审视退伍军人健康管理局中健康社会决定因素的机构间差异。
Examining the Interfacility Variation of Social Determinants of Health in the Veterans Health Administration.
作者信息
Wray Charlie M, Vali Marzieh, Walter Louise C, Christensen Lee, Abdelrahman Samir, Chapman Wendy, Keyhani Salomeh
机构信息
is an Internist in the Division of Hospital Medicine; is a Statistician in the Northern California Institute for Research and Education; is a Geriatrician in the Division of Geriatrics; and is an Internist in the Division of General Internal Medicine; all at the San Francisco Veterans Affairs Medical Center. is a Project Manager and is an Assistant Professor, both in the Department of Biomedical Informatics, University of Utah in Salt Lake City. is the Associate Dean of Digital Health and Informatics in the Centre for Digital Transformation of Health, University of Melbourne, Victoria, Australia. Charlie Wray is an Assistant Professor of Medicine, Louise Walter and Salomeh Keyhani are Professors of Medicine; all in the Department of Medicine, University of California, San Francisco.
出版信息
Fed Pract. 2021 Jan;38(1):15-19. doi: 10.12788/fp.0080.
INTRODUCTION
Recently, numerous studies have linked social determinants of health (SDoH) with clinical outcomes. While this association is well known, the interfacility variability of these risk favors within the Veterans Health Administration (VHA) is not known. Such information could be useful to the VHA for resource and funding allocation. The aim of this study is to explore the interfacility variability of 5 SDoH within the VHA.
METHODS
In a cohort of patients (aged ≥ 65 years) hospitalized at VHA acute care facilities with either acute myocardial infarction (AMI), heart failure (HF), or pneumonia in 2012, we assessed (1) the proportion of patients with any of the following five documented SDoH: lives alone, marginal housing, alcohol use disorder, substance use disorder, and use of substance use services, using administrative diagnosis codes and clinic stop codes; and (2) the documented facility-level variability of these SDoH. To examine whether variability was due to regional coding differences, we assessed the variation of living alone using a validated natural language processing (NLP) algorithm.
RESULTS
The proportion of veterans admitted for AMI, HF, and pneumonia with SDoH was low. Across all 3 conditions, lives alone was the most common SDoH (2.2% [interquartile range (IQR), 0.7-4.7]), followed by substance use disorder (1.3% [IQR, 0.5-2.1]), and use of substance use services (1.2% [IQR, 0.6-1.8]). Using NLP, the proportion of hospitalized veterans with lives alone was higher for HF (14.4% vs 2.0%, < .01), pneumonia (11% vs 1.9%, < .01), and AMI (10.2% vs 1.4%, < .01) compared with codes. Interfacility variability was noted with both administrative and NLP extraction methods.
CONCLUSIONS
The presence of SDoH in administrative data among patients hospitalized for common medical issues is low and variable across VHA facilities. Significant facility-level variation of 5 SDoH was present regardless of extraction method.
引言
最近，大量研究已将健康的社会决定因素（SDoH）与临床结局联系起来。虽然这种关联广为人知，但退伍军人健康管理局（VHA）内部这些风险因素在不同医疗机构之间的差异尚不清楚。此类信息可能对VHA进行资源和资金分配有用。本研究的目的是探讨VHA内部5种SDoH在不同医疗机构之间的差异。
方法
在2012年因急性心肌梗死（AMI）、心力衰竭（HF）或肺炎在VHA急性护理机构住院的患者队列（年龄≥65岁）中，我们评估了：（1）使用行政诊断代码和门诊停止代码，患有以下五种已记录的SDoH中任何一种的患者比例：独居、住房条件差、酒精使用障碍、物质使用障碍以及使用物质使用服务；（2）这些SDoH在医疗机构层面的记录差异。为了检查差异是否由于区域编码差异导致，我们使用经过验证的自然语言处理（NLP）算法评估独居情况的差异。
结果
因AMI、HF和肺炎入院且患有SDoH的退伍军人比例较低。在所有三种疾病中，独居是最常见的SDoH（2.2%[四分位间距（IQR），0.7 - 4.7]），其次是物质使用障碍（1.3%[IQR，0.5 - 2.1]）和使用物质使用服务（1.2%[IQR，0.6 - 1.8]）。使用NLP方法，与编码相比，HF（14.4%对2.0%，<0.01）、肺炎（11%对1.9%，<0.01）和AMI（10.2%对1.4%，<0.01）患者中独居的住院退伍军人比例更高。行政和NLP提取方法均显示出医疗机构间的差异。
结论
在因常见医疗问题住院的患者行政数据中，SDoH的存在比例较低且在VHA各医疗机构之间存在差异。无论采用何种提取方法，5种SDoH在医疗机构层面均存在显著差异。
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