Browsing by Author "Guerrero, Jonathan"

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    Association of Socio-Demographic Factors and Social Determinants of Health with Physical Activity Level in Patients with Disabilities
    (2025-04-25) Clark, Austin; Mangum, Joshua; Muvuka, Baraka; Guerrero, Jonathan
    Background: Regular exercise has been shown to improve health outcomes and an important component of preventative medicine. The CDC has shown that patients with disabilities get less regular exercise than patients without disabilities. Identifying groups with low physical activity levels, such as patients with disabilities, and the barriers to physical activity can guide policy and decision making to improve health outcomes. This study examined associations between social determinants of health (SDOH) and physical activity levels. Methods: This retrospective study focused on patients with disabilities admitted at 3 urban hospitals in Northwest Indiana between January 2021 and April 2024. SDOH were screened and participants were selected based on CDC’s disability categories (Cognitive, Mobility, Vision, Hearing, Independent Living, and Self Care). Physical activity level was based on exercise minutes per week: Inactive (IA)=0 minutes, Insufficiently Active (ISA)=<150 minutes, and Sufficiently Active (SA)=150+ minutes. Results: 705 patients with disabilities with recorded physical activity levels were identified. No significant differences were found in physical activity levels between disability categories. The IA group differed significantly from both SA and ISA groups in Age Group, Social Connections Risk, and Length of Stay (p=<0.01). The SA and ISA groups showed significant difference in Financial Resource Risk (p=.045). Regression Analysis showed an increased risk for physical inactivity as Age increased (p=<.001), as well as patients with public insurance compared to private (p=0.02). Conclusion: Age is a common risk factor for reduced physical and the association of lower physical activity with Financial Resource Risk and Social Connections Risk is not novel, but further studies using larger samples may offer insight for future interventions. Future research would benefit from more specific physical activity data from patients with disabilities that may also give insight into adaptive interventions to improve exercise levels in this population.
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    Social Determinants of Health and Their Effects on Readmission and 30-Day Readmission in Patients with a History of Cardiovascular Interventions
    (2025-04-25) Delos Reyes, Mark; Muvuka, Baraka; Guerrero, Jonathan
    Social Determinants of Health and Their Effects on Readmission and 30-Day Readmission in Patients with a History of Cardiovascular Interventions Mark Delos Reyes, Baraka Muvuka, Jonathan Guerrero Indiana University School of Medicine- Northwest (IUSM-NW) Background: 30-day readmission is a quality indicator impacting patients and healthcare systems. Medicare patients accounted for 2.3 million 30-day readmissions, costing $35.7 billion 4 years following the 2012 Hospital Readmission Reduction Program (HRRP) launch . Three of six HRRP measures are cardiovascular: myocardial infarction, Heart Failure, and Coronary Artery Bypass Graft Surgery. This study examined relationships between social determinants of health (SDOH), demographics, and behavioral factors on readmission and 30-day readmission among patients with a cardiovascular intervention history in partnership with an urban Northwest Indiana (NWI)-based health system. Methods: This retrospective study analyzed de-identified data from inpatient SDOH screenings in Epic using the Protocol for Responding to and Assessing Patients Assets, Risks and Experiences (PRAPARE) at 3 urban hospitals between January 2021 and April 2024. Data analysis included descriptive, bivariate (Chi-Square, Mann-Whitney U, Kruskal Wallis; p<0.05), and multivariate (binary logistic regression; p<0.05) analyses in SPSS 29.0. This study was exempted by the Indiana University Human Research Protection Program (IRB #14040). Results: The sample comprised 3717 patients, majority White (70.2%), publicly insured (87.4%), and older adults (73+17). Readmissions represented 43.5% of admissions, 19.8% being 30-day readmissions. Bivariate analysis revealed significant associations between readmission and age (p<0.001), ethnicity (p=0.001), race (p<0.001), sex (p<0.001), sexual orientation (p=0.007), insurance type (p<0.001), financial resource risk (<0.001), housing risk (p=0.05), smoking status (p=0.041), BMI (p<0.001), hospital (p<0.001), and comorbidities (p=0.027). Sex, insurance type, sexual orientation, BMI, and hospital were also associated with 30-day readmission. Multivariate analysis revealed significantly higher odds of readmission with prolonged hospital stay (OR=1.051; p<0.001), former smoking (OR=1.759; p=0.039), and patients at a small, lower SES-serving hospital (OR=1.473; p<0.001). Conclusions: Social-behavioral factors were associated with readmissions and 30-day readmissions among patients with a history of cardiovascular interventions. Integrating SDOH and behavioral screenings and interventions into hospital readmission reduction initiatives could strengthen these programs.
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    Social Determinants of Health Associated with Inpatient Admissions for Congestive Heart Failure, Diabetes, Chronic Obstructive Pulmonary Disease, and Asthma
    (2023-07) Deckbar, John Quentin; DeMichael, Kelly; Gad, Wael; Guerrero, Jonathan; Muvuka, Baraka
    Introduction: The CDC and American Lung Association estimate that congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disorder (COPD), and asthma (COPD/asthma) cost Americans $30.7 billion, $327 billion, and $50 billion respectively each year. They account for most inpatient readmissions at St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana. There is need for further research on the social, behavioral, and demographic determinants associated with these conditions. This study examined the social, behavioral, and demographic determinants associated with inpatient admission for CHF, diabetes, COPD/asthma in SMMC’s service area.  Methods: This retrospective study was part of a multi-phased Community-Based Participatory Research partnership between SMMC and Indiana University School of Medicine Northwest. SMMC implemented a pilot screening and referral program to assess social determinants of health in their service area as part of their Hospital Readmission Reduction Program. This study included data from 10,953 inpatient admissions between January 2021 to March 2023, majority of whom were transferred from the emergency department. Data analysis consisted of univariate, bivariate (Chi-square), and multivariate (binary logistic regression) analysis in SPSS 29.0. Results: Bivariate analysis revealed a statistically significant association between CHF and smoking, age, insurance type, and income. Diabetes was significantly associated with smoking, smokeless tobacco use, age group, race, income, and sex. COPD/asthma was significantly associated with smoking, age group, transportation needs, stress, insurance, ethnicity, and sex. Multivariate analysis found the following significant associations: age group with both CHF (p<0.001) and diabetes (p<0.001), former smoking with both CHF (p = 0.007) and COPD/asthma (p = 0.049), current smoking with COPD/asthma (p = 0.016), and sex with diabetes (p <0.001).   Conclusions: These findings indicate significant associations between multiple socio-behavioral factors and admission for CHF, diabetes, COPD/asthma. Multi-risk-factor interventions may address these interactions and contribute to reducing readmission.
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    Social Determinants of Inequities in Neurodegenerative Disease Readmissions in Northwest Indiana: An Advocacy Opportunity
    (2025-04-25) Calumpang, Neon; Armstrong, Grace; Guerrero, Jonathan; Muvuka, Baraka; Gospodarek, Kyle
    Background: Neurodegenerative diseases, such as Alzheimer's and Parkinson's disease, pose significant challenges given their progressive nature and multifaceted care needs. This research examined the intricate interplay between social determinants of health (SDOH) and hospital readmissions among individuals with neurodegenerative diseases. It is part of a Participatory Research partnership between Indiana University School of Medicine-Northwest and an urban health system in Northwest Indiana (NWI). Methods: This retrospective study analyzed a dataset generated from routine SDOH screenings and referrals in Epic using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) for inpatient admissions from 3 NWI urban hospitals between January 2021 to April 2024. Data analysis was conducted in SPSS 29.0 with descriptive statistics, bivariate analysis (Chi-square), and multivariate analysis (binary logistic regression). This study received exemption from Indiana University Human Research Protection Program (IRB #14040). Results: The sample consisted of 1,338 patients admitted for neurodegenerative diseases. Patients were predominantly older adults (73 ± 14), publicly insured (91.5%), and 31% racial/ethnic minorities. The bivariate analysis found that readmission was significantly associated with age (p<0.001), insurance type (p=0.003), hospital (p<0.001), physical activity level (0.034), and length of stay (p<0.001). After adjusting for these factors, the multivariate analysis found higher odds of hospital readmission among patients with public insurance (OR=76.1%; p=0.028), prolonged hospital stay (OR=8.5%; p<0.001), and within a small hospital in a medically underserved area (MUA) (OR=69.6%; p<0.001). Conclusion: Understanding the impact of SDOH on hospital readmissions is crucial for developing multi-level interventions to reduce readmissions, inequities, and healthcare costs. Findings from this research underscore the critical need for policy advocacy and integrated approaches addressing SDOH as part of comprehensive readmission reduction programs. Examples of evidence-based approaches include improving access to quality neurodegenerative care in MUAs, increasing education on at-home neurodegenerative care, and comprehensive SDOH screenings and referrals.
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    Social, Demographic, and Behavioral Determinants of Prolonged Hospital Stay and Readmissions of Postoperative Complications in an Urban Acute Care Hospital
    (2025-04-25) Dres, Alexis; Thompson, Skyler; Sullivan, Maggie; Muvuka, Baraka; Guerrero, Jonathan; Mangum, Joshua; Gosporadek, Kyle
    Background and Hypothesis The correlation between postoperative complications and social determinants of health (SDOH) is a prominent focus in medical literature due to its implications for healthcare quality and hospital outcomes. In evaluating hospital performance, extended hospital stays (LOS) and readmissions (RA) are critical indicators, prompting initiatives like the Hospital Readmission Reduction Program. Despite efforts, disparities affecting surgical outcomes among urban patients remain underexplored. This study aims to investigate how SDOH influence readmissions and prolonged hospital stays among urban patients experiencing postoperative complications. Conducted through a Community-Based Participatory Research (CBPR) collaboration between Indiana University School of Medicine (IUSM) and Power Health in Northwest Indiana, the research addresses gaps in understanding healthcare disparities in urban settings. Methods This retrospective study analyzed a dataset sourced from SMMC via EPIC™, focusing on SDOH, demographic profiles, health behaviors, and outcomes of adult inpatients who experienced prolonged hospital stays or 30-day readmissions after surgical procedures at an urban hospital between January 2021 and April 2024. Data analysis utilized SPSS 29.0, employing methods like frequency analysis, Chi-Square tests (p<0.05), binary logistic regression (p<0.05), and linear logistic regression (p<0.05) tailored to the study population. The study received exemption from the Indiana University Human Research Protection Program (IRB # 14040) on 1/28/2022. Results The study included data from over 900 patients, with 565 readmissions (RA) and 337 extended LOS cases, primarily adults over 50 years old (81.8% RA, 81.4% LOS), White (69.4% RA, 86.3% LOS), and publicly-insured (74.8% RA, 74.7% LOS). Bivariate analysis revealed significant associations between postoperative complications and age (p < 0.001 for RA, p < 0.011 for LOS), veteran status (p = 0.022 for RA, p = 0.058 for LOS), insurance type (p < 0.001 for RA), smoking tobacco use (p < 0.001 for RA, p = 0.026 for LOS), and BMI (p = 0.002 for RA). Multivariate analysis showed that former smoking (OR = 2.144, p < 0.001), underweight BMI (OR = 4.131, p = 0.006), and publicly-insured status (OR = 3.295, p < 0.001) remained significant across all readmission durations. Specifically for 30-day readmission, public insurance (OR = 2.844, p = 0.021) and former smoking (OR = 1.875, p = 0.037) were significant factors. Potential Impact This research highlights various SDOH and health behaviors associated with increased risks of prolonged hospital stays and readmissions following postoperative complications among urban patients. Policy interventions addressing these factors before and after surgery could potentially mitigate readmissions and extended hospital stays due to procedural complications, thereby improving healthcare outcomes and reducing disparities in urban healthcare settings.
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    Socio-Demographic and Behavioral Predictors of Ophthalmic Readmissions in Northwest Indiana
    (2025-04-25) Armstrong, Grace; Calumpang, Neon; Guerrero, Jonathan; Muvuka, Baraka
    Background: With aging populations and increasing life expectancy, the global disease burden of visual impairment is expected to rise. Timely care is essential for the prevention and treatment of vision loss, yet disparities in eye care access persist. This study investigates the social, demographic, and behavioral characteristics associated with ophthalmic readmissions as part of a participatory research partnership between Indiana University School of Medicine–Northwest and an urban health system in Northwest Indiana (NWI). Methods: This retrospective study analyzed data collected from social determinants of health (SDOH) screenings in Epic using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) for all inpatient admissions across 3 NWI urban hospitals from January 2021 to April 2024. Data analysis included descriptive, bivariate (Chi-Square; p<0.05), and multivariate (binary logistic regression; p<0.05) analyses using SPSS 29.0. The study was exempted by the Indiana University Human Research Protection Program (IRB #14040). Results: The study sample consisted of 338 ophthalmic patients who were predominantly White (59.5%) and older adults (79 ± 18). The bivariate analysis found a statistically significant association between ophthalmic readmissions with age (p=0.026), sex (p=0.031), hospital (p=0.014), and length of stay (p<0.001). After controlling for all covariates in the multivariate analysis, increased age (OR=1.016; p=0.033), Hospital C (small hospital in a medically underserved area) (OR=2.396; p=0.006), and prolonged hospital stay (OR=1.091; p=0.002) remained significantly associated with higher odds of ophthalmic readmissions. Conclusion: These findings indicate a significant association between ophthalmic readmissions and several social determinants of health. Understanding predictors of ophthalmic readmissions is a key step towards developing more effective eye care delivery interventions.