TY - JOUR
T1 - The adoption of social determinants of health documentation in clinical settings
AU - Kepper, Maura M.
AU - Walsh-Bailey, Callie
AU - Prusaczyk, Beth
AU - Zhao, Min
AU - Herrick, Cynthia
AU - Foraker, Randi
N1 - Funding Information:
This publication was made possible by the Center for Diabetes Translation Research (P30DK092950), funded by the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK), the Centers for Disease Control and Prevention U48DP006395 and the Washington University's Mentored Training in Implementation Science (MTIS) program supported by the National Heart, Lung and Blood Institute (NHLBI) K12HL137942. It was partially supported by Grant Number T37 MD014218 from the National Institute of Minority Health and Health Disparities (NIMHD) and Grant Number K23HD096204 from the National Institute of Child Health and Human Development, National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Publisher Copyright:
© 2022 Health Research and Educational Trust.
PY - 2023/2
Y1 - 2023/2
N2 - Objective: To understand the frequency of social determinants of health (SDOH) diagnosis codes (Z-codes) within the electronic health record (EHR) for patients with prediabetes and diabetes and examine factors influencing the adoption of SDOH documentation in clinical care. Data Sources: EHR data and qualitative interviews with health care providers and stakeholders. Study Design: An explanatory sequential mixed methods design first examined the use of Z-codes within the EHR and qualitatively examined barriers to documenting SDOH. Data were integrated and interpreted using a joint display. This research was informed by the Framework for Dissemination and Utilization of Research for Health Care Policy and Practice. Data Collection/Extraction Methods: We queried EHR data for patients with a hemoglobin A1c > 5.7 between October 1, 2015 and September 1, 2020 (n = 118,215) to examine the use of Z-codes and demographics and outcomes for patients with and without social needs. Semi-structured interviews were conducted with 23 participants (n = 15 health care providers; n = 7 billing and compliance stakeholders). The interview questions sought to understand how factors at the innovation-, individual-, organizational-, and environmental-level influence SDOH documentation. We used thematic analysis to analyze interview data. Principal Findings: Patients with social needs were disproportionately older, female, Black, uninsured, living in low-income and high unemployment neighborhoods, and had a higher number of hospitalizations, obesity, prediabetes, and type 2 diabetes than those without a Z-code. Z-codes were not frequently used in the EHR (<1% of patients), and there was an overall lack of congruence between quantitative and qualitative results related to the prevalence of social needs. Providers faced barriers at multiple levels (e.g., individual-level: discomfort discussing social needs; organizational-level: limited time, competing priorities) for documenting SDOH and identified strategies to improve documentation. Conclusions: Providers recognized the impact of SDOH on patient health and had positive perceptions of screening for and documenting social needs. Implementation strategies are needed to improve systematic documentation.
AB - Objective: To understand the frequency of social determinants of health (SDOH) diagnosis codes (Z-codes) within the electronic health record (EHR) for patients with prediabetes and diabetes and examine factors influencing the adoption of SDOH documentation in clinical care. Data Sources: EHR data and qualitative interviews with health care providers and stakeholders. Study Design: An explanatory sequential mixed methods design first examined the use of Z-codes within the EHR and qualitatively examined barriers to documenting SDOH. Data were integrated and interpreted using a joint display. This research was informed by the Framework for Dissemination and Utilization of Research for Health Care Policy and Practice. Data Collection/Extraction Methods: We queried EHR data for patients with a hemoglobin A1c > 5.7 between October 1, 2015 and September 1, 2020 (n = 118,215) to examine the use of Z-codes and demographics and outcomes for patients with and without social needs. Semi-structured interviews were conducted with 23 participants (n = 15 health care providers; n = 7 billing and compliance stakeholders). The interview questions sought to understand how factors at the innovation-, individual-, organizational-, and environmental-level influence SDOH documentation. We used thematic analysis to analyze interview data. Principal Findings: Patients with social needs were disproportionately older, female, Black, uninsured, living in low-income and high unemployment neighborhoods, and had a higher number of hospitalizations, obesity, prediabetes, and type 2 diabetes than those without a Z-code. Z-codes were not frequently used in the EHR (<1% of patients), and there was an overall lack of congruence between quantitative and qualitative results related to the prevalence of social needs. Providers faced barriers at multiple levels (e.g., individual-level: discomfort discussing social needs; organizational-level: limited time, competing priorities) for documenting SDOH and identified strategies to improve documentation. Conclusions: Providers recognized the impact of SDOH on patient health and had positive perceptions of screening for and documenting social needs. Implementation strategies are needed to improve systematic documentation.
KW - delivery of health care
KW - diabetes
KW - implementation science
KW - social determinants of health
KW - social needs
UR - http://www.scopus.com/inward/record.url?scp=85135190242&partnerID=8YFLogxK
U2 - 10.1111/1475-6773.14039
DO - 10.1111/1475-6773.14039
M3 - Article
C2 - 35862115
AN - SCOPUS:85135190242
SN - 0017-9124
VL - 58
SP - 67
EP - 77
JO - Health services research
JF - Health services research
IS - 1
ER -