Considering the Role of Socioeconomic Status in Hospital Outcomes Measures
Open accessAbstract
Editorials2 December 2014Considering the Role of Socioeconomic Status in Hospital Outcomes MeasuresHarlan M. Krumholz, MD, SM and Susannah M. Bernheim, MD, MHSHarlan M. Krumholz, MD, SMFrom Yale University School of Medicine, New Haven, Connecticut, and Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut. and Susannah M. Bernheim, MD, MHSFrom Yale University School of Medicine, New Haven, Connecticut, and Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-2308 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Our team at the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital developed readmission measures for the Centers for Medicare & Medicaid Services with the goal of illuminating hospital performance and stimulating efforts to improve patient care. We believed that such efforts could improve patient recovery and reduce the occurrence of adverse health events after discharge. We developed these measures using data from administrative claims and validated them against measures using medical records data (1). National readmission rates within 30 days of hospital discharge were exceedingly high for common diagnoses, such as acute myocardial infarction, heart failure, and ...References1. Keenan PS, Normand SL, Lin Z, Drye EE, Bhat KR, Ross JS, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2008;1:29-37. [PMID: 20031785] doi:10.1161/CIRCOUTCOMES.108.802686 CrossrefMedlineGoogle Scholar2. Daughtridge GW, Archibald T, Conway PH. Quality improvement of care transitions and the trend of composite hospital care. JAMA. 2014;311:1013-4. [PMID: 24618959] doi:10.1001/jama.2014.509 CrossrefMedlineGoogle Scholar3. Lipstein SH, Dunagan WC. The risks of not adjusting performance measures for sociodemographic factors. Ann Intern Med. 2014;161:594-6. [PMID: 25048401] doi:10.7326/M14-1601 LinkGoogle Scholar4. National Quality Forum. Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors. Technical Report. 2014. Accessed at www.qualityforum.org/Publications/2014/08/Risk_Adjustment_for_Socioeconomic_Status_or_Other_Sociodemographic_Factors.aspx on 23 October 2014. Google Scholar5. Kind AJ, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W, et al. Neighborhood socioeconomic disadvantage and 30-day rehospitalization. A restrospective cohort study. Ann Intern Med. 2014;161:765-74. doi:10.7326/M13-2946 LinkGoogle Scholar6. Bikdeli B, Wayda B, Bao H, Ross JS, Xu X, Chaudhry SI, et al. Place of residence and outcomes of patients with heart failure: analysis from the telemonitoring to improve heart failure outcomes trial. Circ Cardiovasc Qual Outcomes. 2014;7:749-56. [PMID: 25074375] doi:10.1161/CIRCOUTCOMES.113.000911 CrossrefMedlineGoogle Scholar7. Keyhani S, Myers LJ, Cheng E, Hebert P, Williams LS, Bravata DM. Effect of clinical and social risk factors on hospital profiling for stroke readmission.A cohort study. Ann Intern Med. 2014;161:775-84. doi:10.7326/M14-0361 LinkGoogle Scholar8. Smedley BD, Stith AY, Nelson AR; Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Pr; 2003. Google Scholar9. Ross JS, Bernheim SM, Lin Z, Drye EE, Chen J, Normand SL, et al. Based on key measures, care quality for Medicare enrollees at safety-net and non-safety-net hospitals was almost equal. Health Aff (Millwood). 2012;31:1739-48. [PMID: 22869652] doi:10.1377/hlthaff.2011.1028 CrossrefMedlineGoogle Scholar10. Medicare Payment Advisory Commission. Report to the Congress: Medicare and the Health Care Delivery System. 2013. Accessed at www.medpac.gov/documents/reports/jun13_entirereport.pdf on 23 October 2014. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Yale University School of Medicine, New Haven, Connecticut, and Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut.Grant Support: Dr. Krumholz is supported by the National Heart, Lung, and Blood Institute Center for Cardiovascular Outcomes Research at Yale University (grant U01 HL105270-05).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2308.Corresponding Author: Harlan M. Krumholz, MD, SM, Yale University School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510; e-mail, harlan.[email protected]edu.Current Author Addresses: Drs. Krumholz and Bernheim: Yale University School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510. PreviousarticleNextarticle Advertisement FiguresReferen
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Hospital encounters are a setting in which social needs are increasingly addressed.
“We included the hospitalization criterion to construct encounter-level measures around hospital encounters as this encounter type represents a setting in which social needs are increasingly addressed16 and offers the best exemplar for attributing documentation and review activities (described in more detail below).”
From Documentation and review of social determinants of health data in the EHR: measures and associated insights (2021) · cites this paper as [16]
The main text (page unavailable) describes growing efforts involving hospitals and community organizations to improve transitional care, and recognizes that some patients need more support after discharge. It does not establish that social needs are increasingly addressed during hospital encounters specifically. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization
Kind, A., Jencks, S., Brock, J., Yu, M., Bartels, C. M., Ehlenbach, W. J., Greenberg, C., & Smith, M. (2014) · Annals of Internal Medicine · doi:10.7326/m13-2946 · Cited by 1,383 · see citing works
Keenan, P. S., Normand, S. T., Lin, Z., Drye, E. E., Bhat, K. R., Ross, J. S., Schuur, J. D., Stauffer, B. D., Bernheim, S. M., Epstein, A. J., et al. (2008) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.108.802686 · Cited by 501 · see citing works
Self-citationPlace of Residence and Outcomes of Patients With Heart Failure
Bikdeli, B., Wayda, B. J., Bao, H., Ross, J. S., Xu, X., Chaudhry, S. I., Spertus, J. A., Bernheim, S. M., Lindenauer, P. K., & Krumholz, H. M. (2014) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.113.000911 · Cited by 64 · see citing works
Self-citationRoss, J. S., Bernheim, S. M., Lin, Z., Drye, E. E., Chen, J., Normand, S. T., & Krumholz, H. M. (2012) · Health Affairs · doi:10.1377/hlthaff.2011.1028 · Cited by 53 · see citing works
Self-citationEffect of Clinical and Social Risk Factors on Hospital Profiling for Stroke Readmission
Keyhani, S., Myers, L. J., Cheng, E. M., Hebert, P. L., Williams, L. S., & Bravata, D. M. (2014) · Annals of Internal Medicine · doi:10.7326/m14-0361 · Cited by 34 · see citing works
The Risks of Not Adjusting Performance Measures for Sociodemographic Factors
Lipstein, S. H., & Dunagan, W. C. (2014) · Annals of Internal Medicine · doi:10.7326/m14-1601 · Cited by 32 · see citing works
Quality Improvement of Care Transitions and the Trend of Composite Hospital Care
Daughtridge, G. W., Archibald, T., & Conway, P. H. (2014) · JAMA · doi:10.1001/jama.2014.509 · Cited by 17 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [8]Smedley BD Stith AY Nelson AR Commitee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care Unequal treatment: confronting racial and ethnic disparities in health care The National Academies Press 2003 25032386
Cited by
Sorted by citations
Patient Characteristics and Differences in Hospital Readmission Rates
Barnett, M. L., Hsu, J., & McWilliams, J. M. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.4660 · Cited by 259 · see citing works
Joynt Maddox, K. E., Reidhead, M., Hu, J., Kind, A. J. H., Zaslavsky, A. M., Nagasako, E. M., & Nerenz, D. R. (2019) · Health Services Research · doi:10.1111/1475-6773.13133 · Cited by 214 · see citing works
Gilman, M., Hockenberry, J. M., Adams, E. K., Milstein, A. S., Wilson, I. B., & Becker, E. R. (2015) · Annals of Internal Medicine · doi:10.7326/m14-2813 · Cited by 121 · see citing works
Wang, M., Pantell, M. S., Gottlieb, L. M., & Adler-Milstein, J. (2021) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocab194 · Cited by 107 · see citing works
Assessment of the Effect of Adjustment for Patient Characteristics on Hospital Readmission Rates
Roberts, E. T., Zaslavsky, A. M., Barnett, M. L., Landon, B. E., Ding, L., & McWilliams, J. M. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.4481 · Cited by 89 · see citing works
Chaiyachati, K. H., Qi, M., & Werner, R. M. (2018) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.4154 · Cited by 72 · see citing works
Safety-Net Hospitals, Neighborhood Disadvantage, and Readmissions Under Maryland's All-Payer Program
Jencks, S. F., Schuster, A. B., Dougherty, G. B., Gerovich, S., Brock, J. E., & Kind, A. (2019) · Annals of Internal Medicine · doi:10.7326/m16-2671 · Cited by 66 · see citing works
Low, L. L., Wah, W., Ng, M. J. M., Tan, S. Y., Liu, N., & Lee, K. H. (2016) · Frontiers in Public Health · doi:10.3389/fpubh.2016.00109 · Cited by 63 · see citing works
A Quality Framework for Emergency Department Treatment of Opioid Use Disorder
Samuels, E. A., D’Onofrio, G., Huntley, K., Levin, S., Schuur, J. D., Bart, G. B., Hawk, K. F., Tai, B., Campbell, C. I., & Venkatesh, A. K. (2018) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2018.08.439 · Cited by 62 · see citing works
Association Between Residential Neighborhood Social Conditions and Health Care Utilization and Costs
Zhang, Y., Ancker, J. S., Hall, J., Khullar, D., Wu, Y., & Kaushal, R. (2020) · Medical Care · doi:10.1097/mlr.0000000000001337 · Cited by 62 · see citing works
Joynt Maddox, K. E., Reidhead, M., Qi, A. C., & Nerenz, D. R. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.0117 · Cited by 61 · see citing works
Zhang, Y., Zhang, Y., Sholle, E., Abedian, S., Sharko, M., Turchioe, M. R., Wu, Y., & Ancker, J. S. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235064 · Cited by 57 · see citing works
Johnston, K. J., & Maddox, K. E. J. (2019) · Health Affairs · doi:10.1377/hlthaff.2018.05032 · Cited by 53 · see citing works
Murray, F., Allen, M., Clark, C. M., Daly, C. J., & Jacobs, D. M. (2021) · BMC Public Health · doi:10.1186/s12889-021-11987-z · Cited by 50 · see citing works
Predicting Readmission at Early Hospitalization Using Electronic Clinical Data
Tabak, Y. P., Sun, X., Nuñez, C. M., Gupta, V., & Johannes, R. S. (2016) · Medical Care · doi:10.1097/mlr.0000000000000654 · Cited by 42 · see citing works
Johnston, K. J., Wen, H., Schootman, M., & Maddox, K. E. J. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05009-3 · Cited by 33 · see citing works
Zhou, L. W., Lansberg, M. G., & de Havenon, A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0289640 · Cited by 32 · see citing works
Community factors and hospital wide readmission rates: Does context matter?
Spatz, E. S., Bernheim, S. M., Horwitz, L. I., & Herrin, J. S. (2020) · PLoS ONE · doi:10.1371/journal.pone.0240222 · Cited by 21 · see citing works
Self-citationSamson, L. W., Chen, L. M., Epstein, A. M., & Maddox, K. E. J. (2018) · Health Affairs · doi:10.1377/hlthaff.2017.0914 · Cited by 20 · see citing works
Public rental housing and its association with mortality – a retrospective, cohort study
Seng, J. J. B., Kwan, Y. H., Goh, H., Thumboo, J., & Low, L. L. (2018) · BMC Public Health · doi:10.1186/s12889-018-5583-6 · Cited by 21 · see citing works
Shahian, D. M., Badhwar, V., O’Brien, S. M., Habib, R., Han, J., McDonald, D. E., Antman, M. S., Higgins, R. S. D., Preventza, O., Estrera, A. L., et al. (2022) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2021.11.067 · Cited by 19 · see citing works
Evaluating How Safety-Net Hospitals Are Identified: Systematic Review and Recommendations
Powell, W. R., Hansmann, K. J., Carlson, A., & Kind, A. (2022) · Health Equity · doi:10.1089/heq.2021.0076 · Cited by 20 · see citing works
Spatz, E. S., Lipska, K. J., Dai, Y., Bao, H., Lin, Z., Parzynski, C. S., Altaf, F. K., Joyce, E. K., Montague, J. A., Ross, J. S., et al. (2016) · Medical Care · doi:10.1097/mlr.0000000000000518 · Cited by 19 · see citing works
Self-citationNguyen, C. A., Gilstrap, L. G., Chernew, M. E., McWilliams, J. M., Landon, B. E., & Landrum, M. B. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.0838 · Cited by 19 · see citing works
Bongiovanni, T., Hansen, K. S., Lancaster, E. M., O’Sullivan, P., Hirose, K., & Wick, E. C. (2019) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2019.12.023 · Cited by 18 · see citing works
Zdradzinski, M. J., Phelan, M. P., & Mace, S. E. (2016) · American Journal of Medical Quality · doi:10.1177/1062860616644779 · Cited by 15 · see citing works
Area-level poverty, race/ethnicity & dialysis star ratings
Kshirsagar, A. V., Manickam, R., Mu, Y., Flythe, J. E., Chin, A. I., & Bang, H. (2017) · PLoS ONE · doi:10.1371/journal.pone.0186651 · Cited by 13 · see citing works
Skyrud, K. D., Vikum, E., Hansen, T. M., Kristoffersen, D. T., & Helgeland, J. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.118.010148 · Cited by 12 · see citing works
Effect of a Real-Time Risk Score on 30-day Readmission Reduction in Singapore
Wu, C. X., Suresh, E., Phng, F. W. L., Tai, K. P., Pakdeethai, J., D'Souza, J. L. A., Tan, W. S., Phan, P., Lew, K. S. M., Tan, G. Y. H., et al. (2021) · Applied Clinical Informatics · doi:10.1055/s-0041-1726422 · Cited by 12 · see citing works
A Quality Measurement Framework for Emergency Department Care of Psychiatric Emergencies
Im, D. D., Scott, K. W., Venkatesh, A. K., Lobon, L. F., Kroll, D. S., Samuels, E. A., Wilson, M. P., Zeller, S. L., Zun, L. S., Clifford, K. C., et al. (2022) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2022.09.007 · Cited by 12 · see citing works
Wee, L. E., Low, L. L., Thumboo, J., Chan, A. W.-M., & Lee, K. H. (2019) · BMC Public Health · doi:10.1186/s12889-019-7009-5 · Cited by 10 · see citing works
Value-Based Payment Reforms in Cardiovascular Care: Progress to Date and Next Steps
Sukul, D., & Eagle, K. A. (2020) · Methodist DeBakey Cardiovascular Journal · doi:10.14797/mdcj-16-3-232 · Cited by 9 · see citing works
Hu, J., Schreiber, M., Jordan, J., George, D. L., & Nerenz, D. R. (2017) · American Journal of Medical Quality · doi:10.1177/1062860617695456 · Cited by 9 · see citing works
Castriotta, L., Giangreco, M., Cogliati-Dezza, M. G., Spanò, M., Atrigna, E., Ehrenfreund, C., Rosolen, V., Paoletti, F., & Barbone, F. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-036857 · Cited by 8 · see citing works
Ng, T. K. S., Matchar, D. B., Pyrkov, T. V., Fedichev, P. O., Chan, A. W.-M., & Kennedy, B. K. (2021) · Aging · doi:10.18632/aging.203447 · Cited by 7 · see citing works
Li, Y., Cen, X., Cai, X., Wang, D., Thirukumaran, C. P., & Glance, L. G. (2016) · Medical Care Research and Review · doi:10.1177/1077558716681938 · Cited by 6 · see citing works
Low, L. L., Maulod, A., & Lee, K. H. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017839 · Cited by 6 · see citing works
Lipitz‐Snyderman, A., Lavery, J. A., Bach, P. B., Li, D. G., Yang, A. W., Strong, V. E. M., Russo, A. E., & Panageas, K. S. (2020) · Cancer Medicine · doi:10.1002/cam4.2800 · Cited by 5 · see citing works
Lipska, K. J., Altaf, F. K., Barthel, A. B., Spatz, E. S., Lin, Z., Herrin, J. S., Bernheim, S. M., & Drye, E. E. (2023) · JAMA Health Forum · doi:10.1001/jamahealthforum.2023.0081 · Cited by 4 · see citing works
Self-citationTime for Value-Based Payment Models to Adopt a Disparities-Sensitive Frame Shift
Chaiyachati, K. H., Bhatt, J., & Zhu, J. M. (2018) · Annals of Internal Medicine · doi:10.7326/m17-2590 · Cited by 3 · see citing works
Mose, J. N., & Kumar, N. (2020) · Health Equity · doi:10.1089/heq.2019.0123 · Cited by 3 · see citing works
Minges, K. E., Chen, P., Loh, K., Sutton, L., & Bernheim, S. M. (2025) · BMJ Open · doi:10.1136/bmjopen-2023-083384 · Cited by 2 · see citing works
Self-citationKhouri, R. K., Hou, H., Dhir, A., Andino, J. J., Dupree, J. M., Miller, D. C., & Ellimoottil, C. S. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2742-x · Cited by 2 · see citing works
Zhu, Y., Stearns, S. C., & Holmes, G. M. (2021) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13647 · Cited by 2 · see citing works
Adjusting for Social Risk Factors in Pediatric Quality Measures: Adding to the Evidence Base
Bucholz, E. M., Toomey, S. L., McCulloch, C. E., & Bardach, N. S. (2022) · Academic Pediatrics · doi:10.1016/j.acap.2021.09.023 · Cited by 2 · see citing works
The Role of Socioeconomic Status in Hospital Outcomes Measures
Zaslavsky, A. M., & Jha, A. K. (2015) · Annals of Internal Medicine · doi:10.7326/l15-5087 · Cited by 1 · see citing works
Using Consistently Low Performance to Identify Low-Quality Physician Groups
Nguyen, C. A., Gilstrap, L. G., Chernew, M. E., McWilliams, J. M., Landon, B. E., & Landrum, M. B. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.17954
Zhu, Y., & Stearns, S. C. (2023) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13815
Equitable Health Care for Children
Nathan, M., Bucholz, E. M., & Moynihan, K. M. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.04.032
- Authors
- Krumholz, H. M., & Bernheim, S. M.
- Affiliations
- Yale New Haven Hospital (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2014-12-02
- Volume
- 161
- Issue
- 11
- Pages
- 833-834
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC5459391
- OpenAlex
- W2093655363
- Cited by
- 50
- References
- 7
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 3 · 2022: 5 · 2021: 6 · 2020: 7 · 2019: 9 · 2018: 6 · 2017: 4 · 2016: 5 · 2015: 3
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (U01HL105270)
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- socioeconomic status, hospital readmission, 30-day readmission rate, hospital performance indicators, Centers for Medicare and Medicaid Services, administrative claims data, heart failure, acute myocardial infarction, health disparities, quality of care, care transitions, health care utilization, health care access
- MeSH terms
- Female, Hospitals, Veterans, Humans, Male, Patient Readmission, Poverty Areas, Residence Characteristics, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
