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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Bibliographic Details
Published in:Medical care Vol. 58; no. 12; p. 1037
Main Authors: Truong, Hannah P, Luke, Alina A, Hammond, Gmerice, Wadhera, Rishi K, Reidhead, Mat, Joynt Maddox, Karen E
Format: Journal Article
Language:English
Published: United States 01.12.2020
Subjects:
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
United States
ISSN:1537-1948, 1537-1948
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Summary: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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ISSN:1537-1948
1537-1948
DOI:10.1097/MLR.0000000000001418