Llamocca Elyse N, Ahmedani Brian K, Lockhart Elizabeth, Beck Arne L, Lynch Frances L, Negriff Sonya L, Rossom Rebecca C, Sanchez Katherine, Sterling Stacy A, Stults Cheryl, Waring Stephen C, Harry Melissa L, Yu Hao, Madziwa Lawrence T, Simon Gregory E
Center for Health Policy and Health Services Research, Henry Ford Health, Detroit (Llamocca, Ahmedani, Lockhart); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Llamocca); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Negriff); HealthPartners Institute, Bloomington, Minnesota (Rossom); Baylor Scott & White Research Institute, Dallas (Sanchez); Division of Research, Kaiser Permanente Northern California, Oakland (Sterling); Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, California (Stults); Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Harvard Pilgrim Health System, Boston (Yu); Health Research Institute, Kaiser Permanente Washington, Seattle (Madziwa, Simon).
Psychiatr Serv. 2025 Jan 1;76(1):22-29. doi: 10.1176/appi.ps.20240148. Epub 2024 Sep 23.
This study investigated codes for adverse social determinants of health (SDoH) across 12 U.S. health systems by using data from multiple health care encounter types for diverse patients covered by multiple payers.
The authors described documentation of 11 SDoH code categories (e.g., educational problems or social environmental problems) between 2016 and 2021; assessed changes over time by using chi-square tests for trend in proportions; compared documentation in 2021 by gender, age, race-ethnicity, and site with chi-square tests; and compared all patients' mental health outcomes in 2021 with those of patients with documented SDoH codes by using exact binomial tests and one-proportion z tests.
Documentation of any SDoH code significantly increased, from 1.7% of patients in 2016 to 2.7% in 2021, as did that for all SDoH categories except educational problems. Documentation was often more prevalent among female patients and those of other or unknown gender than among male patients and among American Indian or Alaska Native, Black or African American, and Hispanic individuals than among those belonging to other race-ethnicity categories. More educational problems were documented for younger patients, and more social environmental problems were documented for older patients. Psychiatric diagnoses and emergency department visits and hospitalizations related to mental health were more common among patients with documented SDoH codes.
SDoH code documentation was infrequent and differed by population subgroup. Differences may reflect documentation practices or true SDoH prevalence variation. Standardized SDoH documentation methods are needed in health care settings.
本研究利用来自多个医疗服务类型的数据，涵盖多个支付方的不同患者，调查了美国12个医疗系统中健康的不良社会决定因素（SDoH）代码。
作者描述了2016年至2021年间11个SDoH代码类别的记录情况（如教育问题或社会环境问题）；通过使用卡方检验趋势比例来评估随时间的变化；通过卡方检验比较2021年按性别、年龄、种族和地点的记录情况；并使用精确二项式检验和单比例z检验比较2021年所有患者的心理健康结果与记录了SDoH代码的患者的心理健康结果。
任何SDoH代码的记录显著增加，从2016年患者的1.7%增至2021年的2.7%，除教育问题外的所有SDoH类别记录情况也是如此。记录在女性患者以及性别为其他或未知的患者中通常比男性患者更普遍，在美洲印第安人或阿拉斯加原住民、黑人或非裔美国人以及西班牙裔个体中比在属于其他种族类别的个体中更普遍。年轻患者记录的教育问题更多，老年患者记录的社会环境问题更多。记录了SDoH代码的患者中，精神科诊断以及与心理健康相关的急诊科就诊和住院更为常见。
SDoH代码记录不常见，且因人群亚组而异。差异可能反映记录做法或SDoH的实际患病率差异。医疗环境中需要标准化的SDoH记录方法。
