A growing body of evidence suggests that the longer a person lives in a distressed community the worse his or her chances are for economic stability and good health. In a recent report, the Economic Innovation Group (EIG) published a Distressed Communities Index (DCI) that combines dimensions of basic community well-being to produce an economic distress index for each U.S. zip code. The dimensions included are:
- Percentage of the population 25 years and older without a high school degree.
- Percentage of habitable housing that is unoccupied, excluding properties that are for seasonal, recreational, or occasional use.
- Percentage of the population 16 years and older that is unemployed.
- Percentage of the population living beneath the poverty line.
- Ratio of a geographic area’s median income to the state’s median income.
- Percentage change in the number of jobs from 2010 to 2013.
- Percentage change in the number of businesses from 2010 to 2013.
A key disadvantage of the U.S. Centers for Medicare & Medicaid Services (CMS) Readmissions Reduction Program is that it does not adjust for socioeconomic factors such as those found in the DCI. That CMS methodology can result in hospitals with the most vulnerable populations being assessed higher payment penalties. Considering that, we wanted to know if patients living in Virginia zip codes with a high economic distress index are more likely to be readmitted for hospitalization. To answer this question, VHHA combined the readmissions database with the DCI. Logistic regression was used to determine the relationship between the two variables. VHHA found a strong association between economic distress and readmission rates (p < 0.0001).
Hospitals interested in using this information to help reduce readmissions have several action options -- one high-tech, the other not. Both require a multidisciplinary team. Marketing departments, an unlikely partner in readmission prevention, are vital in this instance due to their insight about the zip codes comprising a facility’s service area. Hospital marketers can identify those zip codes in the hospital’s market with a distress index of 50 or greater. Those distressed zones can be shared with hospital case management and discharge planned staff, raising awareness of patients who reside in distressed zip codes with a statistically greater likelihood for readmission. Hospitals can then plan to support those patients with supplemental assistance to access physicians, therapists and pharmacies. Follow up contact with patients to identify other areas of risk for those living in distressed zip codes could yield knowledge which can be applied to plans for future patient care. The high-tech approach requires marketing, case management and information services staff to work together to electronically identify patients from economically distressed zip codes and upon admission share information containing key patient attributes (age, insurance status, top diagnoses, last hospitalization) with case management and discharge planning. Shared communication with clinical staff through electronic medical records can be helpful in the process of gathering information on patients’ living conditions, potential safety issues at home, and family support. Whichever approach is taken, learning about patient demographics and pairing appropriate resources to the patient is one strategy to potentially minimize readmissions among more vulnerable patients from distressed communities who intuitively rely on their local hospital for support as a reliable hub for health care access and social service needs. (3/18)