Association Between ICD-10 Codes for Social Needs and Subsequent Emergency and Inpatient Use.

IF 3.3 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Medical Care Pub Date : 2024-01-01 Epub Date: 2023-11-09 DOI:10.1097/MLR.0000000000001948
David T Liss, Raymond H Kang, Manisha Cherupally, Andrew J Cooper, Paula-Natalia Barreto-Parra, Cassandra Aikman, Matthew J O'Brien
{"title":"Association Between ICD-10 Codes for Social Needs and Subsequent Emergency and Inpatient Use.","authors":"David T Liss, Raymond H Kang, Manisha Cherupally, Andrew J Cooper, Paula-Natalia Barreto-Parra, Cassandra Aikman, Matthew J O'Brien","doi":"10.1097/MLR.0000000000001948","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>International Classification of Diseases, 10th revision Z codes capture social needs related to health care encounters and may identify elevated risk of acute care use.</p><p><strong>Objectives: </strong>To examine associations between Z code assignment and subsequent acute care use and explore associations between social need category and acute care use.</p><p><strong>Research design: </strong>Retrospective cohort study.</p><p><strong>Subjects: </strong>Adults continuously enrolled in a commercial or Medicare Advantage plan for ≥15 months (12-month baseline, 3-48 month follow-up).</p><p><strong>Outcomes: </strong>All-cause emergency department (ED) visits and inpatient admissions during study follow-up.</p><p><strong>Results: </strong>There were 352,280 patients with any assigned Z codes and 704,560 sampled controls with no Z codes. Among patients with commercial plans, Z code assignment was associated with a 26% higher rate of ED visits [adjusted incidence rate ratio (aIRR) 1.26, 95% CI: 1.25-1.27] and 42% higher rate of inpatient admissions (aIRR 1.42, 95% CI: 1.39-1.44) during follow-up. Among patients with Medicare Advantage plans, Z code assignment was associated with 42% (aIRR 1.42, 95% CI: 1.40-1.43) and 28% (aIRR 1.28, 95% CI: 1.26-1.30) higher rates of ED visits and inpatient admissions, respectively. Within the Z code group, relative to community/social codes, socioeconomic Z codes were associated with higher rates of inpatient admissions (commercial: aIRR 1.10, 95% CI: 1.06-1.14; Medicare Advantage: aIRR 1.24, 95% CI 1.20-1.27), and environmental Z codes were associated with lower rates of both primary outcomes.</p><p><strong>Conclusions: </strong>Z code assignment was independently associated with higher subsequent emergency and inpatient utilization. Findings suggest Z codes' potential utility for risk prediction and efforts targeting avoidable utilization.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"60-66"},"PeriodicalIF":3.3000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MLR.0000000000001948","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/11/9 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

Background: International Classification of Diseases, 10th revision Z codes capture social needs related to health care encounters and may identify elevated risk of acute care use.

Objectives: To examine associations between Z code assignment and subsequent acute care use and explore associations between social need category and acute care use.

Research design: Retrospective cohort study.

Subjects: Adults continuously enrolled in a commercial or Medicare Advantage plan for ≥15 months (12-month baseline, 3-48 month follow-up).

Outcomes: All-cause emergency department (ED) visits and inpatient admissions during study follow-up.

Results: There were 352,280 patients with any assigned Z codes and 704,560 sampled controls with no Z codes. Among patients with commercial plans, Z code assignment was associated with a 26% higher rate of ED visits [adjusted incidence rate ratio (aIRR) 1.26, 95% CI: 1.25-1.27] and 42% higher rate of inpatient admissions (aIRR 1.42, 95% CI: 1.39-1.44) during follow-up. Among patients with Medicare Advantage plans, Z code assignment was associated with 42% (aIRR 1.42, 95% CI: 1.40-1.43) and 28% (aIRR 1.28, 95% CI: 1.26-1.30) higher rates of ED visits and inpatient admissions, respectively. Within the Z code group, relative to community/social codes, socioeconomic Z codes were associated with higher rates of inpatient admissions (commercial: aIRR 1.10, 95% CI: 1.06-1.14; Medicare Advantage: aIRR 1.24, 95% CI 1.20-1.27), and environmental Z codes were associated with lower rates of both primary outcomes.

Conclusions: Z code assignment was independently associated with higher subsequent emergency and inpatient utilization. Findings suggest Z codes' potential utility for risk prediction and efforts targeting avoidable utilization.

ICD-10社会需求代码与随后急诊和住院患者使用之间的关联。
背景:《国际疾病分类》第10次修订Z代码捕捉了与卫生保健接触相关的社会需求,并可能确定急性护理使用的高风险。目的:探讨Z码分配与随后的急症护理使用之间的关系,并探讨社会需求类别与急症护理使用之间的关系。研究设计:回顾性队列研究。受试者:连续参加商业或医疗保险优惠计划≥15个月的成年人(12个月基线,3-48个月随访)。结果:在研究随访期间,全因急诊科(ED)就诊和住院人数。结果:352280例患者有指定的Z编码,704560例对照组没有指定的Z编码。在商业计划的患者中,Z代码分配与随访期间急诊科就诊率增加26%[调整发病率比(aIRR) 1.26, 95% CI: 1.25-1.27]和住院率增加42% (aIRR 1.42, 95% CI: 1.39-1.44)相关。在医疗保险优势计划的患者中,Z代码分配分别与42% (aIRR 1.42, 95% CI: 1.40-1.43)和28% (aIRR 1.28, 95% CI: 1.26-1.30)的急诊科就诊率和住院率升高相关。在Z码组中,相对于社区/社会码,社会经济Z码与较高的住院率相关(商业:aIRR 1.10, 95% CI: 1.06-1.14;医疗保险优势(aIRR 1.24, 95% CI 1.20-1.27)和环境Z编码与两种主要结局的较低发生率相关。结论:Z码分配与随后较高的急诊和住院使用率独立相关。研究结果表明,Z码在风险预测和针对可避免利用率的努力方面具有潜在的效用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Medical Care
Medical Care 医学-公共卫生、环境卫生与职业卫生
CiteScore
5.20
自引率
3.30%
发文量
228
审稿时长
3-8 weeks
期刊介绍: Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信