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

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Objective Racial/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 10 th 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. Methods This 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 Andersen’s 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. Results There 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. Conclusions Consistent 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’.