Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Association of American Medical Colleges, Washington, District of Columbia, USA.
Popul Health Manag. 2023 Apr;26(2):113-120. doi: 10.1089/pop.2022.0248. Epub 2023 Mar 10.
Attention to 10th Revision of the International Classification of Disease (ICD-10)-CM Z-codes as a mechanism for capturing social risk has grown over the years. However, it remains unclear whether the use of Z-codes has changed over time. This study sought to examine the trends in Z-code use between their introduction in 2015 and the end of 2019 across 2 markedly different states. Using the Healthcare Cost and Utilization Project, all emergency department visits or hospitalizations at short-term general hospitals in Florida and Maryland from 2015 Q4 through 2019 were identified. This study focused on a subset of the Z-codes that are intended to capture social risk to identify the percentage of encounters with a Z-code, percentage of facilities using Z-codes, and facility median of number of encounters with a Z-code per 1000 encounters across quarters, states, and care settings. In total, 495,212 (0.84%) of 58,993,625 encounters had a Z-code. Despite Florida's higher area deprivation, Z-codes were less frequently used and increasing more slowly than when compared with those in Maryland. There were 2.1 times the use of Z-codes in Maryland than in Florida at the encounter level. This difference was also seen when evaluating the median number of encounters with a Z-code, per 1000 encounters (12.1 vs. 3.4). Z-codes were more commonly used at major teaching facilities, and for patients who were uninsured or on Medicaid. The use of ICD-10-CM Z-codes has increased over time, with this increase occurring at nearly all short-term general hospitals. Their use was higher in Maryland than in Florida and among major teaching facilities.
多年来，人们越来越关注国际疾病分类第十次修订版（ICD-10-CM）Z 编码作为捕捉社会风险的一种手段。然而，目前尚不清楚 Z 编码的使用是否随时间而变化。本研究旨在检查 2015 年引入 Z 编码以来，在佛罗里达州和马里兰州这两个明显不同的州，Z 编码使用趋势的变化。利用医疗保健成本和利用项目，确定了佛罗里达州和马里兰州短期综合医院 2015 年第四季度至 2019 年所有急诊就诊或住院的病例。本研究重点关注了一组旨在捕捉社会风险的 Z 编码，以确定 Z 编码出现的百分比、使用 Z 编码的医疗机构的百分比，以及每 1000 次就诊中 Z 编码出现的中位数。在总共 58993625 次就诊中，有 495212 次（0.84%）就诊有 Z 编码。尽管佛罗里达州的地区贫困程度较高，但与马里兰州相比，Z 编码的使用频率较低，增长速度也较慢。在就诊层面，马里兰州的 Z 编码使用量是佛罗里达州的 2.1 倍。在评估每 1000 次就诊中 Z 编码出现的中位数时，也观察到了这一差异（12.1 比 3.4）。Z 编码在主要教学医院和没有保险或参加医疗补助计划的患者中更为常见。随着时间的推移，ICD-10-CM Z 编码的使用有所增加，几乎所有短期综合医院都在增加。在马里兰州的使用频率高于佛罗里达州，在主要教学医院的使用频率也高于其他医院。
