Department of Medicine, University of Washington, Seattle.
Program on Policy Evaluation and Learning in the Pacific Northwest, Seattle, Washington.
JAMA Netw Open. 2024 Feb 5;7(2):e2356121. doi: 10.1001/jamanetworkopen.2023.56121.
Publicly available, US Census-based composite measures of socioeconomic disadvantage are increasingly being used in a wide range of clinical outcomes and health services research. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are 2 of the most commonly used measures. There is also early interest in incorporating area-level measures to create more equitable alternative payment models.
To review the evidence on the association of ADI and SVI with health care spending, including claims-based spending and patient-reported barriers to care due to cost.
A systematic search for English-language articles and abstracts was performed in the PubMed, Web of Science, Embase, and Cochrane databases (from inception to March 1, 2023). Peer-reviewed articles and abstracts using a cross-sectional, case-control, or cohort study design and based in the US were identified. Data analysis was performed in March 2023.
This review included 24 articles and abstracts that used a cross-sectional, case-control, or cohort study design. In 20 of 24 studies (83%), ADI and SVI were associated with increased health care spending. No association was observed in the 4 remaining studies, mostly with smaller sample sizes from single centers. In adjusted models, the increase in spending associated with higher ADI or SVI residence was $574 to $1811 for index surgical hospitalizations, $3003 to $24 075 for 30- and 90-day episodes of care, and $3519 for total annual spending for Medicare beneficiaries. In the studies that explored mechanisms, postoperative complications, readmission risk, and poor primary care access emerged as health care system-related drivers of increased spending.
The findings of this systematic review suggest that both ADI and SVI can play important roles in efforts to understand drivers of health care spending and in the design of payment and care delivery programs that capture aspects of social risk. At the health care system level, higher health care spending and poor care access associated with ADI or SVI may represent opportunities to codesign interventions with patients from high ADI or SVI areas to improve access to high-value health care and health promotion more broadly.
基于美国人口普查的公开可得的综合社会经济劣势指标越来越多地被用于广泛的临床结果和卫生服务研究。地区贫困指数 (ADI) 和社会脆弱性指数 (SVI) 是最常用的两种指标。人们也对纳入地区层面的指标来创建更公平的替代支付模式产生了初步兴趣。
综述 ADI 和 SVI 与医疗保健支出的关联证据，包括基于索赔的支出和患者因费用而报告的护理障碍。
在 PubMed、Web of Science、Embase 和 Cochrane 数据库中进行了英语文章和摘要的系统检索（从创建到 2023 年 3 月 1 日）。确定了基于横断面、病例对照或队列研究设计且基于美国的同行评议文章和摘要。数据分析于 2023 年 3 月进行。
本综述包括 24 篇使用横断面、病例对照或队列研究设计的文章和摘要。在 24 项研究中的 20 项（83%）中，ADI 和 SVI 与医疗保健支出增加有关。在其余 4 项研究中没有观察到关联，这些研究大多来自单个中心的样本量较小。在调整后的模型中，与更高 ADI 或 SVI 居住相关的支出增加为指数手术住院的 574 美元至 1811 美元、30 天和 90 天护理期的 3003 美元至 24075 美元以及 Medicare 受益人的年度总支出 3519 美元。在探索机制的研究中，术后并发症、再入院风险和初级保健机会不足成为与医疗保健支出增加相关的医疗保健系统驱动因素。
本系统综述的结果表明，ADI 和 SVI 都可以在理解医疗保健支出驱动因素和设计支付和护理提供计划方面发挥重要作用，这些计划可以捕获社会风险的各个方面。在医疗保健系统层面，与 ADI 或 SVI 相关的更高医疗保健支出和较差的护理机会可能代表着与来自 ADI 或 SVI 较高地区的患者共同设计干预措施的机会，以更广泛地改善获得高价值医疗保健和健康促进的机会。
