Suzanne Mitchell
University of Massachusetts Chan Medical School, MA·Public Health & Epidemiology
About 1 in 5 hospital stays in the United States involve a patient with diabetes. Many of these admissions stem from complications driven by social determinants of health (SDOH), the everyday conditions that shape health, such as housing, food, money and transportation.
- Fields
Public Health & Epidemiology
Medicine & Clinical Research
- Topics
type 2 diabetes
social determinants of health
health-related social needs
- Grants
- 1 known grant, through May 2029
What they work on
- Test whether REDDCAT2 delays hospital readmission within 90 days compared with usual discharge care for patients with type 2 diabetes, in a comparative effectiveness trial. The intervention pairs REDD-CAT social-needs screening with patient navigation.
- Assess the effect of REDDCAT2 on medical service use, diabetes outcomes and resolution of social needs at 30 and 90 days after discharge, with a navigator helping patients prioritize and address needs.
- Develop a patient risk profile algorithm from trial data on social determinants of health, to identify people with diabetes at highest risk of poor outcomes after hospitalization.
More about the research
When these needs go unmet, patients do worse. Hospital staff often notice such needs during care, but there is no streamlined way to find, prioritize and address them during a hospital stay. The project treats hospitalization as an opportunity to resolve these social needs for people living with type 2 diabetes.
Why it matters
People with type 2 diabetes often return to hospital because of unmet needs such as food, housing or transportation. If screening at discharge combined with patient navigation reduces readmissions and emergency visits, hospitals could adopt the approach as a practical way to address these needs. That could improve diabetes outcomes and lower health care costs.
Known grants
From NIH and NSF research grants. Labs often have other funding we can't see.
Closest labs
Sae Takada
University of California-Los Angeles, CA·Public Health & Epidemiology
Evaluate whether Whole Person Care-Los Angeles, a social care program for Medicaid enrollees, improves diabetes screening, retention in care, medication adherence and blood sugar control compared with propensity score-matched non-enrollees.
Arthi Rao
Georgia Institute of Technology, GA·Engineering
Refine socioecological theories of transportation disadvantage and its effect on healthcare access through extensive engagement with community, health-system and industry stakeholders.
Daniel Liebzeit
University of Iowa, IA·Medicine & Clinical Research
Identify barriers and facilitators to adding the 4Ms of age-friendly care to hospital-to-home transitions through interviews with older adults, caregivers, clinicians, administrators and community service professionals.
The school
University of Massachusetts Chan Medical School: 29 labs on PI Pages, $350M a year on research, 55 research doctorates a year.
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