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Integrated Healthcare System01:20

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An integrated healthcare system (IHS) is a set of organizations that provides for or arranges to provide coordinated and continuous service to a defined population. The IHS takes responsibility for that particular population's health status and outcome, both clinically and fiscally. An integrated healthcare system is a well-organized, well-coordinated, and collaborative network. The integrated delivery system is a network that connects different healthcare providers to deliver organized,...
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Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
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Specialized care provided over an extended period is called tertiary care. Usually, a primary or secondary care physician will refer a patient to tertiary care. A patient's maximum physical and mental function is restored in tertiary care, which is caused due to the impact of a chronic illness or condition. Tertiary care aims to achieve the highest level of functioning possible while managing chronic illness. For example, a patient who falls and fractures their hip will need secondary care...
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Nursing Clinical Information System (NCIS)
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Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
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Social Determinants of Health ICD-10 Code Use by a Large Integrated Healthcare System.

Cynthia Hau1, Janet M Grubber1, Ryan E Ferguson1,2

  • 1Cooperative Studies Program Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, USA.

Healthcare (Basel, Switzerland)
|November 13, 2025
PubMed
Summary

Social determinants of health (SDOH) code use is increasing in the Veterans Affairs (VA) health system. However, systematic annual SDOH assessments are not yet standard practice, requiring further development of universal screening tools.

Keywords:
EHR documentationSDOH ICD recordcode utilizationsocial determinants of health

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Area of Science:

  • Health Services Research
  • Public Health Informatics
  • Clinical Data Analysis

Background:

  • Identifying social determinants of health (SDOH) is crucial for effective clinical care and data-driven healthcare.
  • International Classification of Diseases, 10th Revision (ICD-10) codes for adverse SDOH exist but are underutilized in many health systems.
  • This study examines SDOH code utilization within a large integrated healthcare system, the U.S. Department of Veterans Affairs (VA).

Purpose of the Study:

  • To assess the utilization patterns of ICD-10 SDOH codes within the VA Health Care System.
  • To analyze trends in SDOH code documentation over a six-year period.
  • To identify challenges and opportunities for improving SDOH data collection in integrated healthcare settings.

Main Methods:

  • Utilized real-world clinical data from 13,523 participants in the pragmatic Diuretic Comparison Project trial (2016-2022).
  • Extracted and analyzed ICD-10 SDOH records from electronic health records within the VA.
  • Assessed SDOH code utilization across study years and outpatient clinic types.

Main Results:

  • A total of 29,305 SDOH records were identified, with 99.2% from outpatient encounters.
  • Social, mental, and housing care services generated the most SDOH records.
  • Participant SDOH record prevalence increased from 6.9% in the first year to 10.3% in the sixth year, indicating improved documentation.

Conclusions:

  • SDOH code utilization shows a positive trend within the VA, suggesting progress toward systematic documentation.
  • SDOH assessments may not be occurring annually or systematically across all integrated health settings.
  • Further development of universal screening tools and mandatory routine SDOH evaluations are needed to fully leverage this data for patient care.