WMJ Vol 121 Issue 3: Leveraging Social Determinants of Health to Reduce Hospital Length of Stay: A Pilot QI Project for Solid Tumor Oncology Patients During the COVID-19 Pandemic

ABSTRACT

Introduction: The impact of the social determinants of health (SDOH) on hospitalized cancer patients and hospital length of stay is unknown. At our institution, a hospital-wide SDOH survey that examined patient-specific barriers to various domains of SDOH and facilitated hospital discharge was integrated into the electronic medical record. This study reports the effect of the SDOH survey on length of stay for oncology patients and the outpatient referrals generated to facilitate the discharge.

Methods: We examined length of stay index data on inpatient oncology patients and 2 comparator services (bone marrow transplant, internal medicine). We evaluated the length of stay using a 2-sample t test, and the rate of referrals per discharge using a 2-sample Poisson test.

Results: Compared to the baseline length of stay, after the launch of the SDOH survey, there was a significant (8.9%) decrease in the average length of stay for oncology patients (8.14 to 7.41 days, P = 0.004), the LOS decrease for the bone marrow transplant and subset was a nonsignificant trend only (P > 0.1). Average referrals per discharge increased from baseline 1.063 per discharge to 1.159 after implementation (P = 0.004), and the mean values increased by 9%.

Conclusions: The SDOH survey tool assisted in a timely examination of patient-specific barriers to discharge, leveraged care coordination, and facilitated a safe hospital discharge. Such efforts increase the efficiency of health care service delivery in response to public health threats, such as the COVID-19 pandemic.

Intended Audience

The target audience for this journal-based activity is healthcare providers caring for the people and communities of Wisconsin and beyond.

Learning Objectives

As a result of this journal-based activity, learners, as members of the healthcare team, will be able to:

  1. Discuss connections between social determinants of health (SDOH), such as sociodemographic factors, and extended hospital length of stay (LOS)
  2. Summarize the results of a study exploring the impact of a SDOH screen, administered at admission, on the mean observed hospital LOS and the number of referrals generated to facilitate hospital discharge for oncology patients
  3. Elaborate on applicability of the intervention described in the article to learner’s clinical practice
Course summary
Available credit: 
  • 1.00 AAPA Category 1 CME
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC Contact Hours
  • 1.00 University of Wisconsin–Madison Continuing Education Hours
    • 1.00 Approved for AMA PRA Category 1 Credit™
Registration opens: 
05/17/2023
Course expires: 
05/16/2024
Cost:
$0.00
Part of: 
Wisconsin Medical Journal Volume 121
Rating: 
0

FACULTY DISCLOSURE

It is the policy of the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) to identify, mitigate and disclose all relevant financial relationships with ineligible companies* held by the  speakers/presenters, authors, planners, and other persons who may influence content of this accredited continuing education (CE).  In addition, speakers, presenters and authors must disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation.

For this accredited continuing education activity all relevant financial relationships have been mitigated and detailed disclosures are listed below.

Name of IndividualIndividual's Role in Activity

Financial Relationship Disclosure

Discussion of
Unlabeled/Unapproved
Uses of Drugs/Devices
in Presentation?

Sailaja Kamaraju, MD, MSAccreditation SpecialistNo relevant relationships with ineligible companies to discloseNo
David Atkinson, MBAAuthorNo relevant relationships with ineligible companies to discloseNo
Tamiah Wright, DNP, RN, APNP, AGCNS-BCAuthorNo relevant relationships with ineligible companies to discloseNo
John Charlson, MD:AuthorNo relevant relationships with ineligible companies to discloseNo
Thomas Wetzel, MS:AuthorNo relevant relationships with ineligible companies to discloseNo
Grace Campbell, PhD, MSW, CRRNAuthorNo relevant relationships with ineligible companies to discloseNo
Jennifer Cadman, RNAuthorNo relevant relationships with ineligible companies to discloseNo
Joni Williams, MD, MPHAuthorNo relevant relationships with ineligible companies to discloseNo
Leonard Egede, MD, MSAuthorNo relevant relationships with ineligible companies to discloseNo
Janet Retseck, MDAuthorNo relevant relationships with ineligible companies to discloseNo
Anjishnu Banerjee, PhDAuthorNo relevant relationships with ineligible companies to discloseNo
Valarie Ehrlich, PA-CAuthorNo relevant relationships with ineligible companies to discloseNo
Melinda Stolley, PhDAuthorNo relevant relationships with ineligible companies to discloseNo
Steve Power, MBAAuthorNo relevant relationships with ineligible companies to discloseNo
Sarina B. Schrager, MDEditor No relevant relationships with ineligible companies to discloseNo
Paul Hunter, MDReviewer AbbVie (Stock), Abbott Laboratories (Stock), AstraZeneca (Stock), BioMarin Pharmaceutical (Stock), Bristol Myers Squibb Company (Stock), Boston Scientific Corporation (Stock), Becton, Dickinson and Company (Stock),  Catalent Pharma Solutions, LLC (Stock), Eli Lilly and Company (Stock), Exact Sciences (Stock), Edwards Lifesciences Corporation (Stock), Globus Medical, Inc. (Stock), GlaxoSmithKline (Independent Contractor - Other), Horizon Therapeutics plc (Stock), Halozyme Inc (Stock), HOLOGIC (Stock), Integer Holdings Corporation (Stock), Intuitive Surgical (Stock), Intra-Cellular Therapies (Stock), Insulet Corporation (Stock), Jazz Pharmaceuticals (Stock), Johnson & Johnson Health Care Systems Inc. (Stock), KONINKLIJKE PHILIPS (Stock), Lab Corp America (Stock), Merck (Independent Contractor - Consultant),, McKesson Corporation (Stock), Medtronic (Stock), Moderna (Independent Contractor - Consultant), Nestle HealthCare Nutrition Inc. (Stock), Neurocrine Biosciences, Inc. (Stock), Novartis (Stock), Novo Nordisk (Stock), Pfizer (Stock, grant/contract), Roche (Stock), STERIS Corporation (Stock), Sarepta Therapeutics, Inc. (Stock), SANOFI PASTEUR INC. (Stock & Indpendent Contractor), Seqirus USA Inc (Independent Contractor - Other), Thermo Fisher Scientific (Stock), Vertex Pharmaceuticals, Zimmer Biomet Holdings, Inc. (Stock),No
Geoffrey R. Swain, MD, MPHReviewer No relevant relationships with ineligible companies to discloseNo
Laura Ozkan, PA Reviewer No relevant relationships with ineligible companies to discloseNo
Roberta Pawlak, PhD, RN, NEA-BC Reviewer No relevant relationships with ineligible companies to discloseNo

*Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on, patients.

The ACCME does not consider providers of clinical services directly to patients to be ineligible companies.

Discloser List CME Internal Report

Accreditation

Accreditation Statement

Joint Accreditation with Commendation MarkIn support of improving patient care, this activity has been planned and implemented by the University of Wisconsin–Madison ICEP and the Wisconsin Medical Journal.  The University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


Credit Designation Statements

American Medical Association (AMA)

The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC)

The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 ANCC contact hour.  

American Academy of Physician Assistants (AAPA)

The University of Wisconsin–Madison ICEP has been authorized by the American Academy of PAs  (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until 5/24/2024. PAs should only claim credit commensurate with the extent of their participation.

Continuing Education Units

The University of Wisconsin–Madison ICEP, as a member of the University Professional & Continuing Education Association (UPCEA), authorizes this program for 0.1 continuing education units (CEUs) or 1 hour.

Available Credit

  • 1.00 AAPA Category 1 CME
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC Contact Hours
  • 1.00 University of Wisconsin–Madison Continuing Education Hours
    • 1.00 Approved for AMA PRA Category 1 Credit™

Cost:
$0.00
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