/book-cd-products/aha-survey/.  Accessed March 4, 2019.

National Quality Forum. Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors, Technical Report. August 15, 2014; http://www.qualityforum.org/Publications/2014/08/Risk_Adjustment_for_Socioeconomic_Status_or_Other_Sociodemographic_Factors.aspx. Accessed July 26, 2016.

AHRQ Indicator Methodology: U.S. Department of Health & Human Services, AHRQ Agency for Healthcare Research and Quality archive;
Publication # 08-0029-EF, Chapter 3: Creation of New Race-Ethnicity Codes and SES Indicators for Medicare Beneficiaries - Chapter 3: Creating and Validating and Index of Socioeconomic Status; http://archive.ahrq.gov/research/findings/final-reports/medicareindicators/medicareindicators3.html . Accessed 30 June 2015.

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