Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes
Authors' conclusion
In this cross-sectional study of Medicare Advantage beneficiaries with T2D, some HRSNs were associated with care quality and utilization. The results of the study may be used to direct interventions to the social needs most associated with T2D health outcomes and inform policy decisions at the insurance plan and community level.
Study context
- Population
- Medicare Advantage beneficiaries with T2D, aged 20–89 years, continuously enrolled in 2019, who responded to the HRSN survey; mean (SD) age 71.0 (8.3) years, 55.4% women
- Participants
- 21,528 beneficiaries
- Exposure
- Presence vs absence of each health-related social need
- Outcome
- Quality outcomes (diabetes medication adherence, statin adherence, HbA1c test in past 12 months, controlled HbA1c) and utilization outcomes (all-cause hospitalization, potentially avoidable hospitalization, ED discharge, readmission)
Methodological detailsmedical and pharmacy claims data, HRSN survey, Claims data from 2019; HRSN survey October 16, 2019 to February 29, 2020; analyzed June 2021 to January 2022
- Medical and pharmacy claims data
- HRSN survey
- Claims data from 2019; HRSN survey October 16, 2019 to February 29, 2020; analyzed June 2021 to January 2022
Main finding
As reported in the abstract
Loneliness: lower diabetes medication adherence, OR
0.85
95% CI 0.73–0.99
Lack of transportation: lower diabetes medication adherence, OR
0.80
95% CI 0.69–0.92
Utility insecurity: lower diabetes medication adherence, OR
0.86
95% CI 0.76–0.98
Housing insecurity: lower diabetes medication adherence, OR
0.78
95% CI 0.67–0.91
Observational data: associations, not effects.
Further findings
Prevalence of health-related social needs (HRSNs)
- At least 1 HRSN
- 56.9%
- Financial strain, among those reporting HRSNs
- 73.6%
- Food insecurity, among those reporting HRSNs
- 47.5%
- Poor housing quality, among those reporting HRSNs
- 39.1%
ED visits per 1000 beneficiaries (marginal effects)
- Loneliness: increased ED visits
- 173.0 (95% CI 74.2-271.9)
- Lack of transportation: increased ED visits
- 244.6 (95% CI 150.4-338.9)
Acute care utilization with food insecurity, per 1000 beneficiaries (marginal effects)
- ED visits
- 84.6 (95% CI 19.8-149.4)
- Inpatient encounters
- 30.4 (95% CI 9.5-51.3)
- Avoidable hospitalizations
- 17.1 (95% CI 4.7-29.5)
- Food insecurity was the HRSN most consistently associated with higher acute care utilization
Original publication
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