Prediction of Readmission Following Sepsis Using Social Determinants of Health

Fatemeh Amrollahi, MS; Brent D. Kennis, BS; Supreeth Prajwal Shashikumar, PhD; Atul Malhotra, MD; Stephanie Parks Taylor, MD, MSc; James Ford, MD; Arianna Rodriguez, MD; Julia Weston, MD; Romir Maheshwary, MD; Shamim Nemati, PhD; Gabriel Wardi, MD; Angela Meier, MD, PhD

doi:10.1097/CCE.0000000000001099

Critical Care Explorations (Jun 2024)

Prediction of Readmission Following Sepsis Using Social Determinants of Health

Fatemeh Amrollahi, MS,
Brent D. Kennis, BS,
Supreeth Prajwal Shashikumar, PhD,
Atul Malhotra, MD,
Stephanie Parks Taylor, MD, MSc,
James Ford, MD,
Arianna Rodriguez, MD,
Julia Weston, MD,
Romir Maheshwary, MD,
Shamim Nemati, PhD,
Gabriel Wardi, MD,
Angela Meier, MD, PhD

Affiliations

Fatemeh Amrollahi, MS: 1 Department of Biomedical Informatics, University of California San Diego, La Jolla, CA.
Brent D. Kennis, BS: 2 School of Medicine, University of California San Diego, La Jolla, CA.
Supreeth Prajwal Shashikumar, PhD: 1 Department of Biomedical Informatics, University of California San Diego, La Jolla, CA.
Atul Malhotra, MD: 3 Division of Pulmonary, Critical Care and Sleep Medicine, University of California at San Diego, La Jolla, CA.
Stephanie Parks Taylor, MD, MSc: 4 Division of Hospital Medicine, University of Michigan, Ann Arbor, MI.
James Ford, MD: 5 Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA.
Arianna Rodriguez, MD: 6 Department of Medicine, University of California San Diego, La Jolla, CA.
Julia Weston, MD: 6 Department of Medicine, University of California San Diego, La Jolla, CA.
Romir Maheshwary, MD: 6 Department of Medicine, University of California San Diego, La Jolla, CA.
Shamim Nemati, PhD: 1 Department of Biomedical Informatics, University of California San Diego, La Jolla, CA.
Gabriel Wardi, MD: 3 Division of Pulmonary, Critical Care and Sleep Medicine, University of California at San Diego, La Jolla, CA.
Angela Meier, MD, PhD: 8 Department of Anesthesiology, Division of Critical Care, University of California, San Diego, La Jolla, CA.

DOI: https://doi.org/10.1097/CCE.0000000000001099
Journal volume & issue: Vol. 6, no. 6
p. e1099

Abstract

Read online

OBJECTIVES:. To determine the predictive value of social determinants of health (SDoH) variables on 30-day readmission following a sepsis hospitalization as compared with traditional clinical variables. DESIGN:. Multicenter retrospective cohort study using patient-level data, including demographic, clinical, and survey data. SETTINGS:. Thirty-five hospitals across the United States from 2017 to 2021. PATIENTS:. Two hundred seventy-one thousand four hundred twenty-eight individuals in the AllofUs initiative, of which 8909 had an index sepsis hospitalization. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Unplanned 30-day readmission to the hospital. Multinomial logistic regression models were constructed to account for survival in determination of variables associate with 30-day readmission and are presented as adjusted odds rations (aORs). Of the 8909 sepsis patients in our cohort, 21% had an unplanned hospital readmission within 30 days. Median age (interquartile range) was 54 years (41–65 yr), 4762 (53.4%) were female, and there were self-reported 1612 (18.09%) Black, 2271 (25.49%) Hispanic, and 4642 (52.1%) White individuals. In multinomial logistic regression models accounting for survival, we identified that change to nonphysician provider type due to economic reasons (aOR, 2.55 [2.35–2.74]), delay of receiving medical care due to lack of transportation (aOR, 1.68 [1.62–1.74]), and inability to afford flow-up care (aOR, 1.59 [1.52–1.66]) were strongly and independently associated with a 30-day readmission when adjusting for survival. Patients who lived in a ZIP code with a high percentage of patients in poverty and without health insurance were also more likely to be readmitted within 30 days (aOR, 1.26 [1.22–1.29] and aOR, 1.28 [1.26–1.29], respectively). Finally, we found that having a primary care provider and health insurance were associated with low odds of an unplanned 30-day readmission. CONCLUSIONS:. In this multicenter retrospective cohort, several SDoH variables were strongly associated with unplanned 30-day readmission. Models predicting readmission following sepsis hospitalization may benefit from the addition of SDoH factors to traditional clinical variables.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

About the journal