University of Alabama at Birmingham, Birmingham, Alabama, United States.
Appl Clin Inform. 2020 Aug;11(4):556-563. doi: 10.1055/s-0040-1715650. Epub 2020 Aug 26.
Social determinants of health play an important role in the likelihood of readmission and therefore should be considered in care transition planning. Unfortunately, some social determinants that can be of value to care transition planners are missing in the electronic health record. Rather than trying to understand the value of data that are missing, decision makers often exclude these data. This exclusion can lead to failure to design appropriate care transition programs, leading to readmissions.
This article examines the value of missing social determinants data to emergency department (ED) revisits, and subsequent readmissions.
A deidentified data set of 123,697 people (18+ years), with at least one ED visit in 2017 at the University of Alabama at Birmingham Medical Center was used. The dependent variable was all-cause 30-day revisits (yes/no), while the independent variables were missing/nonmissing status of the social determinants of health measures. Logistic regression was used to test the relationship between likelihood of revisits and social determinants of health variables. Moreover, relative weight analysis was used to identify relative importance of the independent variables.
Twelve social determinants were found to be most often missing. Of those 12, only "lives with" (alone or with family/friends) had higher odds of ED revisits. However, relative logistic weight analysis suggested that "pain score" and "activities of daily living" (ADL) accounted for almost 50% of the relevance for ED revisits when compared among all 12 variables.
In the process of care transition planning, data that are documented are factored into the care transition plan. One of the most common challenges in health services practice is to understand the value of missing data in effective program planning. This study suggests that the data that are documented (i.e., missing) could play an important role in care transition planning as a mechanism to reduce ED revisits and eventual readmission rates.
健康的社会决定因素对再入院的可能性起着重要作用，因此应在护理交接计划中加以考虑。不幸的是，电子健康记录中缺少一些对护理交接规划者有价值的社会决定因素。决策者往往不是试图理解缺失数据的价值，而是排除这些数据。这种排除可能导致无法设计适当的护理交接方案，从而导致再入院。
本文探讨了缺失的社会决定因素数据对急诊科（ED）复诊和随后再入院的价值。
使用了一个来自阿拉巴马大学伯明翰分校医疗中心的 123697 人的匿名数据集（18 岁及以上），这些人在 2017 年至少有一次 ED 就诊。因变量是全因 30 天复诊（是/否），而自变量是健康社会决定因素测量的缺失/非缺失状态。Logistic 回归用于检验复诊可能性与社会决定因素变量之间的关系。此外，相对权重分析用于确定自变量的相对重要性。
发现 12 个社会决定因素最常缺失。在这 12 个因素中，只有“居住方式”（独自居住或与家人/朋友一起居住）与 ED 复诊的可能性更高。然而，相对逻辑权重分析表明，与所有 12 个变量相比，“疼痛评分”和“日常生活活动”（ADL）几乎占 ED 复诊相关性的 50%。
在护理交接计划过程中，记录的数据被纳入护理交接计划。在卫生服务实践中，最常见的挑战之一是了解缺失数据在有效计划制定中的价值。本研究表明，记录的数据（即缺失数据）可以在护理交接计划中发挥重要作用，作为减少 ED 复诊和最终再入院率的一种机制。
