Social Determinants of Health–Related Z Codes and Health Care Among Patients With Hypertension

Lee, Jun Soo; MacLeod, Kara E.; Kuklina, Elena V.; Tong, Xin; Jackson, Sandra

doi:10.1016/j.focus.2023.100089

Cited by 8 publications

(4 citation statements)

References 26 publications

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“… 47 Practical complexities that have been discussed among empirical studies include misunderstandings around who within a clinical setting can or should document a patient's social needs, a general lack of standard operating procedures for routine Z-code documentation, a lack of familiarity with SDoH Z codes among health administrators, and a possible likelihood that providers (vs billing and compliance staff) may be less aware of SDoH Z codes. 8 , 22 The potentially subjective nature of many Z codes (ie, subjectivity of problems relating to loneliness/isolation, upbringing, housing and economic circumstances, etc) adds to this complexity. Future empirical work should explore this further.…”

Section: Discussionmentioning

confidence: 99%

“…We conducted a scoping review of the most recent studies (<5 years, 2019–2023) reported in peer-reviewed literature on Z-code documentation in relation to mental health care delivered within the United States (inclusion criteria). Our search was limited to studies published within the past 5 years for the following reasons: (1) although Z codes were first introduced in 2015/2016, clinical documentation of SDoH Z codes has been reportedly slow and low, likely due to practice-level complexities that have been discussed in the literature 22 , 23 ; (2) health disparities due to SDoH-related factors became more apparent during the COVID-19 pandemic; and (3) mental illness, including substance abuse, became a global public health crisis and concern following the COVID-19 pandemic. 9 , 24 A search was conducted in March 2024 for papers indexed in PubMed, PsycINFO, Scopus, and Web of Science, or searchable in Google Scholar.…”

Section: Methodsmentioning

confidence: 99%

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Social determinants of health Z-code documentation practices in mental health settings: a scoping review

Hendricks-Sturrup,

Yankah,

2024

Health Affairs Scholar

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Mental health remains an urgent global priority, alongside efforts to address underlying social determinants of health (SDoH) that contribute to the onset or exacerbate mental illness. SDoH factors can be captured in the form of International Classification of Disease, Tenth Revision, Clinical Modification [ICD-10 CM] SDoH Z codes. In this scoping review, we describe current SDoH Z code documentation practices, with a focus on mental health care contexts. Among 2,743,061,374 health care encounters noted across 12 studies in the United States, SDoH Z code documentation rates ranged from 0.5% to 2.4%. Documentation often involved patients under 64 years of age who are publicly insured and experience comorbidities, including depression, bipolar disorder and schizophrenia, chronic pulmonary disease, and substance abuse disorders. Documentation varied across hospital types, number of beds per facility, patient race/ethnicity, and geographic region. Variation was observed regarding patient sex/gender, although SDoH Z codes were more frequently documented for males. Documentation was most observed in government, nonfederal and private not-for-profit hospitals. From these insights, we offer policy and practice recommendations, as well as considerations for patient data privacy, security, and confidentiality, to incentivize more routine documentation of Z codes to better assist patients with complex mental health care needs.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Social determinants of health Z-code documentation practices in mental health settings: a scoping review

Hendricks-Sturrup,

Yankah,

2024

Health Affairs Scholar

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“…To ensure data quality and consistency, we excluded individuals who were not continuously enrolled in a health plan, had a pregnancy-associated diagnosis (Appendix Table 1), 17, 18 or were covered by capitated health insurance (as healthcare utilization and costs are not fully captured among those with capitated health insurance) during our study period (2016 to 2021). Participants were also excluded if any state identifiers were missing or unknown.…”

Section: Methodsmentioning

confidence: 99%

Impact of State Telehealth Parity Laws for Private Payers on Hypertension Management before and during the COVID-19 Pandemic

Zhang,

Lee,

Popoola

et al. 2023

Preprint

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BACKGROUNDTelehealth has emerged as an effective tool for managing common chronic conditions such as hypertension, especially during the COVID-19 pandemic. However, the impact of state telehealth payment and coverage parity laws on hypertension management remains uncertain.METHODSData from the MerativeTMMarketScan® Commercial Claims and Encounters Database from January 1, 2016 to December 31, 2021 were used to construct the study cohort. The sample included non-pregnant individuals aged 25–64 years with hypertension. We reviewed and coded telehealth parity laws related to hypertension management in all 50 states and the District of Columbia, distinguishing between payment parity laws and coverage parity laws. The primary outcomes were antihypertension medication use, measured by the average medication possession ratio (MPR), medication adherence (MPR ≥80%), and average number of days of drug supply. We used a generalized difference-in-difference (DID) design to examine the impact of these laws. Results were presented as marginal effects and 95% confidence intervals (CI).RESULTSAmong 353,220 individuals, states with payment parity laws were significantly linked to increased average MPR by 0.43 percentage point (95% CI: 0.07 - 0.79), and an increase of 0.46 percentage point (95% CI: 0.06 - 0.92) in the probability of medication adherence. Payment parity laws also led to an average increase of 2.14 days (95% CI: 0.11 - 4.17) in antihypertensive drug supply, after controlling for state-fixed effects, year-fixed effects, individual sociodemographic characteristics and state time-varying covariates including unemployment rates, GDP per capita, and poverty rates. In contrast, coverage parity laws were associated with a 2.13-day increase (95% CI: 0.19 - 4.07) in days of drug supply, but did not significantly increase the average MPR or probability of medication adherence. In addition, telehealth payment or coverage parity laws were positively associated with the number of hypertension-related telehealth visits, but this effect did not reach statistical significance. These findings were consistent in sensitivity analyses.CONCLUSIONSState telehealth payment parity laws were significantly associated with greater medication adherence, whereas coverage parity laws were not. With the increasing adoption of telehealth parity laws across states, these findings may support policymakers in understanding potential implications on management of hypertension.Clinical PerspectiveWhat Is New?Telehealth is an effective tool to manage hypertension and state-level telehealth parity laws can influence its application. Prior studies have not clearly differentiated between the impacts of payment parity and coverage parity. Using a quasi-experimental generalized difference-in-differences design, we assessed the effects of telehealth payment parity and coverage parity laws on hypertension management.Our study found that state telehealth payment parity laws were significantly associated with increased hypertension medication adherence, while coverage parity laws were not.What Are the Clinical Implications?The widespread adoption of telehealth payment parity laws may significantly impact hypertension management, during emergencies like the COVID-19 pandemic and beyond.Considering that hypertension impacts approximately half of the adult population, our study provides valuable insights into the potential benefits of telehealth parity laws for private payers in enhancing the management of hypertension.With the increasing adoption of telehealth parity laws across states, integrating telehealth into hypertension management holds significant implications for the evolving U.S. healthcare system in the digital age.

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“…Other recent mile markers signaling healthcare’s accelerating attention to social determinants include the adoption of Z codes for documenting social risk factors in the International Classification of Diseases, Tenth Revision (ICD-10) ( 16 ), the American Academy of Pediatrics’ endorsement of universal screening for food insecurity ( 17 ), the recent policy statement on social needs from the American College of Physicians ( 18 ), and a recent initiative by the American Hospital Association to “Redefine the H,” a campaign that seeks to associate the “H” sign for a nearby hospital with communitywide efforts to address health more broadly ( 19 ). Moreover, in recognition of the burgeoning literature in the field, the National Library of Medicine (NLM) has made Social Determinants of Health a Medical Subject Headings (MeSH) term to enable literature searches on this topic ( 20 ).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of hospital and health system initiatives to address social determinants of health in the United States: a scoping review of the peer-reviewed literature

Rangachari,

Thapa,

Sherpa

et al. 2024

Front. Public Health

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BackgroundDespite the incentives and provisions created for hospitals by the US Affordable Care Act related to value-based payment and community health needs assessments, concerns remain regarding the adequacy and distribution of hospital efforts to address SDOH. This scoping review of the peer-reviewed literature identifies the key characteristics of hospital/health system initiatives to address SDOH in the US, to gain insight into the progress and gaps.MethodsPRISMA-ScR criteria were used to inform a scoping review of the literature. The article search was guided by an integrated framework of Healthy People SDOH domains and industry recommended SDOH types for hospitals. Three academic databases were searched for eligible articles from 1 January 2018 to 30 June 2023. Database searches yielded 3,027 articles, of which 70 peer-reviewed articles met the eligibility criteria for the review.ResultsMost articles (73%) were published during or after 2020 and 37% were based in Northeast US. More initiatives were undertaken by academic health centers (34%) compared to safety-net facilities (16%). Most (79%) were research initiatives, including clinical trials (40%). Only 34% of all initiatives used the EHR to collect SDOH data. Most initiatives (73%) addressed two or more types of SDOH, e.g., food and housing. A majority (74%) were downstream initiatives to address individual health-related social needs (HRSNs). Only 9% were upstream efforts to address community-level structural SDOH, e.g., housing investments. Most initiatives (74%) involved hot spotting to target HRSNs of high-risk patients, while 26% relied on screening and referral. Most initiatives (60%) relied on internal capacity vs. community partnerships (4%). Health disparities received limited attention (11%). Challenges included implementation issues and limited evidence on the systemic impact and cost savings from interventions.ConclusionHospital/health system initiatives have predominantly taken the form of downstream initiatives to address HRSNs through hot-spotting or screening-and-referral. The emphasis on clinical trials coupled with lower use of EHR to collect SDOH data, limits transferability to safety-net facilities. Policymakers must create incentives for hospitals to invest in integrating SDOH data into EHR systems and harnessing community partnerships to address SDOH. Future research is needed on the systemic impact of hospital initiatives to address SDOH.

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Social Determinants of Health–Related Z Codes and Health Care Among Patients With Hypertension

Cited by 8 publications

References 26 publications

Social determinants of health Z-code documentation practices in mental health settings: a scoping review

Social determinants of health Z-code documentation practices in mental health settings: a scoping review

Impact of State Telehealth Parity Laws for Private Payers on Hypertension Management before and during the COVID-19 Pandemic

Characteristics of hospital and health system initiatives to address social determinants of health in the United States: a scoping review of the peer-reviewed literature

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