健康相关社会需求与再入院率增加：全国再入院数据库的研究结果。
Health-Related Social Needs and Increased Readmission Rates: Findings from the Nationwide Readmissions Database.
机构信息
Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Association of American Medical Colleges, Washington, DC, USA.
出版信息
J Gen Intern Med. 2021 May;36(5):1173-1180. doi: 10.1007/s11606-021-06646-3.
BACKGROUND
While health-related social needs (HRSN) are known to compromise health, work to date has not clearly demonstrated the relationship between clinically acknowledged social needs, via ICD-10 Z-codes, and readmission.
OBJECTIVE
Assess the rate of 30-, 60-, and 90-day readmission by the level of ICD-10-identified social need. In addition, we examined the associations between demographics, social need, hospital characteristics, and comorbidities on 30-day readmission.
DESIGN
Retrospective study using the 2017 Nationwide Readmission Database PARTICIPANTS: We identified 5 domains of HRSN from ICD-10 diagnosis codes including employment, family, housing, psychosocial, and socioeconomic status (SES) and identified how many and which an individual was coded with during the year.
MAIN MEASURES
The proportion of patients with 30-, 60-, and 90-day readmission stratified by the number of HRSN domains with a multivariable logistic regression to examine the relationship between the number/type of and readmission adjusting for sex, age, payer, hospital characteristics, functional limitations, and comorbidities.
KEY RESULTS
From 13,217,506 patients, only 2.4% had at least one HRSN diagnosis. Among patients without HRSN, 11.5% had a 30-day readmission, compared to 27.0% of those with 1 domain, increasing to 63.5% for patients with codes in 5 domains. Similar trends were observed for 60- and 90-day readmission; 78.7% of patients with documented HRSN in all 5 domains were hospitalized again within 90 days. The adjusted odds ratio for readmission for individuals with all 5 domains was 12.55 (95% CI: 9.04, 17.43). Housing and employment emerged as two of the most commonly documented HRSN, as well as having the largest adjusted odds ratio.
CONCLUSIONS
There is a dose-response relationship between the number of HRSN diagnoses and hospital readmission. This work calls attention to the need to develop interventions to reduce readmissions for those at social risk and demonstrates the significance of ICD-10 Z-codes in health outcomes studies.
背景
尽管健康相关的社会需求（HRSN）已知会影响健康，但迄今为止的研究并未清楚地表明通过 ICD-10 Z 编码确定的临床公认的社会需求与再入院之间的关系。
目的
按 ICD-10 确定的社会需求水平评估 30、60 和 90 天的再入院率。此外，我们还研究了人口统计学、社会需求、医院特征和合并症与 30 天再入院之间的关联。
设计
使用 2017 年全国再入院数据库进行回顾性研究
参与者
我们从 ICD-10 诊断代码中确定了 5 个 HRSN 领域，包括就业、家庭、住房、心理社会和社会经济地位（SES），并确定了个体在这一年中被编码了多少个以及哪些领域。
主要措施
按 HRSN 领域数量对 30、60 和 90 天再入院的患者进行分层，采用多变量逻辑回归分析，以调整性别、年龄、付款人、医院特征、功能限制和合并症后，检查数量/类型与再入院之间的关系。
主要结果
在 13,217,506 名患者中，只有 2.4%有至少一个 HRSN 诊断。在没有 HRSN 的患者中，11.5%在 30 天内再次入院，而有 1 个领域的患者为 27.0%，有 5 个领域的患者增加到 63.5%。在 60 天和 90 天的再入院中观察到类似的趋势；在所有 5 个领域均有记录的 HRSN 的患者中，有 78.7%在 90 天内再次住院。有 5 个领域的个人再入院的调整比值比为 12.55（95%CI：9.04，17.43）。住房和就业是最常见的记录 HRSN 之一，且调整后的比值比最大。
结论
HRSN 诊断数量与医院再入院之间存在剂量反应关系。这项工作引起了人们对需要制定干预措施以减少处于社会风险中的患者再入院的关注，并证明了 ICD-10 Z 编码在健康结果研究中的重要性。
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