在综合护理管理项目中，风湿和肌肉骨骼疾病患者的健康状况社会决定因素文档记录。
Social Determinants of Health Documentation Among Individuals With Rheumatic and Musculoskeletal Conditions in an Integrated Care Management Program.
机构信息
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Brigham and Women's Hospital, Harvard Medical School, and Boston Children's Hospital, Boston, Massachusetts.
出版信息
Arthritis Care Res (Hoboken). 2023 Dec;75(12):2529-2536. doi: 10.1002/acr.25174. Epub 2023 Aug 7.
OBJECTIVE
Social determinants of health (SDoH), such as poverty, are associated with increased burden and severity of rheumatic and musculoskeletal diseases. This study was undertaken to study the prevalence and documentation of SDoH-related needs in electronic health records (EHRs) of individuals with these conditions.
METHODS
We randomly selected individuals with ≥1 International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) code for a rheumatic/musculoskeletal condition enrolled in a multihospital integrated care management program that coordinates care for medically and/or psychosocially complex individuals. We assessed SDoH documentation using terms for financial needs, food insecurity, housing instability, transportation, and medication access according to EHR note review and ICD-10 SDoH billing codes (Z codes). We used multivariable logistic regression to examine associations between demographic factors (age, gender, race, ethnicity, insurance) and ≥1 (versus 0) SDoH need as the odds ratio (OR) with 95% confidence interval (95% CI).
RESULTS
Among 558 individuals with rheumatic/musculoskeletal conditions, 249 (45%) had ≥1 SDoH need documented in EHR notes by social workers, care coordinators, nurses, and physicians. A total of 171 individuals (31%) had financial insecurity, 105 (19%) had transportation needs, 94 (17%) had food insecurity; 5% had ≥1 related Z code. In the multivariable model, the odds of having ≥1 SDoH need was 2.45 times higher (95% CI 1.17-5.11) for Black versus White individuals and significantly higher for Medicaid or Medicare beneficiaries versus commercially insured individuals.
CONCLUSION
Nearly half of this sample of complex care management patients with rheumatic/musculoskeletal conditions had SDoH documented within EHR notes; financial insecurity was the most prevalent. Only 5% of patients had representative billing codes suggesting that systematic strategies to extract SDoH from notes are needed.
目的
健康的社会决定因素（SDoH），如贫困，与风湿和肌肉骨骼疾病的负担和严重程度增加有关。本研究旨在研究这些疾病患者电子健康记录（EHR）中与 SDoH 相关需求的患病率和记录情况。
方法
我们随机选择了在多医院综合护理管理计划中登记的至少有一个风湿/肌肉骨骼疾病国际疾病分类第 9/10 修订版（ICD-9/10）代码的患者，该计划协调对医疗和/或心理社会复杂患者的护理。我们根据 EHR 记录审查和 ICD-10 SDoH 计费代码（Z 代码），使用财务需求、食品不安全、住房不稳定、交通和药物获取等术语评估 SDoH 记录情况。我们使用多变量逻辑回归来检查人口统计学因素（年龄、性别、种族、民族、保险）与≥1（与 0 相比）个 SDoH 需求之间的关联，作为比值比（OR）和 95%置信区间（95%CI）。
结果
在 558 名患有风湿/肌肉骨骼疾病的患者中，有 249 名（45%）在 EHR 记录中由社会工作者、护理协调员、护士和医生记录了至少一个 SDoH 需求。共有 171 名患者（31%）存在财务不安全问题，105 名患者（19%）存在交通需求，94 名患者（17%）存在食品不安全问题；5%的患者有≥1 个相关 Z 代码。在多变量模型中，与白人相比，黑人患者有≥1 个 SDoH 需求的可能性高 2.45 倍（95%CI 1.17-5.11），而医疗保险或医疗补助受益人的可能性明显高于商业保险患者。
结论
在这项复杂的护理管理患者样本中，近一半患有风湿/肌肉骨骼疾病的患者的 EHR 记录中记录了 SDoH；财务不安全是最普遍的。只有 5%的患者有代表性的计费代码，这表明需要系统的策略从记录中提取 SDoH。
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