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Study: Few hospitalists documenting children’s social determinants of health

July 11, 2023

Few health care providers in hospitals are documenting children’s social determinants of health (SDOH), potentially missing opportunities to provide support, according to a new study.

“It is possible that the stressful conditions of hospitalization itself can unmask social needs, making identification of these conditions an important part of inpatient care,” authors wrote in “Social Determinants of Health ICD-10 Code Use in Inpatient Pediatrics,” (McQuistion K, et al. Pediatrics. July 11, 2023).

Authors analyzed a nationally representative data set with about 4,000 hospitals looking for use of International Classification of Diseases, 10th Revision (ICD-10) codes related to social determinants of health for pediatric inpatients. These included Z codes Z55-Z65 covering social risk factors like food insecurity, social needs like homelessness and adverse childhood experiences like family substance use. They also included codes recommended by the AAP.

The study compares code use in 2016 to use in 2019, before and after the American Hospital Association Coding Clinic broadened the list of which types of health care providers could document Z codes.

Social determinants of health codes were used in 69.1% of hospitals in 2019, up from 61.5%. However, they were documented in only about 1.9% of cases in 2019, up from 1.4%, according to the study.

Code Z62, “problems related to upbringing,” was used most often. Social determinants codes were used more frequently for adolescents than younger children, occurring at a rate of about 7.1% in 2019, up from 5.2% in 2016. Looking at racial differences, Native American patients had social determinants codes documented most often at 3.8% in 2019, up from 2.4%.

Children whose hospital admission was related to mental health had the most frequent documentation of social determinants at 26.1% in 2019, up from 23%.

Authors stressed the importance of screening, saying it “can provide valuable insight into population health needs, and a more holistic appreciation for the challenges individual patients/families are facing in terms of addressing their overall health.”

They acknowledged they did not have a baseline of what percentage of patients likely had social needs, and some patients may have undergone screening that wasn’t documented. Still, they called the codes “underutilized” and said possible barriers to use include lack of awareness about the codes and who can use them, lack of training and lack of financial incentive.

“Novel approaches to SDOH documentation such as utilizing volunteers or multidisciplinary care team members to enter SDOH ICD-10 codes, implementing structured screening with automatic SDOH ICD-10 coding, or development of natural language processing data extraction tools could be used to reduce the burden on providers,” they wrote.

They also called for efforts to ensure providers have resources to which they can refer patients.

Authors of a related commentary noted additional barriers may include patient privacy concerns.

“With financial incentives on the horizon we must ensure our EHR (electronic health record) is prepared to navigate these delicate hurdles,” they wrote. “This requires EHR innovations that are not only functional for providers but also transparent and trustworthy for caregivers. …Creating an infrastructure suitable for social care integration requires specific attention to partnership with technology companies to innovate EHRs as we know it, keeping the patient perspective in mind at every step.”



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