从政策到实践:从政策到实践:评估州创新模式倡议在将健康的社会决定因素纳入美国 ASCVD 住院治疗方面取得的早期成功。

IF 5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Tarang Parekh, Hong Xue, Rishi K Wadhera, Lawrence J Cheskin, Alison E Cuellar
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引用次数: 0

摘要

本研究探讨了 CMS 州创新模式(SIM)对捕捉动脉粥样硬化性心血管疾病(ASCVD)成人住院患者社会风险因素的影响。该研究使用带有倾向得分权重的差分(DID)方法,比较了以 ASCVD 为主要诊断的成人住院患者(1,485,354 人)中使用 ICD-9 V 编码("SDOH 编码")对 SDOH/社会因素进行二次诊断的记录情况。数据收集时间为 2010 年 1 月 1 日至 2015 年 9 月 30 日,涵盖了 2013 年 10 月 SIM 实施前后的时期。从 2010 年 1 月至 2015 年 9 月,SDOH 代码在患有 ASCVD 的成人中使用频率较低(0.55%,95% CI:0.43%-0.67%)。在 SIM 州(0.56% 至 0.93%)和对比州(0.46% 至 0.56%),与 ASCVD 相关的 SDOH 代码从实施前增加到实施后。在 ASCVD 住院治疗期间,SIM 的实施与 SDOH 代码利用率的大幅提高有关(调整后 OR 1.30,95%CI:1.18-1.43)。在急诊入院患者中,使用 SDOH 代码的几率(AOR 1.86,95%CI:1.76-1.97)比 ASCVD 常规入院患者高出 86%。当研究对象仅限于参加医疗保险的老年人(>=65 岁)时,研究结果与之相似(AOR 1.50,95%CI 1.31-1.71),而对于医疗补助受益人,研究结果并不显著。该研究指出了医疗服务提供者在记录患有 ASCVD 的成人的 SDOH 方面所面临的挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
From policy to practice: assessing the state innovation models initiative's early success in incorporating social determinants of health in ASCVD hospitalizations in the United States.

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.

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来源期刊
American journal of epidemiology
American journal of epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
7.40
自引率
4.00%
发文量
221
审稿时长
3-6 weeks
期刊介绍: The American Journal of Epidemiology is the oldest and one of the premier epidemiologic journals devoted to the publication of empirical research findings, opinion pieces, and methodological developments in the field of epidemiologic research. It is a peer-reviewed journal aimed at both fellow epidemiologists and those who use epidemiologic data, including public health workers and clinicians.
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