The Promise of Using Social Determinants of Health Diagnoses

The conditions in which people live often play a greater role in personal health than genetic factors. Those external forces – such as homelessness, spousal relationships, family death, and poor educational performance, to name a few – are known as social determinants of health (SDOH). And they are, as the acronym implies, determinative. SDOH have a defined association with health that exists prior to the delivery of care, is not necessarily ameliorated by the quality of care received, and health care providers are often helpless to solve its challenges.1 An emphasis on improving health care quality and reducing cost over the past decade has prompted increased scrutiny on the effects of SDOH as they relate to health care service utilization trends. For instance, efforts to reduce readmissions by health care providers can be complicated in situations where patients lack access to reliable transportation, pharmacy services, or local medical offices. The October 2015 update to the International Classification of Diseases (10th revision) provided an opportunity for health care professionals to identify, diagnose, and document patient health status issues that affect care outcomes. As a result, there now are specific codes to identify SDOH. That marker enables health care providers to track how SDOH affects care outcomes. A recent analysis of inpatient and emergency room data conducted by the Missouri Hospital Association revealed that patients with an SDOH diagnosis had 213 percent more inpatient and emergency room visits in 2016 than those without a SDOH diagnosis.2 To determine the prevalence of SDOH in Virginia patient data, the VHHA Analytics Team examined All Payer Claims Database (APCD) cases from 2015 to 2017. The chart below identifies the top five SDOH codes present in Virginia data. It is important to note that the abundance of ambulatory records, in contrast to inpatient records, in the database may impact the order and type of SDOH diagnoses observed in the data. Another factor that influences the data is the reality that the APCD does not include all patient populations. APCD records are culled from insurance claims made by policy holders, so health care use rendered to uninsured patients is not included in the database. Moving forward, VHHA will conduct research that explores whether SDOH patterns change as the data is categorically parsed as inpatient and ambulatory services, and that examines ways in which SDOH diagnoses impact health care utilization.

1 Buntin, M. B. & Ayanian, J. Z. (2017). Social Risk Factors and Equity in Medicare Payment. New England Journal of Medicine, 376, 507-510. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMp1700081
2 Reidhead, Mat (September 2018). Decoding Social Determinants of Health. Hospital Industry Data Institute.