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Social Inequalities and Hospitalisations in Switzerland SIHOS

English title Social Inequalities and Hospitalisations in Switzerland SIHOS
Applicant Bayer-Oglesby Lucy
Number 167506
Funding scheme NRP 74 Smarter Health Care
Research institution Institut für Soziale Arbeit und Gesundheit Hochschule für Soziale Arbeit Fachhochschule Nordwestschweiz
Institution of higher education University of Applied Sciences and Arts Northwestern Switzerland (without UTE) - FHNW
Main discipline Health
Start/End 01.03.2017 - 31.12.2021
Approved amount 377'870.00
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All Disciplines (4)

Discipline
Health
Medical Statistics
Methods of Epidemiology and Preventive Medicine
Public Health and Health Services

Keywords (9)

Mortality; Socioeconomic Factors; Hospitalization; Comorbidity; Treatment Outcome; Chronic Disease; Cohort Studies; Vulnerable Populations; Patient Readmission

Lay Summary (German)

Lead
Soziale Ungleichheiten in der stationären Gesundheitsversorgung in der Schweiz.Die Gesundheit eines Menschen wird durch seine soziale Lage mitbestimmt. In der Schweiz besteht jedoch wenig Wissen über das Zusammenspiel von sozioökonomischen und sozialen Faktoren, gesundheitlichen Beeinträchtigungen und Versorgungsleistungen. Hier setzt die Studie an.
Lay summary

Daten zeigen, dass ein niedriger sozialer Status mit einem grösseren Krankheits- und Sterberisiko verbunden ist. Um die Versorgungsqualität zu verbessern, braucht es vertieftes Wissen zu entsprechenden Krankheitsbildern und medizinischen Behandlungen sowie zur Versorgung von betroffenen Bevölkerungsgruppen. In der Schweiz existiert jedoch keine Datenbasis, um diese Zusammenhänge untersuchen zu können. Der Grund liegt darin, dass die Daten aus dem Gesundheitsbereich nicht mit den Daten aus dem Sozialbereich verknüpft sind.

Ziel der Studie ist es, Spitaldaten mit Daten zur sozialen Lage zu verknüpfen. Auf dieser Basis sollen Zusammenhänge zwischen sozioökonomischen und sozialen Faktoren, spezifischen chronischen Krankheiten, der Inanspruchnahme und der Ergebnisqualität von Spitalleistungen identifiziert werden.

Die bestehenden medizinischen und sozioökonomischen Daten werden in einer neuen Datenbank anonymisiert zusammengeführt und verknüpft. Diese umfasst Daten von 600`000 Personen im Alter ab 15 Jahren mit insgesamt 80`000 Hospitalisierungen. Anschliessend werden die Zusammenhänge zwischen Merkmalen der stationären Behandlung und Nachsorge sowie der sozialen Lage und der Zugehörigkeit zu einer vulnerablen Gruppe statistisch analysiert. Die Ergebnisse werden in Fokusgruppen mit Patientinnen und Patienten sowie Fachpersonen aus dem Bereich Medizin, Migration und Soziales qualitativ vertieft. Es werden Ansätze entwickelt, wie die Versorgungsqualität für vulnerable Gruppen verbessert werden kann.

Die Studie trägt dazu bei, die Gesundheitsversorgung von vulnerablen Gruppen zu verbessern, soziale Ungleichheiten in der Versorgung zu reduzieren und somit zu einem besseren Gesundheitszustand der Schweizer Bevölkerung beizutragen. Zudem schafft sie eine Grundlage, um ein Monitoring der sozioökonomischen und sozialen Faktoren in der Gesundheitsversorgung zu etablieren. Es ist ausserdem vorgesehen, geeignete Indikatoren in nationale Gesundheitsmonitorings zu überführen.

Direct link to Lay Summary Last update: 23.02.2017

Lay Summary (French)

Lead
Les inégalités sociales dans les soins stationnaires en SuisseLa santé d’une personne est en partie liée à sa situation sociale. En Suisse toutefois, les connaissances sur l’interaction entre les facteurs socioéconomiques et sociaux, les atteintes à la santé et les prestations de soins sont encore lacunaires. Une situation à laquelle l’étude entend remédier.
Lay summary

Les données montrent qu’un statut social inférieur induit un risque accru de maladie et de décès. Dans l’optique d’une meilleure prise en charge, il est nécessaire de disposer de connaissances approfondies des pathologies et traitements médicaux correspondants ainsi que de la prise en charge des groupes de population concernés. En Suisse, il n’existe cependant aucune base de données permettant d’étudier ces corrélations du fait de l’absence de croisement entre les données sanitaires et sociales.

L’étude vise à croiser des données sur les établissements de santé avec des données sur la situation sociale afin d’identifier des corrélations entre facteurs socioéconomiques et sociaux, maladies chroniques spécifiques, recours aux prestations hospitalières et qualité des résultats obtenus.

Les données médicales et socioéconomiques existantes sont rassemblées et croisées sous forme anonyme dans une nouvelle base de données. Ces données portent sur 600 000 personnes de 15 ans et plus associées à 80 000 hospitalisations au total. Ensuite, les corrélations entre critères relatifs au traitement et au suivi stationnaires et critères relatifs à la situation sociale et à l’appartenance à un groupe vulnérable sont analysées sous l’angle statistique. Les résultats font l’objet d’une étude qualitative approfondie au sein de groupes de discussion avec des patients et des spécialistes du monde médical, de la question migratoire et du secteur social. Des approches visant à améliorer la qualité de la prise en charge des groupes vulnérables sont développées.

L’étude contribue à améliorer la prise en charge des groupes vulnérables et à réduire les inégalités sociales en matière d’accès aux soins, et, par conséquent, promeut une population suisse en meilleure santé. Elle jette les bases en vue de l’établissement d’un monitorage des facteurs socioéconomiques et sociaux dans le système de santé et vise en outre à fournir des indicateurs appropriés à des monitorages nationaux de la santé.

Direct link to Lay Summary Last update: 23.02.2017

Lay Summary (English)

Lead
Social inequalities in the provision of in-patient healthcare in SwitzerlandThe health of individuals is determined in part by their social status. In Switzerland, however, little is known about the interplay of socio-economic and social factors, poor health and the provision of healthcare. This is the starting point for the study.
Lay summary

Background. Data show that low social status is associated with a greater risk of falling ill and dying. In-depth knowledge about the relevant clinical pictures and medical treatments and about the care provided for affected groups within the population is needed in order to improve the quality of medical care. However, in Switzerland these interrelationships cannot be studied because the data basis does not exist. The reason for this is that healthcare data are not linked to data from the social sphere.

Aims. The aim of the study is to link hospital data with data describing social status. On this basis, correlations will be identified between socio-economic and social factors, specific chronic diseases, the use of hospital services and the quality of the associated results.

Existing medical and socio-economic data will be combined and linked in anonymised form in a new database. The database will cover 600,000 people aged 15 and over accounting for a total of 80,000 hospitalisations. The correlations between the characteristics of in-patient treatment and follow-up care, social status and belonging to a vulnerable group will then undergo statistical analysis. Focus groups with patients and specialists from the fields of medicine, migration and social affairs will enhance the quality of the results. Approaches for improving the quality of care provided to vulnerable groups will be developed.

The study will help to improve healthcare provision to vulnerable groups and reduce social inequality in provision. As such, it will contribute to improving the health of the Swiss population. It will also create a basis for establishing monitoring of the socio-economic and social factors relating to the provision of healthcare. In addition, it is intended to transfer suitable indicators to a national health monitoring programme.

Direct link to Lay Summary Last update: 23.02.2017

Responsible applicant and co-applicants

Employees

Project partner

Collaboration

Group / person Country
Types of collaboration
Prof. Dr. Thomas Mansky, Technische Universität Berlin (TU Berlin) Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
PD Dr. Christian Schindler, Swiss Tropical and Public Health Institute (SwissTPH) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
3. Nationale Tagung Gesundheit & Armut Poster Soziale Ungleicheiten in der stationären Gesundheitsverorgung in der Schweiz (NFP74-Projekt SIHOS) 22.06.2018 Bern, Switzerland Bachmann Nicole; Solèr Maria; Bayer-Oglesby Lucy; Zumbrunn Andrea;


Abstract

BACKGROUND. A clear social gradient of mortality as well as morbidity because of chronic diseases has been shown for Europe (Marmot et al., 2012), including Switzerland (Bachmann et al., 2015). However, reliable data on the effects of socioeconomic factors on hospitalisation, readmission or mortality are largely missing. Efforts to improve quality of care and deliver more equitable care are curtailed if social determinants are not taken into account.OBJECTIVES. The SIHOS-study aims at providing evidence regarding the links between social determinants and risks for adverse outcomes after hospitalisation for chronic health problems. It pursues the following main objectives:1. To analyse the social gradient in use and outcome of inpatient health care services in Switzerland and to gain new and differentiated insight into specific chronic diseases or medical interventions that show an especially high degree of social inequality 2. To identify vulnerable groups who need specific attention and better guidance through the health care system 3. To reduce the risk of ineffective interventions, under- over- and misuse of health services by providing evidence regarding adequate treatment fitting the needs of socially disadvantaged subgroups4. To develop, evaluate and implement record linkage procedures of health and social data, thus facilitating future research based on record linkage.The SIHOS-study addresses the so-called blind spot of health inequity research (Tiesmeyer et al. 2008) i.e. the influence of the health care system on health inequity that has rarely been analysed to date. In Switzerland, particularly, the impact of the social dimension on hospitalisations could not yet be addressed because of sparse data. It is neither efficient nor realistic to obtain the necessary combined information on hospitalisations and the social dimension with a new survey with a large enough sample size and with the necessary precision for the envisaged research. Therefore, the SIHOS-study will rely on existing data from the Swiss national inpatient health care statistics, register data and census data that will be combined to form a novel database by cryptologic record linkage and thus made accessible to pertinent research. RESEARCH APPROACH. The study design of SIHOS corresponds to a retrospective cohort study. The novel database will include individual level census data of about 600'000 subjects aged 15 and over with about 80'000 hospitalisations and permits the examination of hospitalisations for chronic conditions in Switzerland in two ways. Firstly, based on a population cohort that consists of three consecutive samples of the structural survey that is followed for hospitalisations and readmissions within one year. (Re)-admission rates according to social gradient and for vulnerable groups will be calculated. Secondly, based on an inpatient cohort that has as its starting point hospitalisations for chronic conditions in Switzerland in the period 2011 to 2014 and that is determined by those patients, who participated in the structural survey in the year preceding their index hospitalisation for a (specific) chronic condition. The patients of this cohort are followed up for one year after the index hospitalisation for readmission, fatal outcome, transitions to rehabilitation and to long-term care as well as for emigration to control for censoring. Multivariate regression models will be developed, e.g. taking into account hierarchical and longitudinal data structure, distributions of variables and variance at different levels. Dependent variables include indicators of use of inpatient care (number of admissions, length of stay, heavy use) and of related outcomes (readmission within 30 days, fatal outcomes within one year, time to readmission/fatal outcomes). As primary predictors, social status and belonging to a vulnerable group, e.g. elderly people living alone, will be used. Covariates to be evaluated include age, sex, institutional factors as well as clinical characteristics of the patients (e.g. comorbidity and severity of case). IMPLEMENTATION. Focus group interviews will be conducted to: (1) provide insights into the processes and experiences of hospital stays of vulnerable groups from a patient and providers perspective, (2) generate hypotheses on the interactions of patient-specific factors and the care system, thus explaining the outcomes observed in the quantitative part of our study and (3) gather starting points for improving health care of vulnerable groups and to enhance equity in the Swiss health care system. To cover a wide range of different perspectives and experiences, participants of the focus groups will include patients living with chronic conditions, representatives of vulnerable groups, migration/social welfare experts, hospital staff, medical practitioners and case managers. In addition, the SIHOS-study delivers the basis for the long-term monitoring of the social dimension of health as suggested by the WHO (2010) and may support the definition and steering of health policies such as Health 2020. It is planned to develop the pertinent indicators of the social dimension e.g. for monitoring the progress of Health 2020 and for the Obsan monitoring system.
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