How often do physicians record the International Classification of Diseases 10th Revision Z-Codes for social determinants of health? A nationwide analysis using the National Ambulatory Medical Care Survey

ObjectiveRacial/ethnic minoritized patients and those who lack health insurance are at the highest risk for experiencing healthcare disparities, mainly because of systemic disparities in the provision of care, termed social determinants of health (SDOH). Starting with the International Classification of Diseases 10th revision (ICD10), physicians can record SDOH factors that may impact their patients health. The objective of this study was to describe the recording of SDOH ICD10 Z-codes in non-federal physician clinic visits and identify the characteristics of those visits. MethodsThis was a cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) in 2016 and 2018, the only two years with available Z-code data. We used Andersens Behavioral Model of Health Services Utilization to select variables for analysis. Visits for children and adults were included in the analysis. We used appropriate unweighted and weighted descriptive statistics which accounts for the complex survey design to analyze the data. ResultsThere were a total of 23,118 unweighted visits representing 1,744,110,765 weighted visits for 2016 and 2018. In 2016, 0.21 per 100 visits (n=32 unweighted, n=1,876,542 weighted) that included a Z-code. In 2018, there were 0.08 per 100 visits (n=10 unweighted, n=681,948 weighted visits) that included a Z-code. Almost all (92.86%, n=39) physician Z-code recording was for patients who was of White race and the majority of visits with a Z-code (59.52%, n=25) were paid for by private insurance. ConclusionsConsistent with smaller-scale research, these results show that physicians may not be using Z-codes with their racial ethnic minoritized patients, suggesting a potential disparity in recording SDOH Z-codes. More work is needed to understand methods to improve uptake of Z-codes.