Use of social determinants of health codes in home-based primary care

Abstract

Background: The Affordable Care Act created funding for nurse practitioner education programs to transform the primary health care workforce through student awareness of how social, political, economic, and environmental factors influence individual and population health. Funding established Academic Clinical Partnerships (ACPs) that created value-based health care models, which improved patient outcomes and decreased hospital and emergency department admissions and health care costs. The ACP established a home-based primary health care (HBPC) program to deliver primary care and collect patient data. Purpose: The purposes were to describe the incidence of chronic conditions for HBPC patients and determine associations between chronic conditions and presence of social determinants of health (SDoH). Methodology: Nurse practitioner students were assigned to HBPC clinical placements. A convenience sample of 102 high-risk, homebound patients was identified. Nurse practitioners and students recorded deidentified patient data, including ICD-10-CM codes into a Health Insurance Portability and Accountability Act compliant platform. Secondary analysis of patient records assessed for SDoH through Z codes. Results: Patients had high incidences of hypertension, diabetes, pulmonary disease, heart disease, chronic pain, mood, and substance abuse disorders. Secondary analysis revealed that 92% of patients had indications for the use of Z codes, but these were not recorded. Conclusions: Common Z codes were personal risk factors, housing/economic circumstances, care provider dependency, lifestyle, and family support. Implications for practice: By coding for SDoH, providers and agencies can realize higher reimbursement rates in HBPC settings. Nurse practitioners can use this information to provide better treatment recommendations, more accurate diagnoses, and referrals to enhance primary care services to a patient population negatively affected by SDoH.

Evaluating adherence to American Diabetes Association standards of care in diabetes and impacts of social determinants of health on patients at two nurse practitioner–owned clinics

“…It is known that SDOH impact healthcare outcomes, and our findings reflect that NPs assess for them routinely (Coppa et al, 2021; Hill-Briggs et al, 2020; New England Journal of Medicine Catalyst, 2017). Although assessment was at 100%, there were multiple limitations to proper screening related to documentation.…”

“…Grade A evidence supports the assessment of social determinants of health (SDOH) and referral to appropriate resources in diabetes management (ADA, 2022). Evidence now indicates that SDOH can be viewed as the strongest predictor of health outcomes at the individual and population level (Coppa et al, 2021; Hill-Briggs et al, 2020; New England Journal of Medicine Catalyst, 2017). Despite this knowledge, the COVID-19 pandemic has exacerbated existing disparities and increased the complexity of chronic disease management, with diabetes being the most affected condition (Chudasama et al, 2020).…”

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

“…Although there are potential benefits to documenting social needs with SDOH-related Z codes, to date, this has not been mandated 2 ; for example, a small review of records for high-risk patients found that 92% of patients had information that could have been coded but were not documented with SDOH-related Z codes. 36 There are efforts to increase the documentation of social needs with SDOH-related Z coding in clinical practice. The AHA recently updated guidance to recommend that administrators raise awareness and educate physicians, other healthcare providers, and medical coders on how to screen, document, and code data on patients’ social needs.…”

Supporting professionals to implement integrated, person-centered care for people with chronic conditions: the TARGET pilot study

“…To design the TARGET segmentation tool as truly holistic, it should be expanded with social data, as acknowledged by other studies into segmentation tools as well [ 48 ]. However, these data are often lacking as the internationally classified codes for registering social issues, Z-codes, are systematically underutilized by healthcare professionals and exchange of patient information between domains is complicated [ 17 , 49–52 ]. Instead, the PCAM can be used for registering social data: we recently found evidence that PCAM has adequate measurement properties [ 34 ].…”