The need for improved coding to document the social determinants of health

Handerer, Fritz; Tai, Sara

doi:10.1016/s2215-0366(21)00208-x

Cited by 5 publications

(5 citation statements)

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“…5 These limitations were improved slightly through the development of a more detailed list of SDoH-related codes for ICD-10-CM, known as Z codes, but further expansion of the list of SDoH diagnosis codes is still needed. 21,22 Newer SDoH screening tools being implemented in health systems nationwide may also more detailed information about adverse SDoH. Finally, patients may not want information about adverse SDoH included in their medical records due to perceived stigma.…”

Section: Discussionmentioning

confidence: 99%

“…Third, ICD-9-CM V codes failed to include categories for some important SDoH or contained ambiguous categories that combined multiple SDoH together 5 . These limitations were improved slightly through the development of a more detailed list of SDoH-related codes for ICD-10-CM, known as Z codes, but further expansion of the list of SDoH diagnosis codes is still needed 21,22 . Newer SDoH screening tools being implemented in health systems nationwide may also more detailed information about adverse SDoH.…”

Section: Discussionmentioning

confidence: 99%

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Association Between Adverse Social Determinants of Health and Suicide Death

Llamocca,

Yeh,

Miller-Matero

et al. 2023

Medical Care

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Objective: The aim of this study was to identify adverse social determinants of health (SDoH) International Statistical Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code prevalence among individuals who died by suicide and to examine associations between documented adverse SDoH and suicide. Research Design: A case-control study using linked medical record, insurance claim, and mortality data from 2000 to 2015 obtained from 9 Mental Health Research Network-affiliated health systems. We included 3330 individuals who died by suicide and 333,000 randomly selected controls matched on index year and health system location. All individuals in the study (cases and controls) had at least 10 months of enrollment before the study index date. The index date for the study for each case and their matched controls was the suicide date for that given case. Results: Adverse SDoH documentation was low; only 6.6% of cases had ≥1 documented adverse SDoH in the year before suicide. Any documented SDoH and several specific adverse SDoH categories were more frequent among cases than controls. Any documented adverse SDoH was associated with higher suicide odds [adjusted odds ratio (aOR)=2.76; 95% CI: 2.38–3.20], as was family alcoholism/drug addiction (aOR=18.23; 95% CI: 8.54–38.92), being an abuse victim/perpetrator (aOR=2.53; 95% CI: 1.99–3.21), other primary support group problems (aOR=1.91; 95% CI: 1.32–2.75), employment/occupational maladjustment problems (aOR=8.83; 95% CI: 5.62–13.87), housing/economic problems (aOR: 6.41; 95% CI: 4.47–9.19), legal problems (aOR=27.30; 95% CI: 12.35–60.33), and other psychosocial problems (aOR=2.58; 95% CI: 1.98–3.36). Conclusions: Although documented SDoH prevalence was low, several adverse SDoH were associated with increased suicide odds, supporting calls to increase SDoH documentation in medical records. This will improve understanding of SDoH prevalence and assist in identification and intervention among individuals at high suicide risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association Between Adverse Social Determinants of Health and Suicide Death

Llamocca,

Yeh,

Miller-Matero

et al. 2023

Medical Care

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“…Medical records shape the medical knowledge by keeping information that is considered relevant and in turn, the medical and scientific knowledge shape clinical practice [ 11 , 63 ]. The widely used classification systems ICD [ 17 ] and ICPC [ 54 ] have a strong anchoring in biomedicine [ 64 ], which has led to difficulties in incorporating the social circumstances contributing to distress into clinical practice [ 65 ]. In addition, the social circumstances at work might not be properly considered, since primary health care not always has the prerequisites needed [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

Work-related stress, reason for consultation and diagnosis-specific sick leave: How do they add up?

2023

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Work-related stress is common in Western society and disorders associated with stress are often managed in primary health care. This study was set to increase the understanding of the relationship between reason for consultation, work-related stress and diagnosis-specific sick leave for primary health care patients. The longitudinal observational study included 232 employed non-sick listed patients at seven primary health care centres in Sweden. Of these patients, 102 reported high work-related stress, as measured with the Work Stress Questionnaire, and 84 were on registered sick leave within one year after inclusion. The study showed that, compared to those who did not report high work-related stress, highly stressed patients more often sought care for mental symptoms (60/102 versus 24/130), sleep disturbance (37/102 versus 22/130) and fatigue (41/102 versus 34/130). The risk for sick leave with a mental diagnosis within a year after base-line was higher among patients reporting high work-related stress than among those who did not (RR 2.97, 95% CI 1.59;5.55). No such association was however found for the risk of sick leave with a musculoskeletal diagnosis (RR 0.55, 95% CI 0.22;1.37). Seeking care for mental symptoms, sleep disturbance and fatigue were associated with having a future mental sick leave diagnosis (p-values < 0.001), while seeking care for musculoskeletal symptoms was associated with having a future musculoskeletal sick leave diagnosis (p-value 0.009). In summary, compared to those who did not report high work-related stress, patients with high work-related stress more often sought care for mental symptoms, sleep disturbance and fatigue which lead to a mental sick leave diagnosis. Reporting high work-related stress was, however, not linked to having sought care for musculoskeletal symptoms nor future sick leave due to a musculoskeletal diagnosis. Hence, both patients and general practitioners seem to characterize work-related stress as a mental complaint.

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“…In the process of our questionnaire development, we discovered that the selection of social factors for the ICD had some limitations. The methodology and rationale for inclusion of factors were not always transparent or evidence based, resulting in a limited list of social factors that affect physical and mental health ( 7 ). We addressed these limitations by widening our search bases for item generation.…”

Section: Methodsmentioning

confidence: 99%

“…There are 853 codes in common medical coding systems (SNOMED, LOINC, ICD-10) to record social contextual information, which is too extensive to streamline observations ( 6 ). Furthermore, some of the most important social determinants, such as migration status, or structural racism are not addressed in current coding systems ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Development and content validation of a questionnaire to assess the social determinants of mental health in clinical practice

Handerer,

Kinderman,

Nevard

et al. 2024

Front. Psychiatry

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IntroductionThere is growing consensus that consideration of the Social Determinants of Mental Health should be at the centre of mental health care provision. To facilitate this, a validated means to assess mental health service users' social contextual information is arguably needed. We therefore developed a questionnaire to assess the Social Determinants of Mental Health in clinical practice.MethodsOur guideline-informed development consisted of three steps; i) construct and purpose definition, ii) initial item generation based on the literature, similar questionnaires, and a selection of the ICD-10, iii) evaluation, revision, and content validation of the questionnaire. Initially we developed 249 items that were reduced, revised, and validated in several stages to 73 items. Content validation of the questionnaire was achieved through surveys and focus groups including mental health care service users and professionals.ResultsThe surveys and focus groups indicated the need for a standardised assessment of adverse social factors and highlighted that the benefits of such an assessment would be a more holistic approach to identifying and addressing fundamental factors involved in the development of mental health difficulties. Importantly, this study also revealed how any assessment of the Social Determinants of Mental Health must prioritise the assessed person having a central role in the process and control over their own data. The focus groups identified contradicting recommendations regarding the most suitable context to administer the questionnaire.DiscussionThe resulting questionnaire can be considered to be theoretically robust and partially validated. Future research is discussed.

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The need for improved coding to document the social determinants of health

Cited by 5 publications

References 3 publications

Association Between Adverse Social Determinants of Health and Suicide Death

Association Between Adverse Social Determinants of Health and Suicide Death

Work-related stress, reason for consultation and diagnosis-specific sick leave: How do they add up?

Development and content validation of a questionnaire to assess the social determinants of mental health in clinical practice

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