Parekh Tarang, Xue Hong, Wadhera Rishi K, Cheskin Lawrence J, Cuellar Alison E
Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030, United States.
Epidemiology Program, College of Health Sciences, University of Delaware, Newark, DE 19713, United States.
Am J Epidemiol. 2025 Jun 3;194(6):1709-1716. doi: 10.1093/aje/kwae313.
The study examines effects of the Centers for Medicaid and Medicare Services State Innovation Models (SIM) on capturing social risk factors in adults hospitalized with atherosclerotic cardiovascular disease (ASCVD). Using a difference-in-differences (DID) approach with propensity score weights, the study compared documentation of secondary diagnosis of social determinants of health (SDOH)/social factors using ICD-9 V codes ("SDOH codes") in adults hospitalized with ASCVD as a primary diagnosis (n = 1 485 354). Data were gathered from January 1, 2010, to September 30, 2015, covering the period before and after the SIM implementation in October 2013. From January 2010 to September 2015, SDOH codes were infrequently utilized among adults with ASCVD (0.55%; 95% CI, 0.43%-0.67%). The SDOH codes with ASCVD increased from pre- to postperiod in SIM states (0.56%-0.93%) and comparison states (0.46%-0.56%). State Innovation Models implementation was associated with greater improvement in SDOH codes utilization (adjusted OR 1.30; 95% CI, 1.18-1.43) during ASCVD hospitalizations. The odds of SDOH codes utilization were 86% higher in emergency department admissions (AOR, 1.86; 95% CI, 1.76-1.97) than in routine admissions with ASCVD. Findings were similar when limiting population to older adults (≥65 years) enrolled in Medicare (AOR 1.50; 95% CI, 1.31-1.71), whereas not significant for Medicaid beneficiaries. The study points to challenges for healthcare providers in documenting SDOH in adults with ASCVD.
该研究考察了医疗保险和医疗补助服务中心的州创新模式（SIM）对患有动脉粥样硬化性心血管疾病（ASCVD）的住院成人患者社会风险因素记录情况的影响。该研究采用倾向得分加权的双重差分（DID）方法，比较了以ASCVD作为主要诊断的住院成人患者（n = 1485354）中使用国际疾病分类第九版（ICD-9）V码（“健康社会决定因素[SDOH]编码”）记录健康社会决定因素/社会因素二级诊断的情况。数据收集时间为2010年1月1日至2015年9月30日，涵盖2013年10月SIM实施前后的时间段。2010年1月至2015年9月，患有ASCVD的成人患者很少使用SDOH编码（0.55%；95%CI，0.43%-0.67%）。在SIM州，伴有ASCVD的SDOH编码从前期到后期有所增加（从0.56%增至0.93%），在对照州也有所增加（从0.46%增至0.56%）。州创新模式的实施与ASCVD住院期间SDOH编码利用率的更大改善相关（调整后的比值比为1.30；95%CI，1.18-1.43）。在急诊科入院时，SDOH编码的使用几率比ASCVD常规入院时高86%（调整后的比值比为1.86；95%CI，1.76-1.97）。当将研究人群限制为参加医疗保险的老年人（≥65岁）时，研究结果相似（调整后的比值比为1.50；95%CI，1.31-1.71），而对于医疗补助受益人则无显著差异。该研究指出了医疗保健提供者在记录患有ASCVD的成人患者的SDOH方面面临的挑战。
