# Social Determinants of Health ICD-10 Code Use by a Large Integrated Healthcare System

## TL;DR

This study examines how a large US healthcare system uses ICD-10 codes to document social determinants of health, finding gradual but uneven adoption over six years.

## Contribution

The study provides empirical evidence on SDOH code usage trends in a major integrated healthcare system over time.

## Key findings

- 99.2% of SDOH records were from outpatient encounters, with social, mental, and housing care services generating the most records.
- SDOH code use increased from 6.9% to 10.3% of participants over six years, but assessments were not consistently annual.
- Despite growth, the study highlights the need for universal screening tools and routine SDOH evaluations.

## Abstract

Background/Objectives: Identifying social determinants of health (SDOH) is important for effective clinical care. The ICD-10 introduced diagnostic categories to describe patients’ adverse SDOH, but these codes are infrequently used across health systems, presenting challenges to implement data-driven healthcare. This study illustrates SDOH code utilization within a setting that is recognized as one of the largest integrated healthcare systems across the United States. Methods: Real-world clinical data were used with ICD-10 SDOH records obtained from 13,523 participants randomized into the Diuretic Comparison Project, a pragmatic trial conducted within the Veterans Affairs (VA) Health Care System between 2016 and 2022. SDOH code utilization was assessed across study years and among the specialized outpatient clinics. Results: A total of 29,305 SDOH records were identified, and 99.2% were from outpatient encounters. Social, mental, and housing care services generated the most SDOH records. Moreover, 3894 (28.8%) participants had at least one SDOH record during the 6-year period. Particular, 6.9% of participants had a record in the first year, and this increased to 7.6%, 8.1%, 8.7%, 9.6%, 10.3% in consecutive years. Conclusions: Our results suggest that SDOH code utilization has continued to improve within the VA, but SDOH assessments may not occur annually or be performed systematically within an integrated health setting. Much work is needed to develop universal screening tools and mandate routine SDOH evaluations. Nevertheless, a persistent increase in the counts of ICD-10 SDOH records shows a positive movement towards systematic documentation, supporting service providers to efficiently identify patients with adverse SDOH.