Social Determinants of Health - JE Part B
Social Determinants of Health
Social Determinants of Health (SDoH) are conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life risks and outcomes.
The SDoH may impact the patient’s health and lead to health disparities in a variety of complex and intersecting ways. The examples below are nonmedical factors that could be addressed to improve health outcomes and achieve greater health equity:
- A beneficiary without a vehicle may need transportation assistance if therapy treatment is ordered to recover from a procedure
- Beneficiary may not have adequate refrigerator capacity to keep a prescription cold, when necessary
- A wound on a foot may not heal correctly if a beneficiary is homeless. Cleaning the wound and keeping it sterile may be difficult
- Language or literacy level may limit the comprehension of the medical information
- Access to grocery stores with healthy food options may be limited in the area and affect the ability to have a nutritional diet
Collecting SDoH information from the patient before, during, or after the health care encounter would allow assignment of the appropriate ICD-10-CM diagnosis code(s).
Initiating Discussion with Patients
Respect the patient’s privacy if they are uncomfortable discussing topics related to SDoH. Standard screening may not be accepted by all patients. The patient may ask why a provider needs to know if they are safe, have a place to live, access to food and transportation. Establishing a trusting patient-physician relationship is important when providing an explanation for the questions.
For example: A provider planning treatment may need to know if the patient can store medication, be able to follow-up, perform personalized care, and more.
Standardized, evidence based SDoH risk assessment tools are available that have been tested and validated through research, and includes the domains of food insecurity, housing insecurity, transportation needs, and utility difficulties. One possible evidence-based tool includes the CMS Accountable Health Communities (AHC) tool (under resources). There are other standardized, evidence-based tools available that may be incorporated into the Electronic Health Record (EHR) or medical record.
Applying SDoH discussions with patients may assist to reduce disparities in managing chronic diseases when understanding limitations that may affect treatment options. Digital health intervention options (such as smartphones, wearables, videoconferencing, social media, and virtual reality) may be limited for managing chronic disease and facilitating accessible, personalized care. These tools may benefit certain groups of patients, while other groups it may cause unintentional health inequities.
Important to check periodically with patients to follow-up on identified social risks to see if circumstances have changed.
Reporting SDoH diagnosis codes - Z55-Z65
ICD-10-CM includes a variety of classifications to code for persons with potential health hazards related to socioeconomic and psychosocial circumstances. Refer to the ICD-10-CM to code to the highest specificity in the following categories:
- Z55 Problems related to education and literacy
- Z65 Problems related to employment or unemployment
- Z57 Occupational exposure to risk factors
- Z58 Problems related to physical environment
- Z59 Problems related to housing and economic circumstances
- Z60 Problems related to social environment
- Z62 Problems related to upbringing
- Z63 Other problems related to primary support group, including family circumstances
- Z64 Problems related to certain psychosocial circumstances
- Z65 Problems related to other psychosocial circumstances
Claims Data
Top five diagnosis codes
- Z59.00 - Homelessness, unspecified
- Z63.4 - Disappearance and death of family member
- Z59.6 - Low income
- Z63.6 - Dependent relative needing care at home
- Z63.0 - Problems in relationship with spouse or partner
