Social Determinants of Health and Successful Community Discharge: An Evaluation Using the AHRQ Social Determinants of Health Database

Research Objectives: To evaluate the relationship between contextual social determinants of health and successful community discharge after post-acute rehabilitation care.

Design: This was a cross-sectional, secondary analysis of data from the Agency for Healthcare Research and Quality Social Determinants of Health (AHRQ SDOH) dataset for 2018 with data about the social and economic characteristics of communities from the American Community Survey and other administrative datasets at the ZCTA-level. We identified community risks through a principal factor analysis with varimax rotation identifying and scoring factors with an eigenvalue of > 1. We regressed rate of successful community discharge on the retained factors. Significance was set at 0.001.

Setting: AHRQ ZCTA-level data aggregated to RSAs, which are post-acute care utilization areas for rehabilitation services for the US.

Participants: This study used area-level data aggregated from Medicare claims to 1711 Rehabilitation Service Areas (RSA).

Interventions: N/A

Main Outcome Measures: Percent successful community discharge following post-acute care rehabilitation for each RSA based on Centers for Medicare and Medicaid Services quality measure specifications, with adjustment for individual clinical risk factors.

Results: Principal factor analysis identified 16 factors representing diverse community characteristics. Thirteen factors were significantly associated with and accounted for 85.34% of the variation in successful community discharge for RSAs. Economic disadvantage was strongly and positively associated with a higher rate of successful community discharge (B=0.44, p< 0.0001). Immigrant enclaves (B=-0.38, p< 0.0001), high-rent areas (B=-0.37, p< 0.0001), and ex-urban long-distance commuter suburbs (B=-0.33, p< 0.0001) are all sites with significantly lower successful community discharge. Model R-squared for these four factors alone was 0.58.

Conclusions: Community social and economic characteristics are significantly associated with successful community discharge after post-acute care rehabilitation. These findings suggest non-clinical targets that policymakers, researchers, and administrators can leverage to understand and improve post-acute care outcomes.

Author(s) Disclosures: This work was supported by the Agency for Healthcare Research and Quality (AHRQ) R01- R01-HS029891. All authors declare no conflicts.