心理健康机构中的健康社会决定因素 Z 代码文档实践:范围审查

Rachele M. Hendricks-Sturrup, Sandra Yankah, Christine Y Lu
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摘要

精神健康仍然是全球的当务之急,同时还要努力解决导致精神疾病发病或加重的基本健康社会决定因素(SDoH)。SDoH因素可以通过国际疾病分类第十版临床修订版[ICD-10 CM] SDoH Z代码的形式来捕捉。在这篇范围综述中,我们描述了当前 SDoH Z 代码的记录实践,重点关注精神健康护理背景。在美国的 12 项研究记录的 2,743,061,374 次医疗护理中,SDoH Z 代码的记录率从 0.5% 到 2.4% 不等。记录的患者通常年龄在 64 岁以下,有公共保险,并患有抑郁症、双相情感障碍和精神分裂症、慢性肺病和药物滥用障碍等并发症。不同类型的医院、每家医院的床位数、患者的种族/民族以及地理区域的文件记录各不相同。在患者的性别方面也存在差异,但男性更常记录 SDoH Z 代码。在政府医院、非联邦医院和非营利性私立医院中,记录的情况最多。从这些洞察中,我们提出了政策和实践建议,以及对患者数据隐私、安全和保密性的考虑,以鼓励更多的常规 Z 代码记录,从而更好地帮助有复杂心理健康护理需求的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Social Determinants of Health Z Code Documentation Practices in Mental Health Settings: A Scoping Review
Mental health remains an urgent global priority, alongside efforts to address underlying social determinants of health (SDoH) that contribute to the onset or exacerbate mental illness. SDoH factors can be captured in the form of International Classification of Disease, Tenth Revision, Clinical Modification [ICD-10 CM] SDoH Z codes. In this scoping review, we describe current SDoH Z code documentation practices, with a focus on mental health care contexts. Among 2,743,061,374 health care encounters noted across 12 studies in the United States, SDoH Z code documentation rates ranged from 0.5% to 2.4%. Documentation often involved patients under 64 years of age who are publicly insured and experience comorbidities, including depression, bipolar disorder and schizophrenia, chronic pulmonary disease, and substance abuse disorders. Documentation varied across hospital types, number of beds per facility, patient race/ethnicity, and geographic region. Variation was observed regarding patient sex/gender, although SDoH Z codes were more frequently documented for males. Documentation was most observed in government, nonfederal and private not-for-profit hospitals. From these insights, we offer policy and practice recommendations, as well as considerations for patient data privacy, security, and confidentiality, to incentivize more routine documentation of Z codes to better assist patients with complex mental health care needs.
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