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A recent study offers important insights into the low rates for screening and documenting Social Determinants of Health (SDOH) in health care settings.
SDOHs are a person’s social, environmental, and economic conditions that are strongly linked to their health outcomes. This includes factors such as unemployment, homelessness, and illiteracy, among others. Despite the potential of SDOHs to provide a more comprehensive understanding of a patient’s health and influence important policy changes, clinical offices are not adequately tracking this information.
To gain a better understanding of the challenges related to tracking social factors, researchers from the University of Colorado Anschutz Medical Campus and Johns Hopkins published new research in Health Affairs Scholar that analyzes the use of Z-codes by code type, setting, and patient demographics between Medicaid and commercial insurance beneficiaries. Z-codes are codes used to document SDOH information for patients.
“To better serve a more diverse population, there’s a critical need for health care offices to identify and appropriately document social factors impacting a patient’s health. However, when the system in place to track social factors is highly underutilized, it showcases a clear issue that needs to be addressed and we’re hoping our research can inform ways to do so,” said the study’s first author Jason Gibbons, Ph.D., assistant professor and a health economist in the Colorado School of Public Health at CU Anschutz.
The researchers found that less than two percent of both Medicaid and commercially insured patients received Z-codes in their records. However, they also found notable differences in the use of the codes between the programs and called attention to important findings:
- Z-code use was more than 50% more prevalent among Medicaid beneficiaries than commercially insured beneficiaries.
- Patients receiving Z-codes in Medicaid were more likely to receive Z-codes indicating economic hardship, while patients with commercial insurance were more likely to receive Z-codes representing issues with social relationships.
- Mental health and psychiatric settings were the most common settings where Z-code use was identified in both programs.
- Medicaid patients were more likely to receive Z-code diagnoses in the inpatient settings, while commercially insured patients were more likely to receive Z-code diagnoses in the outpatient setting.
“We’re hoping these results can help with current and future policy efforts to implement programs that address the needs of clinicians to document SDOHs better, whether they see Medicaid and commercially insured patients or both,” said Gibbons.
To incentivize and expand Z-code use, the researchers outline recommendations such as broader integration of Z-codes as quality metrics into quality improvement and equity programs being developed by Centers for Medicare & Medicaid Services (CMS) and states through section 1115 waivers, integration of Z-codes into clinical decision support tools and electronic health records systems that prompt providers to ask patients about SDOH and record responses.
Gibbons adds, “We also recommend provider education regarding the importance of accurately capturing patient SDOH and making them a focal point of clinical care wherever possible.”
To conduct this study,
