In New Jersey, chronic conditions are closely tied to social
determinants of health, including geographic location and employment status.
By Jessica Kent
February 01,
2019 - New Jersey’s poorest zip codes have the highest rates of
individuals with chronic diseases seeking care in emergency rooms, showing a
strong link between the social determinants of health and poor outcomes,
according to a new state report.
The team from
the Center for Health Analytics, Research and Transformation (CHART) at the New
Jersey Hospital Association (NJHA) also found a clear relationship between
employment status, income and nutrition, and poor health status.
Chronic
diseases are on the rise in New Jersey, the report said, and the prevalence of
these conditions is straining healthcare delivery across the state. To better
understand the impact of chronic conditions on care delivery in New Jersey, the
CHART team examined patient record data from more than three million hospital
ER visits in 2017.
The results
showed that hospitals in New Jersey spend over $2 billion each year providing
emergency care to patients who don’t need to be admitted for more advanced
treatment. Approximately 1.2 million, or 39 percent, of these visits were
associated with patients who had one or more chronic conditions.
On average,
these visits are 54 percent costlier than those associated with patients who
had no chronic conditions.
“These are
real, measurable impacts on our state,” said
Sean Hopkins, Senior Vice President of CHART.
“But chronic
diseases also have a myriad of additional consequences on individuals and
communities that are more challenging to quantify. What we do know from our
research is that there is a clear relationship between social
determinants of health and chronic disease cases in the ED.”
The results
demonstrated that the three poorest counties in the state, including
Cumberland, Essex, and Atlantic, exhibited the highest rates of chronic disease
patients seeking care in hospital ERs. The statewide average use rate for ER
visits for patients with chronic conditions is 129.62 per 1000 population.
Cumberland
county’s use rate was almost double the statewide average, at 237.29, while
Essex saw a rate of 166.0 and Atlantic had an ER usage rate of 202.15.
These findings
demonstrate the critical role that non-clinical
factors can play in a person’s overall health.
“While poor
health habits such as lack of exercise, poor diet and smoking are a major
contributor to the onset of chronic conditions, geographic location may also be
a major factor,” the report said.
“A person’s zip
code could be equally as
important if not more important than one’s genetic code.”
Cumberland,
Essex, and Atlantic counties also have three of the four highest unemployment
rates in the state, the report pointed out. While the statewide unemployment
average is 4.4 percent, the unemployment rate is 6.6 percent in Cumberland, 5.7
in Essex, and 5.4 percent in Atlantic.
These
statistics reveal why chronic disease patients who live in these counties may
experience higher rates of ER visits.
“You can live
well with a chronic condition, but that requires access to primary care, a
medical home and care management,” said NJHA President and CEO Cathy
Bennett.
“CHART's study
zeroes in on hotspot zip codes where there are clear gaps in that level of
care. These communities demand greater attention to make sure all individuals
have access to the services they need.”
To reduce the
burden of chronic conditions in underserved communities, CHART recommended that
healthcare leaders partner to expand the availability of mobile health clinics,
school-based chronic care
management programs, and health fairs.
“Evidence
suggests that mobile health clinics produce significant cost savings and
represent a cost-effective care delivery model that improves health outcomes in
underserved groups,” the report said.
In addition,
CHART suggested that leaders promote the use of chronic disease
management apps and remote monitoring devices, as well as
discuss new initiatives that will improve population health.
The negative
effects of chronic disease are exacerbated in New Jersey’s lower-income
communities, but action from healthcare leaders can help reduce these impacts.
“Chronic
disease places an enormous financial strain on the healthcare delivery system,
but more importantly, has a debilitating impact on quality of life for the
residents of New Jersey,” the report concluded.
“Information
contained in this study strongly illuminates the need for policy makers,
healthcare providers, state public health agencies, other stakeholders and
individuals themselves to take the necessary steps to effectively begin the
process of mitigating and reducing the presence of chronic disease.”
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