Utilization of Social Determinants of Health ICD-10 Z-Codes Among Hospitalized Patients in the United States, 2016–2017. Issue 12 (December 2020)

• Record Type: Journal Article
• Authors: Truong, Hannah P.; Luke, Alina A.; Hammond, Gmerice; Wadhera, Rishi K.; Reidhead, Mat; Joynt Maddox, Karen E.
• Is Part Of: Medical care. Volume 58:Issue 12(2020)
• Publication Date: 2020-12
• Subjects: Z-codes -- social determinants of health -- ICD-10 -- social factors; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001418
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: 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. Objective: 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. Research Design: Retrospective cohort study using 2016 and 2017 National Inpatient Sample. Participants: Total of 14, 289, 644 inpatient hospitalizations. Measures: Prevalence of SDOH Z-codes (codes Z55–Z65) and descriptive statistics of patients and hospitals. Results: 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. Conclusions: 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. Abstract : Supplemental Digital Content is available in the text.