Related Experiment Video
Updated: Jun 14, 2026

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Social Determinants of Health Z-Codes Are Associated With Low Compliance With Patient-Reported Outcome Measures After
Matthew Parry1, Yagiz Ozdag2, Austin Kloc3
1Department of Orthopaedic Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania.
Background:
There is limited literature on compliance rates for completing patient-reported outcome measures (PROMs) after elective total hip arthroplasty (THA). Social determinants of health (SDOH) refers to social factors that are not classifiable elsewhere and can have a major impact on health-care outcomes. The purpose of this investigation was to assess the relationship between SDOH codes, demographic and surgical factors, and compliance rates for filling out PROMs after THA.
Methods:
This was a retrospective cohort study of elective THA cases performed between 2017 and 2022 at a single institution. Patients less than 18 years of age and patients who had less than two years of follow-up were excluded. The SDOH codes ("Z" codes), mental health codes ("F" codes), and compliance rates were recorded. The study population was binarized into two cohorts: any compliance (greater than 0%) versus no compliance (0%). Bivariate and multivariate regression analyses were performed to assess compliance with PROMs against SDOH, demographic, and surgical factors. A total of 3,392 cases were included, of which 1,779 (52.5%) had completed at least one set of PROM questionnaires, while 1,613 (47.5%) were noncompliant. Overall survey completion in the study period was 25.8%.
Results:
Results of the multivariate regression analyses indicated that having any Z-codes (odds ratio: [OR] 0.355, 95% CI [confidence interval]: 0.123 to 0.842, P = 0.045), being a non-English speaker (OR: 0.202, 95% CI: 0.065 to 0.631, P = 0.006), and men (OR: 0.845, 95% CI: [0.731 to 0.977, P = 0.023) were all independent risk factors for noncompliance. Conversely, married (OR: 1.540, 95% CI: 1.329 to 1.784, P = 0.001) or employed patients (OR: 1.445, 95% CI: 1.216 to 1.717, P = 0.001) had higher odds of being compliant.
Conclusions:
Overall, only 25.8% of PROMs are completed after THA at two years postoperatively. While Z-codes adversely affected compliance rates, not being an English speaker was the biggest factor for PROM noncompliance. Employed or married patients were more likely to be compliant with completing one PROM.
Related Concept Videos
Introduction to z Scores
z scores help...
Introduction to z Scores
z scores help...
z Scores and Unusual Values
This score indicates how far a value is from the mean in terms of standard deviation. For example, if a data value has a z score of +1, the researcher can infer that the particular data value is one standard deviation above the mean. If another data value...
z Scores and Area Under the Curve
SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
Factors Affecting Illness
For instance, risk factors are connected to illness, disability,...
