Links between social environment and health care utilization and costs

ABSTRACT

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.

KEYWORDS:

• Home- and community-based care and services
• social services
• mixed methods
• age-friendly communities
• social support

Ethics approval

Ethics approval for the study was obtained from the Yale Human Subjects Committee (protocol number: 1505015931).

Acknowledgments

The authors wish to acknowledge the following individuals who assisted with data collection and project management: Maureen Canavan, Marcia Mulligan, Chloe Yee, Caitlin Coyle, Amy Salerno, and Seppo Rinne. The authors also thank the interview participants for their time.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by a grant from the Commonwealth Fund [grant number: 20150133 to E.H.B. and L.C.] and the Donaghue Foundation [no grant number to E.H.B. and L.C.];Patrick and Catherine Weldon Donaghue Medical Research Foundation [None];