Why screening misses critical influences on patient health

Editor's Note

Health record codes that track social, environmental, and economic influences on patient health outcomes are vastly underutilized during screening, according a December 19 EurekAlert! report on research from John Hopkins and the University of Colorado Anschutz Medical Campus.  

Published in Health Affairs Scholar, the study analyzes the use of Z-codes to document social determinants of health (SDOH), which include homelessness, unemployment, illiteracy and other social, environmental and economic conditions that are highly correlated with patient health outcomes. Findings indicate that less than 2% of of Medicaid and commercially insured patients received Z-codes in their records.

However, Z-code use was over 50% more prevalent among Medicaid beneficiaries than commercially insured beneficiaries. Z-codes for Medicaid patients were most often related to economic hardship, while those for patients with commercial insurance were more often tied to social relationships.

To improve adoption, researchers suggest that Z-codes be more broadly integrated as quality metrics into programs being developed by Centers for Medicare & Medicaid Services and states’ section 1115 waivers, as well as integrating Z-codes into clinical decision support tools and electronic health records systems.