Utilization of Social Determinants of Health ICD-10 Z-Codes Among Hospitalized Patients in the United States, 2016-2017
The inclusion of Z-codes for social determinants of health (SDOH) in the 10th revision of the International Classification of Diseases (ICD-10) may offer an opportunity to improve data collection of SDOH, but no characterization of their utilization exists on a national all-payer level. To examine t...
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| Published in: | Medical care Vol. 58; no. 12; p. 1037 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
01.12.2020
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| ISSN: | 1537-1948, 1537-1948 |
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| Abstract | The inclusion of Z-codes for social determinants of health (SDOH) in the 10th revision of the International Classification of Diseases (ICD-10) may offer an opportunity to improve data collection of SDOH, but no characterization of their utilization exists on a national all-payer level.
To examine the prevalence of SDOH Z-codes and compare characteristics of patients with and without Z-codes and hospitals that do and do not use Z-codes.
Retrospective cohort study using 2016 and 2017 National Inpatient Sample.
Total of 14,289,644 inpatient hospitalizations.
Prevalence of SDOH Z-codes (codes Z55-Z65) and descriptive statistics of patients and hospitals.
Of admissions, 269,929 (1.9%) included SDOH Z-codes. Average monthly SDOH Z-code use increased across the study period by 0.01% per month (P<0.001). The cumulative number and proportion of hospitals that had ever used an SDOH Z-code also increased, from 1895 hospitals (41%) in January 2016 to 3210 hospitals (70%) in December 2017. Hospitals that coded at least 1 SDOH Z-code were larger, private not-for-profit, and urban teaching hospitals. Compared with admissions without an SDOH Z-code, admissions with them were for patients who were younger, more often male, Medicaid recipients or uninsured. A higher proportion of admissions with SDOH Z-codes were for mental health (44.0% vs. 3.3%, P<0.001) and alcohol and substance use disorders (9.6% vs. 1.1%, P<0.001) compared with those without.
The uptake of SDOH Z-codes has been slow, and current coding is likely poorly reflective of the actual burden of social needs experienced by hospitalized patients. |
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| AbstractList | The inclusion of Z-codes for social determinants of health (SDOH) in the 10th revision of the International Classification of Diseases (ICD-10) may offer an opportunity to improve data collection of SDOH, but no characterization of their utilization exists on a national all-payer level.
To examine the prevalence of SDOH Z-codes and compare characteristics of patients with and without Z-codes and hospitals that do and do not use Z-codes.
Retrospective cohort study using 2016 and 2017 National Inpatient Sample.
Total of 14,289,644 inpatient hospitalizations.
Prevalence of SDOH Z-codes (codes Z55-Z65) and descriptive statistics of patients and hospitals.
Of admissions, 269,929 (1.9%) included SDOH Z-codes. Average monthly SDOH Z-code use increased across the study period by 0.01% per month (P<0.001). The cumulative number and proportion of hospitals that had ever used an SDOH Z-code also increased, from 1895 hospitals (41%) in January 2016 to 3210 hospitals (70%) in December 2017. Hospitals that coded at least 1 SDOH Z-code were larger, private not-for-profit, and urban teaching hospitals. Compared with admissions without an SDOH Z-code, admissions with them were for patients who were younger, more often male, Medicaid recipients or uninsured. A higher proportion of admissions with SDOH Z-codes were for mental health (44.0% vs. 3.3%, P<0.001) and alcohol and substance use disorders (9.6% vs. 1.1%, P<0.001) compared with those without.
The uptake of SDOH Z-codes has been slow, and current coding is likely poorly reflective of the actual burden of social needs experienced by hospitalized patients. The inclusion of Z-codes for social determinants of health (SDOH) in the 10th revision of the International Classification of Diseases (ICD-10) may offer an opportunity to improve data collection of SDOH, but no characterization of their utilization exists on a national all-payer level.BACKGROUNDThe inclusion of Z-codes for social determinants of health (SDOH) in the 10th revision of the International Classification of Diseases (ICD-10) may offer an opportunity to improve data collection of SDOH, but no characterization of their utilization exists on a national all-payer level.To examine the prevalence of SDOH Z-codes and compare characteristics of patients with and without Z-codes and hospitals that do and do not use Z-codes.OBJECTIVETo examine the prevalence of SDOH Z-codes and compare characteristics of patients with and without Z-codes and hospitals that do and do not use Z-codes.Retrospective cohort study using 2016 and 2017 National Inpatient Sample.RESEARCH DESIGNRetrospective cohort study using 2016 and 2017 National Inpatient Sample.Total of 14,289,644 inpatient hospitalizations.PARTICIPANTSTotal of 14,289,644 inpatient hospitalizations.Prevalence of SDOH Z-codes (codes Z55-Z65) and descriptive statistics of patients and hospitals.MEASURESPrevalence of SDOH Z-codes (codes Z55-Z65) and descriptive statistics of patients and hospitals.Of admissions, 269,929 (1.9%) included SDOH Z-codes. Average monthly SDOH Z-code use increased across the study period by 0.01% per month (P<0.001). The cumulative number and proportion of hospitals that had ever used an SDOH Z-code also increased, from 1895 hospitals (41%) in January 2016 to 3210 hospitals (70%) in December 2017. Hospitals that coded at least 1 SDOH Z-code were larger, private not-for-profit, and urban teaching hospitals. Compared with admissions without an SDOH Z-code, admissions with them were for patients who were younger, more often male, Medicaid recipients or uninsured. A higher proportion of admissions with SDOH Z-codes were for mental health (44.0% vs. 3.3%, P<0.001) and alcohol and substance use disorders (9.6% vs. 1.1%, P<0.001) compared with those without.RESULTSOf admissions, 269,929 (1.9%) included SDOH Z-codes. Average monthly SDOH Z-code use increased across the study period by 0.01% per month (P<0.001). The cumulative number and proportion of hospitals that had ever used an SDOH Z-code also increased, from 1895 hospitals (41%) in January 2016 to 3210 hospitals (70%) in December 2017. Hospitals that coded at least 1 SDOH Z-code were larger, private not-for-profit, and urban teaching hospitals. Compared with admissions without an SDOH Z-code, admissions with them were for patients who were younger, more often male, Medicaid recipients or uninsured. A higher proportion of admissions with SDOH Z-codes were for mental health (44.0% vs. 3.3%, P<0.001) and alcohol and substance use disorders (9.6% vs. 1.1%, P<0.001) compared with those without.The uptake of SDOH Z-codes has been slow, and current coding is likely poorly reflective of the actual burden of social needs experienced by hospitalized patients.CONCLUSIONSThe uptake of SDOH Z-codes has been slow, and current coding is likely poorly reflective of the actual burden of social needs experienced by hospitalized patients. |
| Author | Luke, Alina A Wadhera, Rishi K Truong, Hannah P Reidhead, Mat Joynt Maddox, Karen E Hammond, Gmerice |
| Author_xml | – sequence: 1 givenname: Hannah P surname: Truong fullname: Truong, Hannah P organization: Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St Louis, MO – sequence: 2 givenname: Alina A surname: Luke fullname: Luke, Alina A organization: Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St Louis, MO – sequence: 3 givenname: Gmerice surname: Hammond fullname: Hammond, Gmerice organization: Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St Louis, MO – sequence: 4 givenname: Rishi K surname: Wadhera fullname: Wadhera, Rishi K organization: Division of Cardiology, Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA – sequence: 5 givenname: Mat surname: Reidhead fullname: Reidhead, Mat organization: Missouri Hospital Association, Jefferson City – sequence: 6 givenname: Karen E surname: Joynt Maddox fullname: Joynt Maddox, Karen E organization: Center for Health Economics and Policy, Institute for Public Health at Washington University, St Louis, MO |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32925453$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adolescent Adult Age Factors Aged Child Child, Preschool Clinical Coding - organization & administration Clinical Coding - standards Female Hospital Bed Capacity - statistics & numerical data Hospitalization - statistics & numerical data Humans Infant Infant, Newborn International Classification of Diseases - standards Male Middle Aged Ownership - statistics & numerical data Poverty - statistics & numerical data Residence Characteristics - statistics & numerical data Retrospective Studies Sex Factors Social Determinants of Health - statistics & numerical data Socioeconomic Factors United States Young Adult |
| Title | Utilization of Social Determinants of Health ICD-10 Z-Codes Among Hospitalized Patients in the United States, 2016-2017 |
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