Key result
Coordinating transitions with SDOH data improves health outcomes versus standard control practices.
Why the study?
Care continuity during transitions between hospital and home requires reliable communication and understanding of social determinants influencing recovery.
Does a coordinating transitions intervention incorporating social determinants of health improve outcomes in complex chronically ill patients discharged from acute care?
Does a coordinating transitions intervention incorporating social determinants of health improve outcomes in complex chronically ill patients discharged from acute care?
Incorporating social determinants of health data into standard practice workflows during care transitions can improve clinical outcomes for complex chronically ill patients.
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May support SDOH-informed transitions care in complex patients; leaves open confirmation in randomized trials.
Hewner et al. (2017) studied Complex chronic illness. Coordinating transitions intervention vs. Control practices and regional Medicaid population was evaluated on Health outcomes. A coordinating transitions intervention incorporating social determinants of health data improved health outcomes compared with control practices and the regional Medicaid population.
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