Utilization of Social Determinants of Health ICD-10 Z-Codes Among Hospitalized Patients in the United States, 2016-2017.
Utilization of Social Determinants of Health ICD-10 Z-Codes Among Hospitalized Patients in the United States, 2016-2017.
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DOI：
10.1097/mlr.0000000000001418
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发表时间：
2020-12
期刊：
影响因子：
3
通讯作者：
Joynt Maddox KE
中科院分区：
文献类型：
--
作者：
Truong HP;Luke AA;Hammond G;Wadhera RK;Reidhead M;Joynt Maddox KE
在《国际疾病分类》第十次修订版（ICD-10）中纳入健康的社会决定因素Z代码可能为改善健康的社会决定因素数据收集提供机会，但在国家所有支付者一级，没有对其使用情况进行描述。检查SDOH Z代码的患病率，并比较使用和不使用Z代码的患者以及使用和不使用Z代码的医院的特征。回顾性队列研究使用2016年和2017年全国住院患者样本14，289，644例住院患者。SDOH Z代码（代码Z55-Z65）的流行率以及患者和医院的描述性统计。在入院患者中，269，929例（1.9%）包括SDOH Z代码。在整个研究期间，平均每月SDOH Z代码使用量每月增加0.01%（p<0.001）。使用过SDOH Z代码的医院的累计数量和比例也有所增加，从2016年1月的1，895家医院（39%）增加到2017年12月的4，188家医院（86%）。编码至少有1个SDOH Z代码的医院是较大的私立非营利性和城市教学医院。与没有SDOH Z代码的入院相比，有SDOH Z代码的入院患者更年轻，更常见的是男性，医疗补助接受者或没有保险的患者。与没有SDOH Z代码的患者相比，有更高比例的住院患者是精神健康（44.0%对3.3%，p<0.001）和酒精和物质使用障碍（9.6%对1.1%，p<0.001）。SDOH Z代码的采用一直很缓慢，目前的编码可能无法很好地反映住院患者所经历的社会需求的实际负担。
The inclusion of Z-codes for social determinants of health (SDOH) in the tenth revision of the International Classification of Diseases (ICD-10) may offer an opportunity to improve data collection of SDOH, but no characterization of their utilization exists on a national all-payer level. To examine the prevalence of SDOH Z-codes and compare characteristics of patients with and without Z-codes and hospitals that do and do not use Z-codes. Retrospective cohort study using 2016 and 2017 National Inpatient Sample 14,289,644 inpatient hospitalizations. Prevalence of SDOH Z-codes (codes Z55-Z65) and descriptive statistics of patients and hospitals. Of admissions, 269,929 (1.9%) included SDOH Z-codes. Average monthly SDOH Z-code use increased across the study period by 0.01% per month (p<0.001). The cumulative number and proportion of hospitals that had ever used an SDOH Z-code also increased, from 1,895 hospitals (39%) in January 2016 to 4,188 hospitals (86%) in December 2017. Hospitals that coded at least 1 SDOH Z-code were larger, private not-for-profit, and urban teaching hospitals. Compared to admissions without an SDOH Z-code, admissions with them were for patients who were younger, more often male, Medicaid recipients or uninsured. A higher proportion of admissions with SDOH Z-codes were for mental health (44.0% versus 3.3%, p<0.001) and alcohol and substance use disorders (9.6% versus 1.1%, p<0.001) compared to those without. The uptake of SDOH Z-codes has been slow, and current coding is likely poorly reflective of the actual burden of social needs experienced by hospitalized patients.