Links between social environment and health care utilization and costs.
The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.
['Brault|Marie A|MA|', 'Brewster|Amanda L|AL|', 'Bradley|Elizabeth H|EH|', 'Keene|Danya|D|', 'Tan|Annabel X|AX|', 'Curry|Leslie A|LA|']
D000368:Aged D019058:Community Networks D003299:Cooperative Behavior D003695:Delivery of Health Care D005260:Female D006801:Humans D007407:Interviews as Topic D008297:Male D017063:Outcome Assessment, Health Care D010342:Patient Acceptance of Health Care D036301:Qualitative Research D012931:Social Environment D014481:United States
mixed methods social services Home- and community-based care and services age-friendly communities social support