Z Codes for Social Determinants of Health:
Which hospitals are most likely to use them and for which patients?
In its September 2018 report Decoding Social Determinants of Health, the Missouri Hospital Association published research on an emerging source of exceptionally granular data on patient-level social determinants of health. A scan of the current policy and care delivery landscape alludes to myriad direct and indirect benefits for providers that systematically screen for and capture ICD-10 Z codes for SDOH on uniform billing and claims records. The research first found that the use of Z codes for SDOH increased significantly among Missouri hospitals since the implementation of ICD-10 in October 2015. Second, despite the increased use and associated benefits for patients and providers, a comparison of rates of SDOH code assignment to rates of poverty and payer mix suggested ample room for improvement in the consistent application of the codes by hospitals. At the same time, despite inconsistencies in the use of SDOH codes, bivariate and multivariate testing revealed that the Z codes have exceptional predictive ability in health outcomes modeling.
To improve the consistent use of the codes at Missouri hospitals, this follow-up study explores both patient and provider characteristics that contribute to the likelihood of identification and capture of ICD-10 SDOH Z codes during an inpatient hospitalization or emergency department visit.
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