Adding a Vital Sign: Considering the Utility of Place-Based Measures in Health Care Settings

Abstract

During rounds, you prepare to enter the room of a child who was hospitalized overnight for an asthma exacerbation. You review the chart, taking careful notice of the documented history and the physical examination. You also quickly glance at the child' s zip code. This may not be a routine aspect of your care, but this particular zip code stands out. You know that it includes blocks with dilapidated housing conditions, limited access to pharmacies, and unreliable bus routes. You wonder whether this is the reality faced by your patient. This prompts you to more deeply consider your management plans for this child' s hospitalization and for their eventual transition to home. How could or should you think about this child' s zip code in relation to their medical and social needs? Is it a proxy for their own risks or a reflection of their surroundings? Or is it both? With studies in which measures of a child' s neighborhood are linked to adverse postdischarge outcomes 1 and to patient-level social and financial risks themselves, 2 it is becoming increasingly relevant to consider how to interpret and then use such measures during clinical care. As hospitalists grapple with such scenarios and questions, they may begin by considering the extent to which place-based measures, or "geomarkers," 3 may or may not serve as proxies for patient-level social, economic, and environmental risks.

Association Between Neighborhood-level Socioeconomic Deprivation and the Medication Level Variability Index for Children Following Liver Transplantation

“…[4][5][6] In recognition of the role of community/neighborhood on health and disease, the National Academy of Medicine now recommends the routine use of geocoded area-based measures in clinical care in addition to individual psychosocial measures. 56,57 While such screening is being implemented in primary care, [3][4][5][6][58][59][60] use in pediatric transplant medicine is limited. A necessary first step is to identify the mechanism by which place-based risk affects outcomes in pediatric liver transplantation; medication adherence may be a key component as nonadherence remains a major challenge for the medical community.…”

Social Disadvantage, Access to Care, and Disparities in Physical Functioning Among Children Hospitalized with Respiratory Illness

“…Systematic screening could help ensure all patients who may benefit from additional services, such as intensive, culturally tailored education or connections to food, housing, or financial services, will in fact receive them, which may lead to sustained reductions in health disparities. 20 Further research into pairing validated screening tools with proven interventions is needed. 32 This study has additional limitations aside from those noted above.…”

“…17 Furthermore, many of these studies were conducted in the outpatient setting, 18,19 whereas hospitalization provides an additional point of care to address the social determinants of health for vulnerable families. 20 Even for short hospitalizations, the 24/7 nature of hospital care provides the opportunity for frequent interactions with clinicians, nurses, and support staff to clarify illness-related questions, discuss other health concerns and unmet needs, and connect with social services or community resources. These opportunities may be particularly important for families with a higher number of social disadvantage markers and even more beneficial to METHODS: From July 1, 2014, to June 30, 2016, children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children's hospitals for three common respiratory illnesses completed a survey on admission and within 2 to 8 weeks after discharge.…”

“…Although interventions to address social determinants of health for patients with social disadvantages have been associated with within‐group improvements in HRQoL, none have assessed changes in disparities as an outcome 17 . Furthermore, many of these studies were conducted in the outpatient setting, 18,19 whereas hospitalization provides an additional point of care to address the social determinants of health for vulnerable families 20 . Even for short hospitalizations, the 24/7 nature of hospital care provides the opportunity for frequent interactions with clinicians, nurses, and support staff to clarify illness‐related questions, discuss other health concerns and unmet needs, and connect with social services or community resources.…”

Evaluating Quality Adjusted Life Years in the Absence of Standard Utility Values- A Dynamic Joint Modelling Approach

“…al. [16] have given a commentary on how geomarkers can be useful in assessing patient level variability in risks. To understand through an example, an HIV patient, in any stage, staying in a developed country is expected to have a better quality of life than that of a patient in the same stage in a developing or underdeveloped country.…”