EP815 - Incorporating Social Determinants of Health into a Surgical Dashboard to Assess Equity of Outcomes after Colorectal Surgery

Monday, May 12, 2025

1:25 PM – 1:30 PM PT

ePoster Presenter(s)

Rachel I. Ekaireb, MD

General Surgery Resident
UC Davis
SACRAMENTO, CA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Rachel Chan, B.S.

Medical Student
UC Davis School of Medicine
Sacramento, CA, United States

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This individual has no financial relationships with ineligible companies.
Yasamin Taghikhan, DO

Resident
UC Davis Health Graduate Medical Education
San Jose, CA, United States

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This individual has no financial relationships with ineligible companies.
RK

Robert J. Kucejko, MD, MS, MBA

Assistant Professor
UC Davis School of Medicine
West Sacramento, California, United States

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This individual has no financial relationships with ineligible companies.
MM

Miquell O. Miller, MD, MSc

Assistant Professor of Surgery
UC Davis Health
Sacramento, California, United States

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This individual has no financial relationships with ineligible companies.
Erik R. Noren, MD, FACS, FASCRS

Assistant Clinical Professor
University of California Davis
Sacramento, California, United States

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This individual has no relevant relationships with ineligible companies.
Ankit Sarin, MD MHA

Associate Professor and Chief of Colorectal Surgery
University of California Davis
Sacramento, California, United States

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This individual has no relevant relationships with ineligible companies.

Senior Author(s)

Sean Flynn, MD

Assistant Professor
UC Davis Health
Sacramento, CA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Rachel I. Ekaireb, MD: This individual has no financial relationships with ineligible companies.

Rachel Chan, B.S.: This individual has no financial relationships with ineligible companies.

Yasamin Taghikhan, DO: This individual has no financial relationships with ineligible companies.

Robert J. Kucejko, MD, MS, MBA: This individual has no financial relationships with ineligible companies.

Miquell O. Miller, MD, MSc: This individual has no financial relationships with ineligible companies.

Erik R. Noren, MD, FACS, FASCRS: This individual has no relevant relationships with ineligible companies.

Ankit Sarin, MD MHA: This individual has no relevant relationships with ineligible companies.

Sean Flynn, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Social determinants of health (SDOH), defined by the World Health Organization as “non-medical factors that influence health outcomes”, are increasingly recognized to impact surgical outcomes. Across surgical subspecialties, lower SDOH as measured by composite scores such as the Healthy Places Index (HPI) are associated with worse postoperative outcomes. Interactive clinical dashboards are a tool to visualize data trends, inform operational decision-making and can be used to track healthcare inequities. However, no SDOH dashboard specific to surgical outcomes has been described in current literature. Therefore, we describe the development of a novel clinical dashboard incorporating SDOH focused on surgical outcomes and report outcomes of the colorectal surgery division at an academic, quaternary-care hospital.

Methods/Interventions: The Surgical SDOH Dashboard was developed incorporating data from EPIC through Caboodle to a Tableau-based dashboard. Demographic and SDOH data collected include age, gender, race/ethnicity, language, insurance type, and HPI quartile. Surgical outcomes include hospital length of stay, readmission rate, Patient Safety Indicators (PSI), discharge location, and mortality. Quality benchmarks such as risk-adjusted indexes were incorporated from the Vizient database and Agency for Healthcare Research data model. The dashboard was deployed in February 2024 and patient data is updated bimonthly. Dashboard data was extracted and analyzed using excel. Chi squared tests and one-way ANOVA were conducted to query the relationships between HPI quartile, other demographic variables, and surgical outcomes.

Results/Outcomes: At time of inquiry, the Surgical SDOH Dashboard contained data from 1,186 cases from July 2022 to June 2024. Dashboard display tabs include an Equity Snapshot (Fig 1a), which provides a visual of patient demographics, and an Equity Deep Dive (Fig 1b), which displays group outcomes over time. In addition to tracking usual surgical metrics such as case volume and complications, the dashboard can identify potential disparities. Patients in lower HPI quartiles were more likely to be non-white, speak a primary language other than English, and less likely to have commercial insurance. While LOS and PSI events were not significantly different across HPI quartiles, lower HPI quartile was associated with higher readmission rates (Table 1). HPI quartile data was missing for 140 patients, representing 11.8% of total encounters.

Conclusion/Discussion: Our study found among patients undergoing colorectal surgery, lower SDOH composite score as measured by HPI was associated with higher rates of readmission, which aligns with previously published literature. A limitation of the HPI to measure SDOH is its reliance on address zip code, which may omit patients who lack permanent housing. SDOH dashboard data must be extracted to perform multivariate regression analyses. While the SDOH dashboard cannot explain why disparities exist, it can serve as a starting point for investigating root causes. The SDOH dashboard is a novel interactive tool that allows clinicians and researchers to identify, intervene on and subsequently track outcome disparities in a prospective manner, enhancing equitable patient experiences and quality of care.