医疗补助负责任的护理组织实施和围产期索赔的社会风险因素的社会风险因素的文档
Kevin H Nguyen1, Sarah H Gordon1, Kenneth Lim1
1Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
JAMA network open
|April 21, 2025
概括
马萨诸塞州的医疗补助 (Medicaid) 负责护理组织 (ACO) 在产前期间增加了对社会风险因素 (Z码) 的记录. 这一举措可以改善对孕妇和产后患者的护理需求的识别.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
- 卫生政策 卫生政策
背景情况:
- 在产前期解决社会风险因素 (例如,粮食不安全) 可以改善怀孕结果.
- 自2016年推出以来,社会风险因素诊断代码 (Z代码) 在医疗保健索赔中得到了缓慢的采用.
- 马萨诸塞州医疗补助公司在2018年实施了负责任的护理组织 (ACO) 模式,要求进行社会风险查.
研究的目的:
- 评估Medicaid注册人的产周期间Z代码的索赔文件.
- 在马萨诸塞州医疗补助ACO计划实施后,评估Z代码文档的变化.
主要方法:
- 使用马萨诸塞州全付款人索赔数据库 (2016-2020) 进行横截面研究.
- 确定的医疗补助计划注册的活产 (n=79,293).
- 采用差异差异 (DiD) 方法,比较ACO实施前 (2016-2017) 和之后 (2018-2020) 的Z代码文档.
主要成果:
- 总的来说,Z代码的记录很少:产前4.45%,产后60天内1.14%,产后12个月内3.31%.
- 医疗补助ACO实施显著增加了产前Z码文档 (DiD:1.09个百分点).
- 住房/经济情况 (DiD: 1.52 PP) 和粮食不安全 (DiD: 0.58 PP) 代码的增加;产后文档显示变化很小.
结论:
- 马萨诸塞州的医疗补助 (Medicaid) ACO实施与日产期Z代码索赔文件的增加有关,主要是在产前期.
- 虽然整体Z码文档仍然很少,但在护理交付模式中激励社会风险查可以帮助确定孕妇和产后患者的需求.
- 这表明,通过在医疗补助人口中进行结构化社会风险评估,有可能改善护理协调和结果.
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