Hannah P Truong1, Alina A Luke1, Gmerice Hammond1, Rishi K Wadhera2, Mat Reidhead3, Karen E Joynt Maddox1,4. 1. Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St Louis, MO. 2. Division of Cardiology, Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA. 3. Missouri Hospital Association, Jefferson City. 4. Center for Health Economics and Policy, Institute for Public Health at Washington University, St Louis, MO.
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.
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.
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