Examining Social Determinants of Health During a Pandemic: Clinical Application of Z Codes Before and During COVID-19

Frontiers in Public Health

article

Xueying Yang¹  Brooks Yelton²  Shujie Chen¹  Jiajia Zhang¹  Bankole A. Olatosi¹  Shan Qiao¹  Xiaoming Li¹  Daniela B. Friedman² 

[1] Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina;Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina;Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina;Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina;Office for the Study of Aging, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina

关键词: healthy people 2030;    Z codes;    social determinants of health;    coronavirus;    COVID-19;    population health;   

DOI  :  10.3389/fpubh.2022.888459

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Recognition of the impact of social determinants of health (SDoH) on healthcare outcomes, healthcare service utilization, and population health has prompted a global shift in focus to patient social needs and lived experiences in assessment and treatment. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provides a list of non-billable “Z codes” specific to SDoH for use in electronic health records. Using population-level analysis, this study aims to examine clinical application of Z codes in South Carolina before and during the COVID-19 pandemic. The study population consists of South Carolina residents who had a healthcare visit and had their COVID-19 test result reported to the state's Department of Health and Environmental Control before January 14, 2021. Of the 1,190,531 individuals in the overall sample, Z codes were used only for 14,665 (1.23%) of the patients, including 2,536 (0.97%) COVID-positive patients and 12,129 (1.30%) COVID-negative patients. Compared with hospitals that did not use Z codes, those that did were significantly more likely to have higher bed capacity ( p = 0.017) and to be teaching hospitals ( p = 0.03), although this was significant only among COVID-19 positive individuals. Those at inpatient visits were most likely to receive Z codes (OR: 5.26; 95% CI: 5.14, 5.38; p < 0.0001) compared to those at outpatient visits (OR: 0.07; 95%CI: 0.06, 0.07; p < 0.0001). There was a slight increase of Z code use from 2019 to 2020 (OR: 1.33, 95% CI: 1.30, 1.36; p < 0.0001), which was still significant when stratified by facility type across time. As one of the first studies to examine Z code use among a large patient population, findings clearly indicate underutilization by providers. Additional study is needed to understand the potentially long-lasting health effects related to SDoH among underserved populations.

【 授权许可】

CC BY