Measuring Social Vulnerability:
Opportunities to Strive for Equity in
Collaborative Quality Initiatives
MSQC/ASPIRE Meeting
April 12, 2024
Erin Isenberg, MD; Calista Harbaugh, MD, MSc
Department of Surgery, University of Michigan
Feedback:
Disclosures
Dr. Harbaugh has funding from Blue Cross Blue Shield of
Michigan Foundation and the University of Michigan Rogel
Cancer Center which are unrelated to the content.
Surgery is more than the OR
You have made care better in Michigan
Complications
ED Visits
Readmissions
Reoperations
Serious complications
Mortality
Are we improving care equitably?
Reduce disparities
• Standardization
• Close practice gaps
Widen disparities
• Cherry-picking low-risk
• Not accounting for social risk
• Financial penalties
Objectives
Introduce the
social vulnerability
index as a
structural measure
of social risk
Understand social
vulnerability
among MSQC
patients
Explore CQI
opportunities to
strive for equitable
care improvement
Feedback:
Social Vulnerability Index (SVI)
Overall vulnerability
Socioeconomic status
Household composition
& disability
Racial/ethnic minority &
language
Housing &
transportation
Does SVI matter in the MSQC?
73 hospitals
>500,000
inpatient
operations
(2013-2024)
SVI by ZIP code
Complications
Mortality
Utilization
Highly vulnerable patients have worse outcomes
Aggregated SVI at each MSQC hospitals
Opportunities to strive for equity in CQIs
1. Create visibility
in order to address patient-
level disparities
2. Systematically support
hospitals carrying for
disproportionately
underserved populations
Health Equity
Dashboards
Equity-adjusted
Financial
Incentives
Health Equity Dashboards
SVI 1-90 SVI 91-100
Age <65
Age 65
-
79
Age 80+
Race
-
White
Race
-
Black
Complications
10% (40/400)
15% (15/100)
… … … … …
Mortality
1% (4/400) 2% (2/100) … … … … …
ED Visits
5% (20/400)
8% (8/100) … … … … …
Pro:
Makes disparities visible
Con:
Causes (and interventions)
are not clear
Equity-based adjustment for
financial incentives
Hospital Value-
Based Purchasing
Program
?
