Neon Calumpang, Jonathan Guerrero, Kyle Gospodarek

Demographic, Social, and Behavioral Predictors of Readmission for Neurodegenerative Diseases in Northwest Indiana

Introduction

Demographic, social, and behavioral predictors of readmission for neurodegenerative diseases in northwest indiana. Examines demographic, social, and behavioral predictors of hospital readmission for neurodegenerative diseases in Northwest Indiana. Discover how SDOH influence patient outcomes and healthcare costs.

Abstract

Background: Neurodegenerative diseases, such as Alzheimer's and Parkinson's disease, pose significant challenges given their progressive nature and multifaceted care needs. This research examined the intricate interplay between social determinants of health (SDOH) and hospital readmissions among individuals with neurodegenerative diseases. It is part of a Participatory Research partnership between Indiana University School of Medicine-Northwest and an urban health system in Northwest Indiana (NWI). Methods: This retrospective study analyzed a dataset generated from routine SDOH screenings and referrals in Epic using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) for inpatient admissions from 3 NWI urban hospitals between January 2021 to April 2024. Data analysis was conducted in SPSS 29.0 with descriptive statistics, bivariate analysis (Chi-square), and multivariate analysis (binary logistic regression). This study received exemption from Indiana University Human Research Protection Program (IRB #14040). Results: The sample consisted of 1,338 patients admitted for neurodegenerative diseases. Patients were predominantly White (68.9%), older adults (73 ± 14), and publicly insured (91.5%). The bivariate analysis found that readmission was significantly associated with age (p<0.001), insurance type (p=0.003), hospital (p<0.001), physical activity level (0.034), and length of stay (p<0.001). The multivariate analysis found higher odds of hospital readmission among patients with public insurance (OR=76.1%; p=0.028), prolonged hospital stay (OR=8.5%; p<0.001), and admission at a small hospital in a medically underserved area (OR=69.6%; p<0.001). Conclusion: Understanding the impact of SDOH on hospital readmissions is crucial for developing targeted interventions to improve outcomes and reduce healthcare costs. These factors can profoundly influence disease management, adherence to treatment plans, and overall health outcomes. Findings from this research underscore the critical need for integrated approaches addressing SDOH as part of comprehensive disease management strategies. By addressing these SDOH, healthcare systems can potentially reduce readmissions, enhance quality of life, and promote health equity.

Review

This study addresses a critically important area concerning hospital readmissions among individuals with neurodegenerative diseases, a population with complex and evolving care needs. The use of a Participatory Research partnership between an academic institution and an urban health system in Northwest Indiana lends strong real-world applicability to its findings. Leveraging a robust retrospective dataset drawn from routine SDOH screenings using the PRAPARE protocol within Epic, the study examines real-world factors influencing readmission across a substantial sample of 1,338 patients. The methodology, employing descriptive, bivariate, and multivariate analyses, is appropriate for identifying key demographic, social, and behavioral predictors. A notable strength is the identification of specific factors such as public insurance, prolonged hospital stays, and admission to smaller hospitals in medically underserved areas as significant contributors to readmission risk. While the study offers valuable insights, certain aspects warrant further clarification or expansion. The abstract highlights "Demographic, Social, and Behavioral Predictors," but the presented results primarily detail age, insurance type, hospital characteristics, physical activity, and length of stay. A more explicit breakdown of which specific PRAPARE domains (e.g., housing, food security, transportation) were included in the analysis, and their respective findings, would enhance the depth of the SDOH discussion. Furthermore, the reported odds ratio for public insurance ("OR=76.1%") is ambiguously phrased; typically, odds ratios are expressed as a factor (e.g., 1.761 for 76.1% *higher* odds, or 0.761 for 76.1% *of the odds* which implies lower odds). This phrasing requires clarification to avoid misinterpretation of a key finding. Greater precision in defining "small hospital in a medically underserved area" would also strengthen the interpretability of this significant predictor. Despite these points, this research makes a meaningful contribution to understanding the multifaceted drivers of hospital readmissions in neurodegenerative diseases. Its findings powerfully underscore the profound influence of social determinants of health on patient outcomes, advocating for a shift towards integrated, holistic care models that extend beyond purely medical interventions. The identified disparities, particularly concerning public insurance and care settings in underserved areas, are crucial for informing targeted interventions and resource allocation to reduce readmissions and promote health equity within Northwest Indiana and potentially similar regions. This study provides a strong foundation for future research to develop and evaluate specific, SDOH-informed interventions aimed at improving the quality of life and reducing healthcare burdens for this vulnerable patient population.

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