ASRT, Inc., Atlanta, Georgia, USA.
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Health Serv Res. 2021 Jun;56(3):474-485. doi: 10.1111/1475-6773.13629. Epub 2021 Feb 12.
To describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers.
DATA SOURCES/STUDY SETTING: Costs for a heart failure health care program based in a safety-net hospital were reported by program staff for the program year May 2018-April 2019. Additional data sources included hospital records, invoices, and staff survey.
We conducted a retrospective, cross-sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities.
Program cost data were collected using a activity-based, micro-costing approach. In addition, we conducted a survey that was completed by key staff to understand time allocation.
Program costs were approximately $1.33 million, and the annual per patient cost was $1455. Thirty percent of the program costs was for social needs activities: 18% for 30-day supply of medications and addressing socioeconomic barriers to medication adherence, 18% for mobile health services (outpatient home visits), 53% for navigating services through a financial counselor and community health worker, and 12% for transportation to visits and addressing transportation barriers. Most of the program costs were for personnel: 92% of the health care program fixed, 95% of the health care program variable, and 78% of social needs activities.
Historically, social and health care services are funded by different systems and have not been integrated. We estimate the cost of implementing social needs activities into a health care program. This work can inform implementation for hospitals attempting to address social determinants of health and social needs in their patient population.
描述将社会需求活动整合到医疗保健计划中的成本，该计划通过解决社会经济障碍来实现健康公平。
数据来源/研究背景：基于一家社会服务医院的心力衰竭医疗保健计划的工作人员报告了 2018 年 5 月至 2019 年 4 月期间该计划的成本。其他数据源包括医院记录、发票和员工调查。
我们对一个包含健康教育、门诊护理、财务咨询和免费药物、最需要的人提供交通和家庭服务以及与其他社会服务联系的计划进行了回顾性、横断面、案例研究。计划成本按总体和互斥类别进行总结：医疗保健计划（固定和可变）和社会需求活动。
使用基于活动的微观成本方法收集计划成本数据。此外，我们进行了一项调查，该调查由关键工作人员完成，以了解时间分配。
计划成本约为 133 万美元，每位患者的年度成本为 1455 美元。计划成本的 30%用于社会需求活动：18%用于 30 天剂量的药物和解决药物依从性的社会经济障碍，18%用于移动医疗服务（门诊家访），53%用于通过财务顾问和社区健康工作者提供导航服务，12%用于交通出行和解决交通障碍。计划成本的大部分用于人员：医疗保健计划固定成本的 92%，医疗保健计划可变成本的 95%，社会需求活动的 78%。
从历史上看，社会和医疗保健服务由不同的系统提供资金，并未整合。我们估计将社会需求活动纳入医疗保健计划的实施成本。这项工作可以为试图解决患者群体中健康决定因素和社会需求的医院提供实施信息。
