Effects of Individual and Community-Level Social Determinants of Health on Ophthalmology Consultation During an Emergency Department Visit

Abstract

Purpose : To evaluate if established social determinants of health indices, Area of Deprivation Index (ADI), Social Deprivation Index (SDI), and Distressed Community Index (DCI), as well as individual patient demographic characteristics, are associated with ophthalmology consultation likelihood in the ED of a tertiary care facility.

Methods : Electronic medical records were reviewed from patients who presented to Harborview Medical Center ED and the University of Washington Medical Center ED with an eye-related billing code between 2/1/2022 and 1/31/2023. Obtained patient information included primary address, age, sex, race, language, interpreter request, insurance type, and employment status. Patients were excluded if they were in a transient living situation or were younger than 18 years old. ADI, SDI, and DCI scores were calculated based on patient address. Encounters were classified into ophthalmology consulted with referral, ophthalmology consulted without referral, and ophthalmology not consulted. Logistic regression assessed whether individual-level characteristics affected the odds of receiving a consult.

Results : Among 2,003 encounters included, 1327 (66.3%) identified as white and 276 (13.8%) as Black. Ophthalmology was consulted for 1,364 (68.1%) visits (791 were referred and 573 presented initially to ED). Mean ± standard deviation age at time of visit was 49.5 ± 17.8 years. ADI, SDI and DCI scores are shown in Table 1. Patients who received an ophthalmology consult with a referral had significantly higher mean ADI and DCI scores (higher level of "disadvantage") than those in the other groups, while SDI and DCI scores did not differ significantly (Table 1). Younger age was the only factor associated with not receiving an ophthalmology consult when presenting without a referral (p<0.001).

Conclusions : Higher ADI and DCI (more disadvantage) were associated with increased likelihood of receiving an ophthalmology consultation when referred by an outside provider, while younger age was associated with increased likelihood of not receiving a consultation when self-referred to ED.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Table 1. ADI, SDI and DCI raw scores and quantiles by patients who received an ophthalmology consultation and were referred by an outside provider, received a consultation without an outside referral, and those who did not receive a consultation (N= 2,003). All values are mean ± SD.