From policy to practice: Assessing the State Innovation Models initiative's early success in incorporating social determinants of health in ASCVD hospitalizations in the United States

The study examines effects of the CMS State Innovation Models(SIM) on capturing social risk factors in adults hospitalized with Atherosclerotic Cardiovascular Disease (ASCVD). Using a difference-in-differences(DID) approach with propensity score weights, the study compared documentation of secondary diagnosis of SDOH/social factors using ICD-9 V codes ("SDOH codes") in adults hospitalized with ASCVD as a primary diagnosis (N= 1,485,354). Data were gathered from January 1, 2010, to September 30, 2015, covering the period before and after the SIM implementation in October 2013. From January 2010 to September 2015, SDOH codes were infrequently utilized among adults with ASCVD(0.55%, 95% CI: 0.43%-0.67%). SDOH codes with ASCVD increased from pre- to post-period in SIM states(0.56% to 0.93%) and comparison states (0.46% to 0.56%). SIM implementation was associated with greater improvement in SDOH codes utilization (adjusted OR 1.30, 95%CI: 1.18-1.43) during ASCVD hospitalizations. The odds of SDOH codes utilization were 86% higher in ED admissions(AOR 1.86, 95%CI: 1.76-1.97) than in routine admissions with ASCVD. Findings were similar when limiting population to older adults(>=65 years) enrolled in Medicare(AOR 1.50, 95%CI 1.31-1.71), whereas not significant for Medicaid beneficiaries. The study points to challenges for healthcare providers in documenting SDOH in adults with ASCVD.