A large and growing body of evidence shows that sociodemographic factors – age, race, ethnicity, and language, for example – and socioeconomic status (SES), such as income and education, can influence health outcomes. These findings are particularly significant for payment programs that reward or penalize hospitals for the quality of care they provide.
Experts, including an ad-hoc committee of the National Academies of Sciences, Engineering, and Medicine, have examined how social risk factors affect health outcomes and proposed accounting for these factors in Medicare payment programs that, without risk adjustment, disproportionately penalize hospitals that serve vulnerable people. Risk adjustment can include stratified public reporting for patient characteristics, adjustment of performance scores, direct adjustment of payment, and restructured payment incentives.
America’s Essential Hospitals supports including sociodemographic and socioeconomic factors in the risk adjustment of outcomes measures when conceptual and empirical evidence warrants it. Doing so will improve the science of performance measurement by increasing precision and delivering more accurate information to providers, payers, and the public.
Here, find a periodically updated list of research and other resources on the need to risk adjust performance measures for socioeconomic and sociodemographic factors. For further information or to add to this list, please contact INSTITUTE.admin@essentialhospitals.org.
The Evidence for SES Risk Adjustment
Value-Based Payments Disproportionately Impact Safety-Net Hospitals |
Journal of the American Medical Association |
July,
2020 |
Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program |
Health Services Research Journal |
March, 2019 |
The hospital readmission reduction program and social risk |
Health Services Research Journal |
March, 2019 |
Black patients present with more severe vascular disease and a greater burden of risk factors than white patients at time of major vascular intervention |
Journal of Vascular Surgery |
February, 2018 |
Effect of a Hospital-wide Measure on the Readmissions Reduction Program |
New England Journal of Medicine |
October, 2017 |
Report on the effect of social risk factors in Medicare’s value-based payment programs |
Office of the Assistant Secretary for Planning and Evaluation (ASPE) |
December 2016 |
Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care |
Health Affairs |
October 2016 |
Association of Social Determinants With Children’s Hospitals’ Preventable Readmissions Performance |
JAMA Pediatrics |
April 2016 |
Patient Factors Predictive of Hospital Readmissions Within 30 Days |
Journal for Healthcare Quality |
March 2016 |
Do hospital factors impact readmissions and mortality after colorectal resections at minority-serving hospitals? |
Surgery Journal |
February 2016 |
Patient Characteristics and Differences in Hospital Readmission Rates |
JAMA Internal Medicine |
November 2015 |
Hospital-Level Factors Related to 30-Day Readmission Rates |
American Journal of Medical Quality |
November 2015 |
Demographic factors and hospital size predict patient satisfaction variance—implications for hospital value-based purchasing |
Journal of Hospital Medicine |
August 2015 |
Designing Smarter Pay-for-Performance—Let’s Not Go down This Path |
3M Health Information Systems (blog) |
February 2015 |
Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort Study |
Annals of Internal Medicine |
December 2014 |
Socioeconomic factors and the risk for sarcoma. |
European Journal of Cancer Prevention |
November 2014 |
Rethinking the Social History |
New England Journal of Medicine |
October 2014 |
The Risks of Not Adjusting Performance Measures for Patient Sociodemographic Factors |
Annals of Internal Medicine |
October 2014 |
Place of Residence and Outcomes of Patients With Heart Failure: Analysis From the Telemonitoring to Improve Heart Failure Outcomes Trial |
Circulation: Cardiovascular Quality and Outcomes |
September 2014 |
Changing my mind on SES Risk Adjustment |
The Health Care Blog |
September 2014 |
Quality Reporting That Addresses Disparities in Health Care |
The Journal of the American MedicalAssociation |
July 2014 |
Adding Socioeconomic Data To Hospital Readmissions Calculations May Produce More Useful Results |
Health Affairs |
May 2014 |
Socioeconomic Status And Readmissions: Evidence From An Urban Teaching Hospital |
Health Affairs |
May 2014 |
Variation in the risk of readmission among hospitals: the relative contribution of patient, hospital and inpatient provider characteristics |
Journal of General Internal Medicine |
April 2014 |
A Path Forward on Medicare Readmissions |
New England Journal of Medicine |
March 2013 |
Socio-Economic Inequalities: A Review of Methodological Issues and the Relationships with Cancer Survival |
Critical Reviews in Oncology and Hematology |
March 2013 |
Patients Living in Impoverished Areas Have More Severe Ischemic Strokes |
Stroke |
August 2012 |
The Changing Face of Primary Open-Angle Glaucoma in the United States: Demographic and Geographic Changes from 2011-2050 |
American Journal of Ophthalmology |
April 2012 |
Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care |
The Journal of the American Medical Association |
February 2011 |
The Role of Early-Life Socioeconomic Status in Breast Cancer Incidence and Mortality: Unraveling Life Course Mechanisms |
Journal of Aging and Health |
March 2012 |
Risk Prediction Models for Hospital Readmission |
The Journal of the American Medical Association |
October 2011 |
Gender, Race, and Socioeconomic Status Affects Outcomes After Lung Cancer Resections in the United States |
The Annals of Thoracic Surgery |
August 2011 |
Considerations of Culture and Social Class for Families Facing Cancer: The Need for a New Model for Health Promotion and Psychosocial Intervention |
Families, Systems, & Health |
June 2011 |
Patient socioeconomic status is an independent predictor of operative mortality |
Annals of Surgery |
September 2010 |
Associations of Social Networks with Cancer Mortality: A Meta-Analysis |
Critical Reviews in Oncology/Hematology |
August 2010 |
The Family-Centered Medical Home: Specific Considerations for Child Health Research and Policy |
Academic Pediatrics |
July 2010 |
Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of California |
Cancer Causes Control |
October 2009 |
Socioeconomic status and surgical mortality in the elderly |
Medical Care |
September 2008 |
Will Pay-For-Performance And Quality Reporting Affect Health Care Disparities? |
Health Affairs |
May 2007 |
Prevalence of Open-Angle Glaucoma and Ocular Hypertension in Latinos: the Los Angeles Latino Eye Study |
Ophthalmology |
August 2004 |
Socioeconomic Risk Factors for Breast Cancer: Distinguishing Individual- and Community-Level Effects |
Epidemiology |
July 2004 |
Racial Differences in the Cause-Specific Prevalence of Blindness in East Baltimore |
New England Journal of Medicine |
November 1991 |