Abstract
Objective: We sought to determine the relationship between a patient's proximal familial social support, defined as the geographic proximity of family members, and healthcare utilization after complex cardiovascular and oncologic procedures. Background: Social support mechanisms are increasingly identified as modifiable risk factors for healthcare utilization. Methods: We performed a retrospective cohort study of 60,895 patients undergoing complex cardiovascular procedures or oncologic procedures. We defined healthcare utilization outcomes as 30-day all-cause readmission unplanned readmission, nonindex hospital readmission, index hospital length of stay, and home discharge disposition. For each patient, we aggregated the number of first-degree relatives (FDR) living within 30 miles of the patient's home address at the time of the surgical procedure into the following categories: 0 to 1, 2 to 3, 4 to 5, 6+ FDRs. We developed hierarchical multivariable regression models to determine the relationship between the number of FDR living within 30 miles of the patient and the healthcare utilization outcomes. Results: Compared with patients with 0 to 1 FDRs, patients with 6+ FDRs living in close proximity had significantly lower rates of all-cause readmission (12.1% vs 13.5%, P<0.001), unplanned readmission (10.9% vs 12.0%, P=0.001), nonindex readmission (2.6% vs 3.2%, P=0.003); higher rates of home discharge (88.0% vs 85.3%, P<0.001); and shorter length of stay (7.3 vs 7.5 days, P=0.02). After multivariable adjustment, a larger number of FDRs living within 30 miles of the patient was significantly associated with a lower likelihood of all-cause readmission (P<0.001 for trend), 30-day unplanned readmission (P<0.001), nonindex readmission (P<0.001); higher likelihood of home discharge (P<0.001); and shorter index length of stay (P<0.001). Conclusions: The geographic proximity of family members is significantly associated with decreased healthcare utilization after complex cardiovascular and oncologic surgical procedures.
| Original language | English |
|---|---|
| Pages (from-to) | 720-731 |
| Number of pages | 12 |
| Journal | Annals of Surgery |
| Volume | 276 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 1 2022 |
| Externally published | Yes |
Funding
This research was supported by grant 1K08HS025776 from the Agency for Healthcare Research and Quality (B.T.B.). The research was also supported by the NCRR grant, “Sharing Statewide Health Data for Genetic Research” (R01 RR021746, G. Mineau, PI), with additional support from the Utah Department of Health and the University of Utah. The computational resources used were partially funded by the NIH Shared Instrumentation Grant 1S10OD021644-01A1. The authors thank the Pedigree and Population Resource of Huntsman Cancer Institute, the University of Utah (funded in part by the Huntsman Cancer Foundation) for its role in the ongoing collection, maintenance, and support of the Utah Population Database (UPDB). The authors also acknowledge partial support for the UPDB through grant P30 CA2014 from the National Cancer Institute, University of Utah, and from the University of Utah’s program in Personalized Health and Center for Clinical and Translational Science.
Keywords
- geographic information systems
- health services
- readmission
- social support