Abstract
Background: International Classification of Diseases, 10th revision Z codes capture social needs related to health care encounters and may identify elevated risk of acute care use. Objectives: To examine associations between Z code assignment and subsequent acute care use and explore associations between social need category and acute care use. Research Design: Retrospective cohort study. Subjects: Adults continuously enrolled in a commercial or Medicare Advantage plan for ≥15 months (12-month baseline, 3-48 month follow-up). Outcomes: All-cause emergency department (ED) visits and inpatient admissions during study follow-up. Results: There were 352,280 patients with any assigned Z codes and 704,560 sampled controls with no Z codes. Among patients with commercial plans, Z code assignment was associated with a 26% higher rate of ED visits [adjusted incidence rate ratio (aIRR) 1.26, 95% CI: 1.25-1.27] and 42% higher rate of inpatient admissions (aIRR 1.42, 95% CI: 1.39-1.44) during follow-up. Among patients with Medicare Advantage plans, Z code assignment was associated with 42% (aIRR 1.42, 95% CI: 1.40-1.43) and 28% (aIRR 1.28, 95% CI: 1.26-1.30) higher rates of ED visits and inpatient admissions, respectively. Within the Z code group, relative to community/social codes, socioeconomic Z codes were associated with higher rates of inpatient admissions (commercial: aIRR 1.10, 95% CI: 1.06-1.14; Medicare Advantage: aIRR 1.24, 95% CI 1.20-1.27), and environmental Z codes were associated with lower rates of both primary outcomes. Conclusions: Z code assignment was independently associated with higher subsequent emergency and inpatient utilization. Findings suggest Z codes' potential utility for risk prediction and efforts targeting avoidable utilization.
Original language | English (US) |
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Pages (from-to) | 60-66 |
Number of pages | 7 |
Journal | Medical care |
Volume | 62 |
Issue number | 1 |
DOIs | |
State | Published - Jan 1 2024 |
Funding
Funding support was provided by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, #UH1HP29963. UnitedHealth Group provided in-kind access to the study data.
Keywords
- diagnostic coding
- emergency department visits
- health services research
- health-related social needs
- inpatient utilization
- social determinants of health
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health