Social Determinants of Health ICD-10 Code Use in Inpatient Pediatrics

Area of Science:

• Health Services Research
• Pediatric Health Outcomes
• Health Informatics

Background:

• The American Academy of Pediatrics recommends screening for social determinants of health (SDOH) and connecting families with resources.
• Effective response to unmet needs requires systematic identification, documentation, and resource provision.

Purpose of the Study:

• To compare the utilization of SDOH International Classification of Diseases, 10th Revision (ICD-10) codes for pediatric inpatients before and after policy changes in 2018.
• To assess the impact of allowing nonphysicians to use ICD-10 codes for SDOH.

Main Methods:

• Retrospective cohort study using the 2016 and 2019 Kid's Inpatient Database for patients under 21.
• Defined SDOH codes as ICD-10 Z-codes (Z55-Z65) or AAP-recommended codes.
• Compared code usage between 2016 and 2019 using chi-squared tests and logistic regression.

Main Results:

• SDOH code documentation increased from 1.4% in 2016 to 1.9% in 2019 (P < .001).
• Documentation was more frequent in adolescents, Native Americans, and those with mental health diagnoses.
• The number of hospitals using any SDOH code increased by nearly 8%.

Conclusions:

• International Classification of Diseases, 10th Revision (ICD-10) codes are underused for tracking social determinants of health (SDOH) in pediatric inpatient settings.
• Further research is needed to determine if SDOH code documentation improves responses to unmet social needs.
• Strategies to enhance SDOH code use by all healthcare providers should be explored.