Cargando…
A National Snapshot of Social Determinants of Health Documentation in Emergency Departments
INTRODUCTION: Documentation and measurement of social determinants of health (SDoH) are critical to clinical care and to healthcare delivery system reforms targeting health equity. The SDoH are codified in the International Classification of Disease 10(th) Rev (ICD-10) Z codes. However, Z codes are...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Department of Emergency Medicine, University of California, Irvine School of Medicine
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393461/ https://www.ncbi.nlm.nih.gov/pubmed/37527393 http://dx.doi.org/10.5811/westjem.58149 |
_version_ | 1785083163032158208 |
---|---|
author | Ryus, Caitlin R. Janke, Alexander T. Granovsky, Rachel L. Granovsky, Michael A. |
author_facet | Ryus, Caitlin R. Janke, Alexander T. Granovsky, Rachel L. Granovsky, Michael A. |
author_sort | Ryus, Caitlin R. |
collection | PubMed |
description | INTRODUCTION: Documentation and measurement of social determinants of health (SDoH) are critical to clinical care and to healthcare delivery system reforms targeting health equity. The SDoH are codified in the International Classification of Disease 10(th) Rev (ICD-10) Z codes. However, Z codes are listed in only 1–2% of inpatient charts. Little is known about the frequency of Z code utilization specifically among emergency department (ED) patient populations nationally. METHODS: This was a repeated cross-sectional analysis of ED visit data in the United States from the Nationwide Emergency Department Sample from 2016–2019. We characterized the use of Z codes and described associations between Z code use and patient- and hospital-level factors including the following: age; gender; race; insurance status; ED disposition; ED size; hospital urban-rural status; ownership; and clinical conditions. We calculated unadjusted odds ratios for likelihood of Z code reporting for each ED visit. RESULTS: Of approximately 140 million ED visits per year, 0.65% had an associated Z code in 2016, rising to 1.17% by 2019. Visits were more likely to have an associated Z code for adults age <65, male, Black, Medicaid or self-pay patients, and patients admitted to the hospital. Larger EDs, those in metropolitan areas, academic centers, and government-run hospitals were more likely to report Z codes. The most commonly associated clinical conditions were as follows: schizophrenia spectrum and other psychotic disorders; depressive disorder; and alcohol-related disorders. CONCLUSION: There is a paucity of Z code documentation in the health records of ED patients, although use is uptrending. Further research is warranted to better understand the drivers of clinicians’ use of Z codes and to improve on their utility. |
format | Online Article Text |
id | pubmed-10393461 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-103934612023-08-02 A National Snapshot of Social Determinants of Health Documentation in Emergency Departments Ryus, Caitlin R. Janke, Alexander T. Granovsky, Rachel L. Granovsky, Michael A. West J Emerg Med Health Equity INTRODUCTION: Documentation and measurement of social determinants of health (SDoH) are critical to clinical care and to healthcare delivery system reforms targeting health equity. The SDoH are codified in the International Classification of Disease 10(th) Rev (ICD-10) Z codes. However, Z codes are listed in only 1–2% of inpatient charts. Little is known about the frequency of Z code utilization specifically among emergency department (ED) patient populations nationally. METHODS: This was a repeated cross-sectional analysis of ED visit data in the United States from the Nationwide Emergency Department Sample from 2016–2019. We characterized the use of Z codes and described associations between Z code use and patient- and hospital-level factors including the following: age; gender; race; insurance status; ED disposition; ED size; hospital urban-rural status; ownership; and clinical conditions. We calculated unadjusted odds ratios for likelihood of Z code reporting for each ED visit. RESULTS: Of approximately 140 million ED visits per year, 0.65% had an associated Z code in 2016, rising to 1.17% by 2019. Visits were more likely to have an associated Z code for adults age <65, male, Black, Medicaid or self-pay patients, and patients admitted to the hospital. Larger EDs, those in metropolitan areas, academic centers, and government-run hospitals were more likely to report Z codes. The most commonly associated clinical conditions were as follows: schizophrenia spectrum and other psychotic disorders; depressive disorder; and alcohol-related disorders. CONCLUSION: There is a paucity of Z code documentation in the health records of ED patients, although use is uptrending. Further research is warranted to better understand the drivers of clinicians’ use of Z codes and to improve on their utility. Department of Emergency Medicine, University of California, Irvine School of Medicine 2023-07 2023-07-12 /pmc/articles/PMC10393461/ /pubmed/37527393 http://dx.doi.org/10.5811/westjem.58149 Text en © 2023 Ryus et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) |
spellingShingle | Health Equity Ryus, Caitlin R. Janke, Alexander T. Granovsky, Rachel L. Granovsky, Michael A. A National Snapshot of Social Determinants of Health Documentation in Emergency Departments |
title | A National Snapshot of Social Determinants of Health Documentation in Emergency Departments |
title_full | A National Snapshot of Social Determinants of Health Documentation in Emergency Departments |
title_fullStr | A National Snapshot of Social Determinants of Health Documentation in Emergency Departments |
title_full_unstemmed | A National Snapshot of Social Determinants of Health Documentation in Emergency Departments |
title_short | A National Snapshot of Social Determinants of Health Documentation in Emergency Departments |
title_sort | national snapshot of social determinants of health documentation in emergency departments |
topic | Health Equity |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393461/ https://www.ncbi.nlm.nih.gov/pubmed/37527393 http://dx.doi.org/10.5811/westjem.58149 |
work_keys_str_mv | AT ryuscaitlinr anationalsnapshotofsocialdeterminantsofhealthdocumentationinemergencydepartments AT jankealexandert anationalsnapshotofsocialdeterminantsofhealthdocumentationinemergencydepartments AT granovskyrachell anationalsnapshotofsocialdeterminantsofhealthdocumentationinemergencydepartments AT granovskymichaela anationalsnapshotofsocialdeterminantsofhealthdocumentationinemergencydepartments AT ryuscaitlinr nationalsnapshotofsocialdeterminantsofhealthdocumentationinemergencydepartments AT jankealexandert nationalsnapshotofsocialdeterminantsofhealthdocumentationinemergencydepartments AT granovskyrachell nationalsnapshotofsocialdeterminantsofhealthdocumentationinemergencydepartments AT granovskymichaela nationalsnapshotofsocialdeterminantsofhealthdocumentationinemergencydepartments |