Association between patient-reported social and behavioral risks and health care costs in high-risk Veterans health administration patients

Objective: Social risks complicate patients' ability to manage their conditions and access healthcare, but their association with health expenditures is not well established. To identify patient-reported social risk, behavioral, and health factors associated with health expenditures in Veterans Affairs (VA) patients at high risk for hospitalization or death. Data Sources, Study Setting, and Study Design: Prospective cohort study among high-risk Veterans obtaining VA care. Patient-reported social risk, function, and other measures derived from a 2018 survey sent to 10,000 VA patients were linked to clinical and demographic characteristics extracted from VA data. Response-weighted generalized linear and marginalized two-part models were used to examine VA expenditures (total, outpatient, medication, inpatient) 1 year after survey completion in adjusted models. Principal Findings: Among 4680 survey respondents, the average age was 70.9 years, 6.3% were female, 16.7% were African American, 20% had body mass index [greater than or equal to]35, 42.4% had difficulty with two or more basic or instrumental activities of daily living, 19.3% reported transportation barriers, 12.5% reported medication insecurity and 21.8% reported food insecurity. Medication insecurity was associated with lower outpatient expenditures (-$1859.51 per patient per year, 95% confidence interval [CI]: -3200.77 to -518.25) and lower total expenditures (-$4304.99 per patient per year, 95% CI: -7564.87 to -1045.10). Transportation barriers were negatively associated with medication expenditures (-$558.42, 95% CI: -1087.93 to -31.91). Patients with one functional impairment had higher outpatient expenditures ($2997.59 per patient year, 95% CI: 1185.81-4809.36) than patients without functional impairments. No social risks were associated with inpatient expenditures. Conclusions: In this study of VA patients at high risk for hospitalization and mortality, few social and functional measures were independently associated with the costs of VA care. Individuals with functional limitations and those with barriers to accessing medications and transportation may benefit from targeted interventions to ensure that they are receiving the services that they need. KEYWORDS electronic health record, healthcare costs, patient complexity, social and behavioral risk factors, Veterans What is known on this topic * Food insecurity was positively associated with inpatient, medication, and total expenditures but it is unknown what other patient-reported social and behavioral risks are associated with healthcare expenditures of Veterans. What this study adds * Social risks related to food insecurity, transportation barriers, and medication insecurity were fairly common in Veterans at high risk for hospitalization or death. * Medication insecurity, transportation barriers, and basic or instrumental ADL impairment explained meaningful variation in VA total, outpatient, and medication expenditures, but no social risks were associated with inpatient expenditures.
1 | INTRODUCTION Social risks, such as food insecurity, housing instability, and lack of transportation, can complicate patients' ability to manage their conditions and access healthcare, which may adversely affect [...]