Social Determinants of Health ICD-10 Code Use in Inpatient Pediatrics.

BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics endorses screening for social determinants of health (SDOH) and providing families resources for unmet needs. A systematic response to unmet needs requires identification, documentation, and provision of resources. Our goal was to compare SDOH International Classification of Diseases, 10th Revision (ICD-10), code use for pediatric inpatients after policy changes in 2018 permitting coding by nonphysicians. METHODS: We conducted a retrospective cohort study comparing data from the 2016 and 2019 Kid's Inpatient Database for patients <21 years old. The primary variable was the presence of an SDOH code, defined as an ICD-10 Z-code (Z55-Z65) or 1 of 13 ICD-10 codes recommended by the American Academy of Pediatrics. We compared overall SDOH code usage between 2016 and 2019, and by Z-code category, demographic, clinical, and hospital characteristics using χ2 tests and odds ratios. Using logistic regression, we examined hospital-level characteristics for hospitals with >5% of discharges with an SDOH code. RESULTS: SDOH code documentation increased from 1.4% in 2016 to 1.9% in 2019 (P < .001), with no notable differences based on Z-code category. In both periods, SDOH code documentation was more common in adolescents, Native Americans, and patients with mental health diagnoses. The number of all hospitals using any SDOH code increased nearly 8% between 2016 and 2019. CONCLUSIONS: ICD-10 codes remain underused to track SDOH needs within the inpatient pediatric setting. Future research should explore whether SDOH code documentation is associated with increased response to unmet social needs and, if so, how to improve use of SDOH codes by all providers.

Parent Preferences on Screening for Social Determinants of Health in Hospitalized Children.

BACKGROUND: Although there has been much research on screening families for social determinants of health (SDOH) at pediatric outpatient visits, there is little data on family preferences about SDOH screening during hospitalization. This is of critical importance because unmet SDOH, also known as social needs, are associated with poor health outcomes. OBJECTIVE: Our objective was to assess caregiver preferences for social needs screening in the inpatient pediatric setting. METHODS: We surveyed a sample of caregivers of admitted patients at our freestanding tertiary-care children's hospital between March 2021 and January 2022. Caregivers were surveyed with respect to the importance of screening, their comfort with screening, and which domains were felt to be acceptable for screening. RESULTS: We enrolled 160 caregivers. More than 60% of caregivers were comfortable being screened for each of the social needs listed. Between 40% and 50% found screening acceptable, even if resources were unavailable. Forty-five percent preferred to be screened in private, 9% preferred to be screened by a health care team member, and 37% were comfortable being screened either in private or with a health care team member. Electronic screening was the most preferred modality (44%), and if by a health care team member, social workers were preferred over others. CONCLUSIONS: Many caregivers reported the acceptance of and comfort with social needs screening in the inpatient setting. Our findings may help inform future hospital-wide social needs screening efforts.