Z-Coding for Social Contributors to Health in Colorado Federally Qualified Health Centers.

IF 2.2 4区 医学 Q1 NURSING
Sean M Reed, Colin Hensen, Sophia Centi, Tara Siebenaller, Laura D Rosenthal, Denise C Smith, Claudia R Amura, Teri L Hernandez, Amy J Barton
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引用次数: 0

Abstract

Background: Federally Qualified Health Centers (FQHC) provide services to individuals facing systemic barriers to health equity and are disproportionately affected by adverse social determinants of health. To better align healthcare services with the needs of those individuals experiencing health inequities, it is essential to screen for and document problematic social contributors to health in electronic health records, which health systems have been mandated to document by 2026.

Objectives: The aims of this study were to 1) determine the prevalence of documented social contributors to health Z-codes among patients receiving care through Colorado nurse-led FQHCs across urban, rural, and frontier settings; and 2) estimate healthcare utilization and expenditures associated with the presence of documented social contributors to health Z-codes compared to a matched sample of patients without that Z-code documentation.

Methods: We conducted a secondary analysis of the Colorado All Payers Claim Database. Social contributor of health ICD-10 Z-codes, reflecting problematic social structural circumstances as defined by Healthy People 2030, were extracted from patients receiving care in FQHCs. Social contributor of health-related charges were computed using propensity matching to compare individuals with and without documented social contributors of health.

Results: Documentation of social contributors of health Z-codes was notably low. Housing instability was the most common Z-code documented. Chronic pulmonary disease, diabetes, and heart disease were the most prevalent comorbidities among those with identified social contributors of health. The majority of patients with social contributors of health Z-codes were insured through Medicaid and lived in rural areas. Persons with documented social contributors of health had significantly higher predicted annual medical expenditures compared to those without documentation.

Discussion: The low prevalence of social contributors of health coding aligns with previous studies and represents a missed opportunity to provide targeted interventions for populations experiencing adverse social contributors. These findings underscore the need for strategizing and implementing plans to identify and code social contributors of health, especially in facilities serving those experiencing health inequities. Improved documentation of social contributors to health can facilitate data-driven resource allocation and tailored interventions to address adverse social determinants and promote health equity.

科罗拉多州联邦合格医疗中心社会健康贡献者的z编码。
背景:联邦合格卫生中心(FQHC)为面临卫生公平系统性障碍的个人提供服务,并受到不利的健康社会决定因素的不成比例的影响。为了更好地使卫生保健服务与遭遇卫生不平等的个人的需求保持一致,必须在电子卫生记录中筛查和记录有问题的健康社会贡献者,卫生系统已被要求在2026年之前记录这些记录。目的:本研究的目的是:1)确定在城市、农村和边境地区通过科罗拉多州护士领导的fqhc接受护理的患者中,健康z码的社会贡献者的患病率;2)与没有z码文件的匹配患者样本相比,估计与健康z码文件的社会贡献者存在相关的医疗保健利用和支出。方法:我们对科罗拉多州所有付款人索赔数据库进行了二次分析。从在fqhc接受治疗的患者中提取健康的ICD-10 z代码的社会贡献者,反映了健康人群2030定义的有问题的社会结构情况。使用倾向匹配来计算健康相关费用的社会贡献,以比较有和没有记录的健康社会贡献的个人。结果:卫生z码社会贡献者的文献记录明显偏低。住房不稳定是最常见的z码记录。慢性肺部疾病、糖尿病和心脏病是确定的社会健康贡献者中最普遍的合并症。大多数健康z码社会参保者是通过医疗补助计划投保的,并且生活在农村地区。与没有文件的人相比,有文件证明的社会健康贡献者的预计年度医疗支出明显更高。讨论:健康编码的社会贡献者的低流行率与以前的研究一致,并且代表错过了为遭受不良社会贡献者的人群提供有针对性干预措施的机会。这些调查结果强调需要制定战略和实施计划,以确定和规范健康的社会贡献者,特别是在为遭受健康不平等的人提供服务的设施中。改进对健康社会贡献者的记录可以促进数据驱动的资源分配和量身定制的干预措施,以解决不利的社会决定因素并促进卫生公平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Nursing Research
Nursing Research 医学-护理
CiteScore
3.60
自引率
4.00%
发文量
102
审稿时长
6-12 weeks
期刊介绍: Nursing Research is a peer-reviewed journal celebrating over 60 years as the most sought-after nursing resource; it offers more depth, more detail, and more of what today''s nurses demand. Nursing Research covers key issues, including health promotion, human responses to illness, acute care nursing research, symptom management, cost-effectiveness, vulnerable populations, health services, and community-based nursing studies. Each issue highlights the latest research techniques, quantitative and qualitative studies, and new state-of-the-art methodological strategies, including information not yet found in textbooks. Expert commentaries and briefs are also included. In addition to 6 issues per year, Nursing Research from time to time publishes supplemental content not found anywhere else.
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