PMID- 33079198 OWN - NLM STAT- MEDLINE DCOM- 20210108 LR - 20220224 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 3 IP - 10 DP - 2020 Oct 1 TI - Patient-Reported Social and Behavioral Determinants of Health and Estimated Risk of Hospitalization in High-Risk Veterans Affairs Patients. PG - e2021457 LID - 10.1001/jamanetworkopen.2020.21457 [doi] LID - e2021457 AB - IMPORTANCE: Despite recognition of the association between individual social and behavioral determinants of health (SDH) and patient outcomes, little is known regarding the value of SDH in explaining variation in outcomes for high-risk patients. OBJECTIVE: To describe SDH factors among veterans who are at high risk for hospitalization, and to determine whether adding patient-reported SDH measures to electronic health record (EHR) measures improves estimation of 90-day and 180-day all-cause hospital admission. DESIGN, SETTING, AND PARTICIPANTS: A survey was mailed between April 16 and June 29, 2018, to a nationally representative sample of 10 000 Veterans Affairs (VA) patients whose 1-year risk of hospitalization or death was in the 75th percentile or higher based on a VA EHR-derived risk score. The survey included multiple SDH measures, such as resilience, social support, health literacy, smoking status, transportation barriers, and recent life stressors. MAIN OUTCOMES AND MEASURES: The EHR-based characteristics of survey respondents and nonrespondents were compared using standardized differences. Estimation of 90-day and 180-day hospital admission risk was assessed for 3 logistic regression models: (1) a base model of all prespecified EHR-based covariates, (2) a restricted model of EHR-based covariates chosen via forward selection based on minimizing Akaike information criterion (AIC), and (3) a model of EHR- and survey-based covariates chosen via forward selection based on AIC minimization. RESULTS: In total, 4685 individuals (response rate 46.9%) responded to the survey. Respondents were comparable to nonrespondents in most characteristics, but survey respondents were older (eg, >80 years old, 881 [18.8%] vs 800 [15.1%]), comprised a higher percentage of men (4391 [93.7%] vs 4794 [90.2%]), and were composed of more White non-Hispanic individuals (3366 [71.8%] vs 3259 [61.3%]). Based on AIC, the regression model with survey-based covariates and EHR-based covariates better estimated hospital admission at 90 days (AIC, 1947.7) and 180 days (AIC, 2951.9) than restricted models with only EHR-based covariates (AIC, 1980.2 at 90 days; AIC, 2981.9 at 180 days). This result was due to inclusion of self-reported measures such as marital or partner status, health-related locus of control, resilience, smoking status, health literacy, and medication insecurity. CONCLUSIONS AND RELEVANCE: Augmenting EHR data with patient-reported social information improved estimation of 90-day and 180-day hospitalization risk, highlighting specific SDH factors that might identify individuals who are at high risk for hospitalization. FAU - Zulman, Donna M AU - Zulman DM AD - Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California. AD - Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California. FAU - Maciejewski, Matthew L AU - Maciejewski ML AD - Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina. AD - Department of Population Health Sciences, Duke University, Durham, North Carolina. AD - Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina. FAU - Grubber, Janet M AU - Grubber JM AD - Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina. FAU - Weidenbacher, Hollis J AU - Weidenbacher HJ AD - Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina. FAU - Blalock, Dan V AU - Blalock DV AD - Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina. FAU - Zullig, Leah L AU - Zullig LL AD - Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina. AD - Department of Population Health Sciences, Duke University, Durham, North Carolina. FAU - Greene, Liberty AU - Greene L AD - Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California. AD - Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California. FAU - Whitson, Heather E AU - Whitson HE AD - Department of Medicine, Duke University School of Medicine, Durham, North Carolina. AD - Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina. AD - Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina. FAU - Hastings, Susan N AU - Hastings SN AD - Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina. AD - Department of Population Health Sciences, Duke University, Durham, North Carolina. AD - Department of Medicine, Duke University School of Medicine, Durham, North Carolina. AD - Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina. AD - Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina. FAU - Smith, Valerie A AU - Smith VA AD - Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina. AD - Department of Population Health Sciences, Duke University, Durham, North Carolina. AD - Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina. LA - eng GR - IK6 HX003157/HX/HSRD VA/United States PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20201001 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 SB - IM CIN - JAMA Netw Open. 2020 Oct 1;3(10):e2021771. PMID: 33079193 MH - Aged MH - Aged, 80 and over MH - Female MH - Hospitalization/statistics & numerical data MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Patient Reported Outcome Measures MH - *Self Report MH - Social Determinants of Health/*statistics & numerical data MH - Surveys and Questionnaires MH - United States MH - United States Department of Veterans Affairs/organization & administration/statistics & numerical data MH - Veterans/*psychology/statistics & numerical data PMC - PMC7576406 COIS- Conflict of Interest Disclosures: Dr Zulman reported receiving research grants from the US Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), the VA Office of Rural Health, and the Gordon & Betty Moore Foundation outside of the submitted work. Dr Maciejewski reported receiving grants from the VA HSR&D, the National Institutes of Health, and the National Committee for Quality Assurance; and owning Amgen stock owing to his spouse's employment during the conduct of the study. Dr Weidenbacher reported receiving grants from VA Operations during the conduct of the study. Dr Blalock reported receiving grants from the VA Office of Academic Affairs during the conduct of the study. Dr Zullig reported receiving grants from Proteus Digital Health and from the PhRMA Foundation; and receiving personal fees from Novartis outside the submitted work. Dr Hastings reported receiving grants from the VA during the conduct of the study and outside the submitted work. Dr Smith reported receiving grants from VA HSR&D, VA Office of Rural Health, VA Caregiver Support Program, and the National Institutes of Health during the conduct of the study. No other disclosures were reported. EDAT- 2020/10/21 06:00 MHDA- 2021/01/09 06:00 PMCR- 2020/10/20 CRDT- 2020/10/20 12:12 PHST- 2020/10/20 12:12 [entrez] PHST- 2020/10/21 06:00 [pubmed] PHST- 2021/01/09 06:00 [medline] PHST- 2020/10/20 00:00 [pmc-release] AID - 2771871 [pii] AID - zoi200728 [pii] AID - 10.1001/jamanetworkopen.2020.21457 [doi] PST - epublish SO - JAMA Netw Open. 2020 Oct 1;3(10):e2021457. doi: 10.1001/jamanetworkopen.2020.21457.