Molina Melanie F, Pantell Matthew S, Gottlieb Laura M
Department of Emergency Medicine, University of California-San Francisco, San Francisco, CA.
Department of Pediatrics, University of California-San Francisco, San Francisco, CA.
Ann Emerg Med. 2023 Jan;81(1):38-46. doi: 10.1016/j.annemergmed.2022.07.027. Epub 2022 Oct 7.
Social Z codes are International Classification of Diseases, Tenth Revision, Clinical Modification codes that provide one way of documenting social risk factors in electronic health records. Despite the utility and availability of these codes, no study has examined social Z code documentation prevalence in emergency department (ED) settings.
In this descriptive, cross-sectional study of all ED visits included in the 2018 Nationwide Emergency Department Sample, we estimated the prevalence of social Z code documentation and used logistic regression to examine the association between documentation and patient and hospital characteristics.
Of more than 35.8 million adult and pediatric ED visits, there was a 1.21% weighted prevalence (n=452,499) of at least 1 documented social Z code. Social Z codes were significantly more likely to be documented in ED visits among patients aged 35 to 64 compared to patients aged 18 to 34 (18.6/1000 [16.9 to 20.4] versus 12.7/1000 [11.5 to 14.0], odds ratio (OR) 1.47 [1.42 to 1.53]), male patients (16.6/1000 [15.1 to 18.2] versus female 8.5/1000 [7.8 to 9.2], OR 1.97 [1.89 to 2.06]), patients with Medicaid compared to patients with private insurance (15.9/1000 [14.4 to 17.6] versus (6.6/1000 [6.0 to 7.2], OR 2.45 [1.30 to 1.63]), and patients who had a Charlson Comorbidity Index≥1 compared to those with a Charlson Comorbidity Index of 0 (ranges 15.0 to 16.6/1000 versus 10.6/1000 [9.6 to 11.7], ORs ranging 1.43 to 1.58). ED visits with a primary diagnosis of mental, behavioral, and neurodevelopmental illness had the strongest positive association with social Z code documentation (85.6/1000 [78.4 to 93.4], OR 10.75 [9.88 to 11.70]) compared to ED visits without this primary diagnosis.
We found a very low prevalence of social Z code documentation in ED visits nationwide. More systematic social Z code documentation could support targeted social interventions, social risk payment adjustments, and future policy reforms.
社会Z编码是《国际疾病分类第十次修订本，临床修订版》中的编码，提供了一种在电子健康记录中记录社会风险因素的方法。尽管这些编码具有实用性且可获取，但尚无研究调查急诊科环境中社会Z编码记录的患病率。
在这项对2018年全国急诊科样本中所有急诊科就诊病例进行的描述性横断面研究中，我们估计了社会Z编码记录的患病率，并使用逻辑回归分析来研究记录与患者及医院特征之间的关联。
在超过3580万例成人和儿科急诊科就诊病例中，至少有1条社会Z编码记录的加权患病率为1.21%（n = 452,499）。与18至34岁的患者相比，35至64岁的患者在急诊科就诊时更有可能记录社会Z编码（18.6/1000 [16.9至20.4] 对比12.7/1000 [11.5至14.0]，优势比（OR）为1.47 [1.42至1.53]）；男性患者（16.6/1000 [15.1至18.2] 对比女性8.5/1000 [7.8至9.2]，OR为1.97 [1.89至2.06]）；与有私人保险的患者相比，有医疗补助的患者（15.9/1000 [14.4至17.6] 对比6.6/1000 [6.0至7.2]，OR为2.45 [1.30至1.63]）；与Charlson合并症指数为0的患者相比，Charlson合并症指数≥1的患者（范围为15.0至16.6/1000对比10.6/1000 [9.6至11.7]，OR范围为1.43至1.58）。与无此主要诊断的急诊科就诊病例相比，主要诊断为精神、行为和神经发育疾病的急诊科就诊病例与社会Z编码记录的正相关性最强（85.6/1000 [78.4至93.4]，OR为10.75 [9.88至11.70]）。
我们发现全国急诊科就诊病例中社会Z编码记录的患病率非常低。更系统的社会Z编码记录可为有针对性的社会干预、社会风险支付调整及未来政策改革提供支持。
