社区卫生中心提供者识别、治疗和考虑健康的社会决定因素的能力：一项卡片研究
Community health center provider ability to identify, treat and account for the social determinants of health: a card study.
作者信息
Lewis Joy H, Whelihan Kate, Navarro Isaac, Boyle Kimberly R
机构信息
A.T. Still University of Health Sciences School of Osteopathic Medicine in Arizona (ATSU SOMA), 5850 E. Still Circle, Mesa, AZ, 85206, USA.
KRB Clinical Solutions LLC, 24 Underwood Road, Montville, NJ, 07045, USA.
出版信息
BMC Fam Pract. 2016 Aug 27;17(1):121. doi: 10.1186/s12875-016-0526-8.
BACKGROUND
The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20-million of America's highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH.
METHODS
Investigators utilized a pre-study survey and a card study design to obtain evidence from the point of care. The survey assessed providers' perceptions of the SDH and their ability to address them. Then providers filled out one anonymous card per patient on four assigned days over a 4-week period, documenting social factors observed during encounters. The cards allowed providers to indicate if they were able to: provide counseling or other interventions, enter a diagnosis code and enter a billing code for identified factors.
RESULTS
The results of the survey indicate providers were familiar with the SDH and were comfortable identifying social factors at the point of care. A total of 747 cards were completed. 1584 factors were identified and 31 % were reported as having a service provided. However, only 1.2 % of factors were associated with a billing code and 6.8 % received a diagnosis code.
CONCLUSIONS
An obvious discrepancy exists between the number of identifiable social factors, provider ability to address them and documentation with billing and diagnosis codes. This disparity could be related to provider inability to code for social factors and bill for related time and services. Health care organizations should seek to implement procedures to document and monitor social factors and actions taken to address them. Results of this study suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations.
背景
健康的社会决定因素（SDH）是持续塑造个体整体健康状况的条件。随着在初级保健环境中解决社会因素的势头增强，医疗服务提供者识别、治疗和评估这些因素的能力仍不明确。社区健康中心为超过2000万美国高危人群提供护理。这项在三个中心开展的研究评估了医疗服务提供者识别、治疗SDH并为其编码的能力。
方法
研究人员采用研究前调查和卡片研究设计，从医疗现场获取证据。该调查评估了医疗服务提供者对SDH的认知以及应对这些因素的能力。然后，医疗服务提供者在4周内的4个指定日期，为每位患者填写一张匿名卡片，记录诊疗过程中观察到的社会因素。这些卡片使医疗服务提供者能够表明他们是否能够：提供咨询或其他干预措施、输入诊断代码以及为识别出的因素输入计费代码。
结果
调查结果表明，医疗服务提供者熟悉SDH，并且在医疗现场能够自如地识别社会因素。共填写了747张卡片。识别出1584个因素，其中31%的因素报告显示提供了相关服务。然而，只有1.2%的因素与计费代码相关，6.8%的因素有诊断代码。
结论
可识别的社会因素数量、医疗服务提供者应对这些因素的能力以及计费和诊断代码记录之间存在明显差异。这种差异可能与医疗服务提供者无法为社会因素编码以及无法为相关时间和服务计费有关。医疗保健组织应寻求实施程序，以记录和监测社会因素以及为解决这些因素而采取的行动。本研究结果表明，简单的识别方法可能就足够了。增加可搜索代码和报销可能会改善针对个体和人群处理社会因素所采用的方式。
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