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J Pediatr Intensive Care
DOI: 10.1055/s-0043-1774719
DOI: 10.1055/s-0043-1774719
Original Article
A Multicenter Retrospective Evaluation of Social Determinant of Health Z Code Usage among Pediatric Patients with Critical Care Visits during Pediatric Critical Care
Funding The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1 TR002014 including TriNetX network access. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Abstract
Social determinants of health (SDOH) diagnostic codes may facilitate the deployment of appropriate resources to improve patient outcomes, but their use in critically ill pediatric populations is unknown. Our study aims to examine SDOH codes usage hypothesizing that it is underutilized. This is a retrospective observational cohort study utilizing the TriNetX electronic health record database. We included subjects aged less than 18 years with critical care services billing codes and analyzed demographics, International Classification of Diseases, 10th edition diagnostic codes, and SDOH diagnostic codes 1 year before, during (7 days before and after), and 1 year after critical care services. We included 73,444 subjects (1,150 [1.6%] SDOH codes present during; 1,015 [1.4%] 1 year before; and 1,710 [2.3%] 1 year after critical care services) from 39 health care organizations. The most common SDOH diagnostic code utilized was “problems related to upbringing” (50.4%). SDOH diagnostic codes were consistently significantly associated with diagnostic codes related to seizures. SDOH diagnostic code presence was infrequent in critically ill pediatric patients. These findings may indicate not only the underutilization of SDOH diagnostic code but also the underrepresentation of SDOH prevalence in this patient population.
Keywords
critical care - International Classification of Diseases - pediatrics - social determinants of healthPublikationsverlauf
Eingereicht: 28. Juni 2023
Angenommen: 15. August 2023
Artikel online veröffentlicht:
19. September 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 Hsu BS, Hill V, Frankel LR. et al. Executive summary: criteria for critical care of infants and children: PICU admission, discharge, and triage practice statement and levels of care Guidance. Pediatrics 2019; 144 (04) e20192433
- 2 Yıldızdaş D, Aslan N. Current situation of pediatric intensive care specialty and pediatric intensive care units in Turkey: results of a national survey. Turk Arch Pediatr 2021; 56 (02) 141-146
- 3 Sanderson AL, Burns JP. Clinical documentation for intensivists: the impact of diagnosis documentation. Crit Care Med 2020; 48 (04) 579-587
- 4 Usher MG, Fanning C, Wu D. et al. Information handoff and outcomes of critically ill patients transferred between hospitals. J Crit Care 2016; 36: 240-245
- 5 Coughlin SS, Vernon M, Hatzigeorgiou C, George V. Health literacy, social determinants of health, and disease prevention and control. J Environ Health Sci 2020; 6 (01) 3061
- 6 Islam MM. Social determinants of health and related inequalities: confusion and implications. Front Public Health 2019; 7: 11
- 7 Jones KG, Roth SE, Vartanian KB. Health and health care use strongly associated with cumulative burden of social determinants of health. Popul Health Manag 2022; 25 (02) 218-226
- 8 Centers for Medicare and Medicaid Services. ICD-10. Accessed October 31, 2021, at: https://www.cms.gov/medicare/coding/icd10
- 9 Truong HP, Luke AA, Hammond G, Wadhera RK, Reidhead M, Joynt Maddox KE. Utilization of social determinants of health ICD-10 Z-codes among hospitalized patients in the United States, 2016-2017. Med Care 2020; 58 (12) 1037-1043
- 10 Guo Y, Chen Z, Xu K. et al. International Classification of Diseases, Tenth Revision, Clinical Modification social determinants of health codes are poorly used in electronic health records. Medicine (Baltimore) 2020; 99 (52) e23818
- 11 McQuistion K, Stokes S, Allard B. et al. Social determinants of health ICD-10 code use in inpatient pediatrics. Pediatrics 2023; 152 (02) e2022059319
- 12 Hatef E, Ma X, Rouhizadeh M, Singh G, Weiner JP, Kharrazi H. Assessing the impact of social needs and social determinants of health on health care utilization: using patient- and community-level data. Popul Health Manag 2021; 24 (02) 222-230
- 13 Grant T, Croce E, Matsui EC. Asthma and the social determinants of health. Ann Allergy Asthma Immunol 2022; 128 (01) 5-11
- 14 Foley D, Best E, Reid N, Berry MMJ. Respiratory health inequality starts early: the impact of social determinants on the aetiology and severity of bronchiolitis in infancy. J Paediatr Child Health 2019; 55 (05) 528-532
- 15 Slain KN, Barda A, Pronovost PJ, Thornton JD. Social factors predictive of intensive care utilization in technology-dependent children, a retrospective multicenter cohort study. Front Pediatr 2021; 9: 721353
- 16 Hamilton H, West AN, Ammar N. et al. Analyzing relationships between economic and neighborhood-related social determinants of health and intensive care unit length of stay for critically ill children with medical complexity presenting with severe sepsis. Front Public Health 2022; 10: 789999
- 17 Andrist E, Riley CL, Brokamp C, Taylor S, Beck AF. Neighborhood poverty and pediatric intensive care use. Pediatrics 2019; 144 (06) e20190748
- 18 Foster CC, Simon TD, Qu P. et al. Social determinants of health and emergency and hospital use by children with chronic disease. Hosp Pediatr 2020; 10 (06) 471-480
- 19 Akande M, Paquette ET, Magee P, Perry-Eaddy MA, Fink EL, Slain KN. Screening for social determinants of health in the pediatric intensive care unit: recommendations for clinicians. Crit Care Clin 2023; 39 (02) 341-355
- 20 Jackson JL, Grant V, Barnett KS. et al. Structural racism, social determinants of health, and provider bias: impact on brain development in critical congenital heart disease. Can J Cardiol 2023; 39 (02) 133-143
- 21 Shonkoff JP, Garner AS. Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2012; 129 (01) e232-e246
- 22 Tran R, Forman R, Mossialos E, Nasir K, Kulkarni A. Social determinants of disparities in mortality outcomes in congenital heart disease: a systematic review and meta-analysis. Front Cardiovasc Med 2022; 9: 829902
- 23 Gottlieb LM, Hessler D, Long D. et al. Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial. JAMA Pediatr 2016; 170 (11) e162521
- 24 Vest JR, Menachemi N, Grannis SJ. et al. Impact of risk stratification on referrals and uptake of wraparound services that address social determinants: a stepped wedged trial. Am J Prev Med 2019; 56 (04) e125-e133
- 25 Buitron de la Vega P, Losi S, Sprague Martinez L. et al. Implementing an EHR-based screening and referral system to address social determinants of health in primary care. Med Care 2019; 57 (Suppl 6 Suppl 2): S133-S139
- 26 Pollak YLE, Lee JY, Khalid SI, Aquina CT, Hayden DM, Becerra AZ. Social determinants of health Z-codes and postoperative outcomes after colorectal surgery: a national population-based study. Am J Surg 2022; 224 (05) 1301-1307
- 27 Ruiz Escobar E, Pathak S, Blanchard CM. Screening and referral care delivery services and unmet health-related social needs: a systematic review. Prev Chronic Dis 2021; 18: E78
- 28 Fichtenberg C, Delva J, Minyard K, Gottlieb LM. Health and human services integration: generating sustained health and equity improvements. Health Aff (Millwood) 2020; 39 (04) 567-573
- 29 Lindau ST, Makelarski JA, Abramsohn EM. et al. CommunityRx: a real-world controlled clinical trial of a scalable, low-intensity community resource referral intervention. Am J Public Health 2019; 109 (04) 600-606
- 30 Brewster AL, Yuan CT, Tan AX, Tangoren CG, Curry LA. Collaboration in health care and social service networks for older adults: association with health care utilization measures. Med Care 2019; 57 (05) 327-333
- 31 Molina MF, Pantell MS, Gottlieb LM. Social risk factor documentation in emergency departments. Ann Emerg Med 2023; 81 (01) 38-46
- 32 Navathe AS, Zhong F, Lei VJ. et al. Hospital readmission and social risk factors identified from physician notes. Health Serv Res 2018; 53 (02) 1110-1136
- 33 Grant CG, Ramos R, Davis JL, Lee Green B. Community health needs assessment: a pathway to the future and a vision for leaders. Health Care Manag (Frederick) 2015; 34 (02) 147-156
- 34 Meyer D, Lerner E, Phillips A, Zumwalt K. Universal screening of social determinants of health at a large US Academic Medical Center, 2018. Am J Public Health 2020; 110 (Suppl. 02) S219-S221
- 35 Bottino CJ, Rhodes ET, Kreatsoulas C, Cox JE, Fleegler EW. Food insecurity screening in pediatric primary care: can offering referrals help identify families in need?. Acad Pediatr 2017; 17 (05) 497-503
- 36 Bensken WP, Alberti PM, Baker MC, Koroukian SM. An increase in the use of ICD-10 Z-codes for social risks and social needs: 2015 to 2019. Popul Health Manag 2023; 26 (02) 113-120
- 37 Dubowitz H. The safe environment for every kid (SEEK) model: helping promote children's health, development, and safety: SEEK offers a practical model for enhancing pediatric primary care. Child Abuse Negl 2014; 38 (11) 1725-1733
- 38 Sullivan K, Thakur N. Structural and social determinants of health in asthma in developed economies: a scoping review of literature published between 2014 and 2019. Curr Allergy Asthma Rep 2020; 20 (02) 5
- 39 Washington DM, Curtis LM, Waite K, Wolf MS, Paasche-Orlow MK. Sociodemographic factors mediate race and ethnicity-associated childhood asthma health disparities: a longitudinal analysis. J Racial Ethn Health Disparities 2018; 5 (05) 928-938
- 40 Thakur N, Martin M, Castellanos E. et al. Socioeconomic status and asthma control in African American youth in SAGE II. J Asthma 2014; 51 (07) 720-728
- 41 Glick AF, Tomopoulos S, Fierman AH, Trasande L. Disparities in mortality and morbidity in pediatric asthma hospitalizations, 2007 to 2011. Acad Pediatr 2016; 16 (05) 430-437
- 42 Dulin MF, Tapp H, Smith HA. et al. A trans-disciplinary approach to the evaluation of social determinants of health in a Hispanic population. BMC Public Health 2012; 12: 769
- 43 Zsembik BA, Fennell D. Ethnic variation in health and the determinants of health among Latinos. Soc Sci Med 2005; 61 (01) 53-63
- 44 Klinger EV, Carlini SV, Gonzalez I. et al. Accuracy of race, ethnicity, and language preference in an electronic health record. J Gen Intern Med 2015; 30 (06) 719-723
- 45 Anand KJS, Sepanski RJ, Giles K, Shah SH, Juarez PD. Pediatric intensive care unit mortality among Latino children before and after a multilevel health care delivery intervention. JAMA Pediatr 2015; 169 (04) 383-390
- 46 Cabral J, Cuevas AG. Health inequities among Latinos/Hispanics: documentation status as a determinant of health. J Racial Ethn Health Disparities 2020; 7 (05) 874-879
- 47 Fischer A, Conigliaro J, Allicock S, Kim EJ. Examination of social determinants of health among patients with limited English proficiency. BMC Res Notes 2021; 14 (01) 299