5 Findings From the September 2018 Issue of AJMC®

Researchers, policy makers, and health systems alike have started to recognize the importance of addressing social determinants of health, which are the factors outside of a clinician’s office that have a profound effect on a person’s health.

With a focus on social determinants, the September issue of The American Journal of Managed Care^® yields new insights on the health effects of food insecurity, health literacy, language barriers, and more. Here are 5 findings from the research published in the issue.

1. Food insecurity linked to worse utilization and cost outcomes

A longitudinal cohort study by Seth A. Berkowitz, MD, MPH, and coauthors examined the effects of food insecurity—defined as lacking “access to enough food for an active, healthy life”—on healthcare utilization and expenditures. The researchers found that food insecurity was associated with significantly more emergency visits, hospitalizations, and days hospitalized, along with greater odds of having high healthcare spending, even after adjusting for other socioeconomic factors.

Although the study does not explore whether these measures improve when patients become food-secure, the authors conclude that screening for food insecurity in clinical settings and connecting needy patients with community resources may be useful in curtailing food insecurity and shifting patterns of healthcare utilization to benefit patients and health systems.

Read more about food insecurity and its ties to healthcare utilization and costs.

2. “High-touch” care improves outcomes and lowers costs in at-risk seniors

A model of high-intensity care that gives Medicare Advantage patients access to benefits including frequent physician visits and free transportation resulted in fewer hospital admissions and 28% lower healthcare costs compared with standard care, according to a study of the high-touch model employed in Chen Senior Medical Centers. The patients in the high-touch model also experienced more primary care visits and higher rates of preventive medication use.

Reyan Ghany, MD, and coauthors emphasize the potential role of frequent patient—physician contact in eliciting these outcomes, but the courtesy transportation offered in the Chen Medical model may have also been an important component of its success. Access to nonemergency transportation through Medicaid has been recognized as an important tool that allows patients to attend necessary medical appointments.

3. Health literacy is associated with some preventive health screening behaviors

Authors Anil N.F. Aranha, PhD, and Pragnesh J. Patel, MD, investigated health literacy among older African Americans at a patient-centered medical home and determine that better health literacy is linked with completion of some preventive health behaviors, such as influenza and pneumococcal vaccination and mammography. However, they were unable to find associations between health literacy and other preventive procedures or disease control measures.

According to the authors, these results showed that health literacy scales may not be the most effective way to predict preventive behaviors and disease control among this population, especially because such assessments require a longer time to administer among elderly patients. Still, they suggested further investigation into the observed trends, particularly the strong association between body mass index and one of the literacy scales.

4. No evidence that language barriers result in worse lipid or blood pressure control

Despite the previous finding that language barriers between physicians and Latino patients with diabetes are associated with worse glycemic control, a new cohort study by Alicia Fernandez, MD, and coauthors found no such association with lipid or blood pressure control in that patient cohort.

As for the potential reasons that language barriers between Latino patients with limited English proficiency and non—Spanish-speaking doctors did not result in poorer lipid or blood pressure control, the authors hypothesized that these disease measures may be more easily controlled via adherence to medication, whereas glycemic control also requires lifestyle changes and patient buy-in that might be easier to achieve through a language-concordant clinical encounter.

5. After-hours paramedic care at home can reduce need for emergency visits

Lisa I. Iezzoni, MD, MSc, and coauthors reported early results from the Acute Community Care Program (ACCP) in eastern Massachusetts, which trained paramedics to deliver after-hours urgent care at the homes of patients with complex health and social needs. Over 2 years, only between 3.8% and 11.5% of patients who received the service in each quarter visited the emergency department (ED) within 2 to 3 days after their ACCP encounter.

About 70% of patients who received an ACCP visit thought that it spared them an ED visit, which the authors noted is particularly important for the population served by the program, many of whom have felt stigmatized in EDs due to their sociodemographic attributes or physical and behavioral health conditions. Delivering care at home could allow patients to obtain needed care when they would have otherwise avoided an uncomfortable trip to the ED.