Association of Social Determinants of Health Measures and Successful Community Discharge Across Rehabilitation Service Areas

Research Objectives: Evaluate: 1) variation in successful community discharge across Rehabilitation Service Areas (RSAs) nationally, and 2) the relationship between social determinants of health (SDH) variables/indices and successful community discharge across RSAs.

Design: Retrospective cross-sectional analysis of Centers for Medicare & Medicaid Services (CMS) and AHRQ SDH dataset. We performed maximum likelihood factor analysis with varimax rotation and principled mean analysis to identify how many factors to extract from the AHRQ-SDH dataset and calculated a rehabilitation-specific SDH measure (SDH-R) based on these factors and variables. Next, we calculated the Social Deprivation Index (SDI) and the SDH-R for a random sample of 800 RSAs and examined the association between SDI and SDH-R and successful community discharge.

Setting: We examined discharges following post-acute care from long-term care hospitals, home health agencies, and skilled nursing and inpatient rehabilitation facilities.

Participants: The population included 2013–2015 Medicare records from fee-for-service beneficiaries >65 years. The cohort included 2,287,210 records across all diagnostic groups.

Interventions: N/A

Main Outcome Measures: Successful community discharge across the 1711 RSAs nationally using CMS quality measure specifications.

Results: The national average for successful community discharge across RSAs was 55.1%. The pattern of successful community discharge indicates the majority of RSAs(1239, 72.4%) perform at the national average for successful community discharge with 253 RSAs (14.8%) significantly below and 219(12.8%) significantly above the national average. Factor analysis with AHRQ-SDH variables identified five factors with eigenvalues >1.0. The resultant model explained 23.1% of the variation in successful community discharge. The SDH-R model performed significantly better than the SDI (RMSE:SDH-R=0.88 vs SDI=0.99).

Conclusions: Successful community discharge varied across RSAs nationally. We identified SDH variables related to successful community discharge following rehabilitation. More research is needed to understand how SDH impacts community discharge across high- and low-performing RSAs and explore disparities and equity issues related to successful community discharge following post-acute care rehabilitation.

Author(s) Disclosures: This work was supported by the Agency for Healthcare Research and Quality (AHRQ) R01-HS024711 (TR,JP,AH,YK,KE), T32-HS026133 (YK,JD). All authors declare no conflicts.