Improving Quality And Equity Through Neighborhood-Level Measures Of Social Need

The lived environment has a significant impact on individuals’ health outcomes. For instance, outcomes can depend on access to surrounding resources, such as public transportation, job opportunities, and safe places for exercise, as well as exposures to stressors, such as violence, poverty, and high housing costs. In turn, there is continued interest in using neighborhood-level measures of social need to understand health care use and improve health outcomes.

The rationale for these efforts is clear. Higher levels of neighborhood-level socioeconomic disadvantage have been associated with worse health outcomes, higher re-admission risk, and higher potentially preventable health care costs. In payment policy, there have been increasing efforts to include these neighborhood-level measures of socioeconomic disadvantage in risk adjustment to increase resources for clinicians.

At the center of this work is the Area Deprivation Index (ADI), a measure originally developed in 2003 and later adapted by researchers at the University of Wisconsin-Madison. ADI is a composite of 17 census-based variables, including income, employment, and education, as well as measures of housing quality and access to transportation. ADI is available at both state and national levels at the unit of census block group—each of which contains between 600 and 3,000 individuals and is the smallest geographic unit for which the Census Bureau tabulates data.