Social Determinant of Health Documentation Trends and Their Association with Emergency Department Admissions.

Research has shown that health outcomes are significantly driven by patient's social and economic needs and environment, commonly referred to as the social determinants of health (SDoH). Standardized documentation of social and economic needs in healthcare are underutilized. This study examines the prevalence of documented social and economic needs (Z-codes) in a nationwide inpatient database and the association with emergency department (ED) admissions. Multivariate logistic regression was used to assess the effect of social and economic Z-codes on hospital admission through the ED. Payer source, gender, age at admission, comorbidity count, and median ZIP code income quartile covariates were included in the logistic regression analyses. Patients with documented social and economic Z-codes were significantly more likely to be admitted through the ED than those without documented social and economic needs, after adjusting for covariates. Standardized and widespread collection of these valuable Z-codes within EHR systems or administrative claims databases can help with targeted resource allocation to alleviate possible barriers to care and mitigate ED utilization.

Low hepatitis C antibody screening rates among an insured population of Tennessean Baby Boomers.

INTRODUCTION: Chronic Hepatitis C Virus (HCV) infection is common and can cause liver disease and death. Persons born from 1945 through 1965 ("Baby Boomers") have relatively high prevalence of chronic HCV infection, prompting recommendations that all Baby Boomers be screened for HCV. If chronic HCV is confirmed, evaluation for antiviral treatment should be performed. Direct-acting antivirals can cure more than 90% of people with chronic HCV. This sequence of services can be referred to as the HCV "cascade of cure" (CoC). The Tennessee (TN) Department of Health (TDH) and a health insurer with presence in TN aimed to determine the proportion of Baby Boomers who access HCV screening services and appropriately navigate the HCV CoC in TN. METHODS: TDH surveillance data and insurance claim records were queried to identify the cohort of Baby Boomers eligible for HCV testing. Billing codes and pharmacy records from 2013 through 2015 were used to determine whether HCV screening and other HCV-related services were provided. The proportion of individuals accessing HCV screening and other steps along the HCV CoC was determined. Multivariable analyses were performed to identify factors associated with HCV screening and treatment. RESULTS: Among 501,388 insured Tennessean Baby Boomers, 7% were screened for HCV. Of the 40,019 who received any HCV-related service, 86% were screened with an HCV antibody test, 20% had a confirmatory HCV PCR, 9% were evaluated for treatment, and 4% were prescribed antivirals. Hispanics were more likely to be screened and treated for HCV than non-Hispanic whites. HCV screening was more likely to occur in the Nashville-Davidson region than in other regions of TN, but there were regional variations in HCV treatment. CONCLUSIONS: Many insured Tennessean Baby Boomers do not access HCV screening services, despite national recommendations. Demographic and regional differences in uptake along the HCV CoC should inform public health interventions aimed at mitigating the effects of chronic HCV.

Demographic factors influencing nonurgent emergency department utilization among a Medicaid population.

To use administrative medical encounter data to examine nonurgent emergency department (ED) utilization as it relates to member characteristics (i.e., age, gender, race/ethnicity, urbanicity and federal poverty level (FPL)). This 1 year cross-sectional study used medical claims from a managed care organization for Medicaid members enrolled from October 1, 2010 - September 30, 2011. ED encounters occurring during the study period were classified as either urgent or nonurgent using ICD-9 diagnosis codes obtained from medical claims. Examples of urgent diagnoses include head traumas, burns, allergic reactions, poisonings, preterm labor or maternal/fetal distress. A total of 187,263 members aged 2 to 65 years were retained for study. A zero-inflated Poisson regression model examined the influence of member-level characteristics on nonurgent ED utilization, while simultaneously adjusting for all factors. Females were 41 % more likely to have a nonurgent ED visit (p ≤ 0.0001). Members ages 50-65 were least likely to have a nonurgent ED visit (p ≤ 0.0001). White members had higher odds of having at least one nonurgent ED visit (p ≤ 0.0002). Rural members were 7.7 % less likely to have a nonurgent ED visit. Members in the 400 % + FPL category were less likely to seek nonurgent care from an ED (p ≤ 0.0001). A nonurgent ED visit occurs when care is sought at an ED that could have been handled in a primary care setting. Approximately 30-50 % of all ED visits in the United States are considered nonurgent. This study supports the need to determine factors associated with misuse of ED services for nonurgent care. Demographic factors significantly impacting nonurgent ED utilization include gender, age, race/ethnicity, urbanicity and percent of the FPL. Results may be useful in ED utilization management efforts.

Assessment of Administrative Medical Claims Data for Public Health Surveillance of Invasive Group A Streptococcal Necrotizing Fasciitis in Tennessee.

OBJECTIVE: Necrotizing fasciitis (NF) is a severe manifestation of invasive group A streptococcal (iGAS) infection. NF is a rapidly progressive infection of the subcutaneous tissues, including the fascia, and accurate diagnosis and prompt treatment are critical. Population-based surveillance is conducted for iGAS, including the severe manifestations of NF, by the federally funded Active Bacterial Core surveillance (ABCs) program. METHODS: We used administrative claims data from a large managed care organization in Tennessee to enhance the public health surveillance for NF iGAS. For the period 2003-2012, we identified cases of NF in Tennessee by searching the claims database for diagnostic codes indicating the diagnosis of NF. We compared these cases with cases detected in selected Tennessee counties by ABCs. RESULTS: Of 356 managed care patients with a diagnostic code indicating NF, we determined that 20 (6%) patients had been hospitalized with iGAS infection and, therefore, were likely to be true NF cases. Of these 20 patients, only 11 matched with patients identified by ABCs; nine patients had not been previously identified by ABCs. During the same time period, 54 patients with NF were ascertained by ABCs. CONCLUSION: Administrative claims data have the potential to augment disease surveillance but require a large investment in resources compared with the few NF cases identified.