标题： 平衡区域剥夺指数 (bADI)：增强健康社会决定因素指数以加强其与医疗临床结局、利用和成本的关联 显示英文标题

标题： Balanced Area Deprivation Index (bADI): Enhancing social determinants of health indices to strengthen their association with healthcare clinical outcomes, utilization and costs

摘要： 背景：随着基于价值的护理在美国医疗系统中的扩展，减少健康差异已成为当务之急。像广泛使用的区域剥夺指数（ADI）这样的健康社会决定因素（SDoH）指数指导着管理患者健康和成本的努力。然而，ADI对与住房相关的变量（例如，房屋的中间价值）的依赖可能降低了其有效性，特别是在高成本地区，通过掩盖不平等和不良健康结果可能会削弱其作用。 方法：为克服这些局限性，我们开发了平衡后的ADI（bADI），这是一种新的SDoH指数，通过标准化构建减少了对住房指标的依赖。我们使用来自数百万Medicare按服务收费和Medicare优势受益人的数据评估了bADI。相关分析测量了它与临床结果、预期寿命、医疗服务利用和成本之间的关联，并将结果与ADI进行了比较。 结果：bADI与临床结果和预期寿命的相关性比ADI更强。它在昂贵地区的住房成本影响较小，更准确地预测了医疗服务的利用和成本。虽然基于ADI的研究表明最不利和最有利的群体都有较高的医疗成本，但bADI揭示了一个更为复杂的模式，显示出组间成本差异更加准确。 结论：bADI对医疗结果和支出具有更强的预测能力，使其成为责任型护理组织有价值的工具。通过重新分配资源从较不不利到更不利的地区，ACO可以使用bADI来促进人口健康管理计划中的公平和成本效益护理。 显示英文摘要

摘要： Background: As value-based care expands across the U.S. healthcare system, reducing health disparities has become a priority. Social determinants of health (SDoH) indices, like the widely used Area Deprivation Index (ADI), guide efforts to manage patient health and costs. However, the ADI's reliance on housing-related variables (e.g., median home value) may reduce its effectiveness, especially in high-cost regions, by masking inequalities and poor health outcomes. Methods: To overcome these limitations, we developed the balanced ADI (bADI), a new SDoH index that reduces dependence on housing metrics through standardized construction. We evaluated the bADI using data from millions of Medicare Fee-for-Service and Medicare Advantage beneficiaries. Correlation analyses measured its association with clinical outcomes, life expectancy, healthcare use, and cost, and compared results to the ADI. Results: The bADI showed stronger correlations with clinical outcomes and life expectancy than the ADI. It was less influenced by housing costs in expensive regions and more accurately predicted healthcare use and costs. While ADI-based research suggested both the most and least disadvantaged groups had higher healthcare costs, the bADI revealed a more nuanced pattern, showing more accurate cost differences across groups. Conclusions: The bADI offers stronger predictive power for healthcare outcomes and spending, making it a valuable tool for accountable care organizations. By reallocating resources from less to more disadvantaged areas, ACOs could use the bADI to promote equity and cost-effective care within population health initiatives.