Coppa Denise, Winchester Suzy Barcelos, McAlvin Elizabeth, Roberts Mary B, Maestri Xristin
College of Nursing, University of Rhode Island, Providence, Rhode Island.
J Am Assoc Nurse Pract. 2021 Apr 1;34(1):42-49. doi: 10.1097/JXX.0000000000000586.
The Affordable Care Act created funding for nurse practitioner education programs to transform the primary health care workforce through student awareness of how social, political, economic, and environmental factors influence individual and population health. Funding established Academic Clinical Partnerships (ACPs) that created value-based health care models, which improved patient outcomes and decreased hospital and emergency department admissions and health care costs. The ACP established a home-based primary health care (HBPC) program to deliver primary care and collect patient data.
The purposes were to describe the incidence of chronic conditions for HBPC patients and determine associations between chronic conditions and presence of social determinants of health (SDoH).
Nurse practitioner students were assigned to HBPC clinical placements. A convenience sample of 102 high-risk, homebound patients was identified. Nurse practitioners and students recorded deidentified patient data, including ICD-10-CM codes into a Health Insurance Portability and Accountability Act compliant platform. Secondary analysis of patient records assessed for SDoH through Z codes.
Patients had high incidences of hypertension, diabetes, pulmonary disease, heart disease, chronic pain, mood, and substance abuse disorders. Secondary analysis revealed that 92% of patients had indications for the use of Z codes, but these were not recorded.
Common Z codes were personal risk factors, housing/economic circumstances, care provider dependency, lifestyle, and family support.
By coding for SDoH, providers and agencies can realize higher reimbursement rates in HBPC settings. Nurse practitioners can use this information to provide better treatment recommendations, more accurate diagnoses, and referrals to enhance primary care services to a patient population negatively affected by SDoH.
《平价医疗法案》为执业护士教育项目提供资金，旨在通过让学生了解社会、政治、经济和环境因素如何影响个人和人群健康，来转变初级卫生保健劳动力队伍。该资金设立了学术临床合作项目（ACPs），创建了基于价值的医疗模式，改善了患者治疗效果，减少了医院和急诊科就诊人数以及医疗成本。ACPs设立了家庭初级卫生保健（HBPC）项目来提供初级保健并收集患者数据。
描述HBPC患者慢性病的发病率，并确定慢性病与健康社会决定因素（SDoH）之间的关联。
执业护士学生被分配到HBPC临床实习岗位。确定了102名高风险、居家患者的便利样本。执业护士和学生将去识别化的患者数据，包括ICD - 10 - CM编码，录入符合《健康保险流通与责任法案》的平台。通过Z编码对患者记录进行二次分析以评估SDoH。
患者高血压、糖尿病、肺部疾病、心脏病、慢性疼痛、情绪和药物滥用障碍的发病率较高。二次分析显示，92%的患者有使用Z编码的指征，但这些并未被记录。
常见的Z编码是个人风险因素、住房/经济状况、护理提供者依赖、生活方式和家庭支持。
通过对SDoH进行编码，提供者和机构在HBPC环境中可以实现更高的报销率。执业护士可以利用这些信息提供更好的治疗建议、更准确的诊断和转诊，以加强对受SDoH负面影响的患者群体的初级保健服务。
