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国际疾病分类社会编码:追踪社会需求的未充分利用的资源。

ICD Social Codes: An Underutilized Resource for Tracking Social Needs.

作者信息

Torres Jacqueline M, Lawlor John, Colvin Jeffrey D, Sills Marion R, Bettenhausen Jessica L, Davidson Amber, Cutler Gretchen J, Hall Matt, Gottlieb Laura M

机构信息

*Center for Health & Community, UC San Francisco, San Francisco, CA †Children's Hospital Association, Washington, DC ‡Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO §Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO ∥University of Missouri, Pediatric Hospital Medicine Fellowship Children's Mercy Hospital, Kansas City, MO ¶Children's Hospital Association, Overland Park, Kansas, Lenexa, KS #Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN **Department of Family and Community Medicine, University of California at San Francisco, San Francisco, CA.

出版信息

Med Care. 2017 Sep;55(9):810-816. doi: 10.1097/MLR.0000000000000764.

Abstract

BACKGROUND

Social determinants of health (SDH) data collected in health care settings could have important applications for clinical decision-making, population health strategies, and the design of performance-based incentives and penalties. One source for cataloging SDH data is the International Statistical Classification of Diseases and Related Health Problems (ICD).

OBJECTIVE

To explore how SDH are captured with ICD Ninth revision SDH V codes in a national inpatient discharge database.

MATERIALS AND METHODS

Data come from the 2013 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, a national stratified sample of discharges from 4363 hospitals from 44 US states. We estimate the rate of ICD-9 SDH V code utilization overall and by patient demographics and payer categories. We additionally estimate the rate of SDH V code utilization for: (a) the 5 most common reasons for hospitalization; and (b) the 5 conditions with the highest rates of SDH V code utilization.

RESULTS

Fewer than 2% of overall discharges in the National Inpatient Sample were assigned an SDH V code. There were statistically significant differences in the rate of overall SDH V code utilization by age categories, race/ethnicity, sex, and payer (all P<0.001). Nevertheless, SDH V codes were assigned to <7% of discharges in any demographic or payer subgroup. SDH V code utilization was highest for major diagnostic categories related to mental health and alcohol/substance use-related discharges.

CONCLUSIONS

SDH V codes are infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use. Utilization incentives will likely need to be developed to realize the potential benefits of cataloging SDH information.

摘要

背景

在医疗机构中收集的健康社会决定因素(SDH)数据可能在临床决策、人群健康策略以及基于绩效的激励和惩罚措施设计方面具有重要应用。用于编目SDH数据的一个来源是《国际疾病和相关健康问题统计分类》(ICD)。

目的

探讨在国家住院患者出院数据库中,如何使用ICD第九版SDH V编码来记录SDH。

材料与方法

数据来自2013年医疗成本和利用项目(HCUP)国家住院患者样本,这是一个来自美国44个州4363家医院出院情况的全国分层样本。我们估计了ICD - 9 SDH V编码的总体使用率以及按患者人口统计学特征和支付方类别划分的使用率。我们还估计了以下方面的SDH V编码使用率:(a)住院的5个最常见原因;(b)SDH V编码使用率最高的5种疾病。

结果

国家住院患者样本中,总体出院病例中被分配SDH V编码的不到2%。按年龄类别、种族/民族、性别和支付方划分,总体SDH V编码使用率存在统计学显著差异(所有P<0.001)。然而,在任何人口统计学或支付方亚组中,被分配SDH V编码的出院病例均不到7%。与精神健康及酒精/物质使用相关的主要诊断类别的出院病例中,SDH V编码使用率最高。

结论

除了与精神健康及酒精/物质使用相关的出院病例外,SDH V编码在住院环境中很少用于其他出院病例。可能需要制定使用激励措施,以实现编目SDH信息的潜在益处。

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