Patterns of Social Needs Predict Quality-of-Life and Healthcare Utilization Outcomes in Patients from a Large Hospital System

Chengbo Zeng; Manraj N Kaur; Sri Harshini Malapati; Jason B Liu; Allison S Bryant; Peter M Meyers; David W Bates; Nadine J McCleary; Andrea L Pusic; Maria O Edelen

doi:10.1007/s11606-024-08788-6

Patterns of Social Needs Predict Quality-of-Life and Healthcare Utilization Outcomes in Patients from a Large Hospital System

J Gen Intern Med. 2024 May 6. doi: 10.1007/s11606-024-08788-6. Online ahead of print.

Authors

Chengbo Zeng^{1

2}, Manraj N Kaur^{3

4}, Sri Harshini Malapati^{3

4}, Jason B Liu^{3

4

5}, Allison S Bryant^{4

6

7}, Peter M Meyers⁷, David W Bates^{4

8

9}, Nadine J McCleary^{4

10}, Andrea L Pusic^{3

4

11}, Maria O Edelen^{3

4}

Affiliations

¹ Patient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. czeng8@bwh.harvard.edu.
² Harvard Medical School, Boston, MA, USA. czeng8@bwh.harvard.edu.
³ Patient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Harvard Medical School, Boston, MA, USA.
⁵ Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
⁶ Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
⁷ Office of the Chief Medical Officer, Mass General Brigham, Boston, MA, USA.
⁸ Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
⁹ Clinical and Quality Analysis, Information Systems, Mass General Brigham, Boston, MA, USA.
¹⁰ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
¹¹ Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.

PMID: 38710869
DOI: 10.1007/s11606-024-08788-6

Abstract

Background: Unmet social needs (SNs) often coexist in distinct patterns within specific population subgroups, yet these patterns are understudied.

Objective: To identify patterns of social needs (PSNs) and characterize their associations with health-related quality-of-life (HRQoL) and healthcare utilization (HCU).

Design: Observational study using data on SNs screening, HRQoL (i.e., low mental and physical health), and 90-day HCU (i.e., emergency visits and hospital admission). Among patients with any SNs, latent class analysis was conducted to identify unique PSNs. For all patients and by race and age subgroups, compared with no SNs, we calculated the risks of poor HRQoL and time to first HCU following SNs screening for each PSN.

Patients: Adult patients undergoing SNs screening at the Mass General Brigham healthcare system in Massachusetts, United States, between March 2018 and January 2023.

Main measures: SNs included: education, employment, family care, food, housing, medication, transportation, and ability to pay for household utilities. HRQoL was assessed using the Patient-Reported Outcomes Measurement Information System Global-10.

Key results: Six unique PSNs were identified: "high number of social needs," "food and utility access," "employment needs," "interested in education," "housing instability," and "transportation barriers." In 14,230 patients with HRQoL data, PSNs increased the risks of poor mental health, with risk ratios ranging from 1.07(95%CI:1.01-1.13) to 1.80(95%CI:1.74-1.86). Analysis of poor physical health yielded similar findings, except that the "interested in education" showed a mild protective effect (0.97[95%CI:0.94-1.00]). In 105,110 patients, PSNs increased the risk of 90-day HCU, with hazard ratios ranging from 1.09(95%CI:0.99-1.21) to 1.70(95%CI:1.52-1.90). Findings were generally consistent in subgroup analyses by race and age.

Conclusions: Certain SNs coexist in distinct patterns and result in poorer HRQoL and more HCU. Understanding PSNs allows policymakers, public health practitioners, and social workers to identify at-risk patients and implement integrated, system-wide, and community-based interventions.

Keywords: health-related quality of life; healthcare utilization; social determinants of health; social needs.