Grant: Partnerships for Health System Improvement (PHSI)

<html> <body> <p> <strong>BACKGROUND:</strong> The transition period after discharge from hospital signifies a particularly vulnerable time for adverse medical events, with up to 25% of patients being readmitted within 1 month. The current body of literature on predictors of hospital readmission focuses primarily on non-modifiable patient-level clinical characteristics. Interestingly, there is relative silence on social vulnerabilities that may increase risk of readmissions, though one might argue that there is even greater value in characterizing such vulnerabilities given their potential modifiability, particularly those that result in system-level barriers.<br> <br> <strong>OBJECTIVE:</strong> To explore the association between 5 key dimensions of social vulnerability (financial constraint, low health literacy, low saliency of health maintenance, transportation barriers, and poor social support) and adverse events (readmissions, emergency department visits, and mortality) 3 months post-discharge, in a group of medical inpatients.</p> <p> <strong>EXPERTISE:</strong> We have established partnerships with the provincial health authority (Alberta Health Services) and community organizations (Calgary Homeless Foundation, Calgary Urban Project Society clinic) that are piloting initiatives to improve the health of persons who are socially vulnerable. In addition, we have connected with similar groups in Edmonton to form a provincial network of collaborators. By partnering with groups that are actively designing interventions in this arena, our study findings will have a broad reach and ability to effect actual change. Our study team includes a diverse set of expertise (including health services research, sociology, biostatistics, survey methods, and knowledge translation), which is suited to the complex nature of the problem that we are studying.&nbsp;</p> <p> <strong>APPROACH:</strong> We propose a prospective cohort study in patients being discharged to the community, from the general internal medicine units at two tertiary acute care hospitals in Calgary, Alberta. Primary data collection will encompass the 5 social vulnerabilities along with other clinical and sociodemographic factors. These will be assessed using a patient questionnaire developed for this study, which has been validated in our pilot evaluation of 400 patients. Data linkage to administrative databases will provide us with the clinical endpoints of readmission, emergency department visits, and mortality.<br> </p> <p>We will model the time-to-event of any of the events in our composite outcome using multivariable Cox regression models, adjusting for patient sociodemographic and clinical characteristics. The target sample size is 1780, to achieve a power of 80%, a level of significance of 5%, and to detect a relative risk of 1.3, assuming a 20% prevalence for the composite clinical outcome. Assuming a 70% participation rate, data collection will require 11 months. Data linkage will be completed 6 months after data collection, and data analysis 4 months after that. With dissemination of results occurring in the final 3 months, the total project timeline is 24 months.<br> <br> <strong>IMPACT:</strong> This research project has important implications for the prioritization and development of targeted interventions to address the social vulnerabilities that most influence the risk of adverse health outcomes in adult medical inpatients. The uniqueness of this study approach along with our provincial network of partnerships and collaborators are key elements through which our study findings will produce long-term impact.</p> </body> </html>