CoChat
Sign Up
Cited by 64Medical Coding and Health InformationNursing Diagnosis and DocumentationElectronic Health Records Systems

Documenting social determinants of health-related clinical activities using standardized medical vocabularies

Open access
Arons, Abigail, DeSilvey, Sarah, Fichtenberg, Caroline, Gottlieb, Laura·2019·JAMIA Open
DOI 10.1093/jamiaopen/ooy051PMC PMC6951949
Open this paper in CoChat — free accountOpen PDF

Abstract

Objectives: Growing recognition that health is shaped by social and economic circumstances has resulted in a rapidly expanding set of clinical activities related to identifying, diagnosing, and intervening around patients’ social risks in the context of health care delivery. The objective of this exploratory analysis was to identify existing documentation tools in common US medical coding systems reflecting these emerging clinical practices to improve patients’ social health. Materials and Methods: We identified 20 social determinants of health (SDH)-related domains used in 6 published social health assessment tools. We then used medical vocabulary search engines to conduct three independent searches for codes related to these 20 domains included in common medical coding systems (LOINC, SNOMED CT, ICD-10-CM, and CPT). Each of the 3 searches focused on one of three clinical activities: Screening, Assessment/Diagnosis, and Treatment/Intervention. Results: We found at least 1 social Screening code for 18 of the 20 SDH domains, 686 social risk Assessment/Diagnosis codes, and 243 Treatment/Intervention codes. Fourteen SDH domains (70%) had codes across all 3 clinical activity areas. Discussion: Our exploratory analysis revealed 1095 existing codes in common medical coding vocabularies that can facilitate documentation of social health-related clinical activities. Despite a large absolute number of codes, there are addressable gaps in the capacity of current medical vocabularies to document specific social risk factor screening, diagnosis, and interventions activities. Conclusions: Findings from this analysis should help inform efforts both to develop a comprehensive set of SDH codes and ultimately to improve documentation of SDH-related activities in clinical settings.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/jamiaopen/ooy051

Cites

2 of 2 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 34

  1. [1]McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270 18: 2207– 12. 8411605
  2. [2]McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002; 21 2: 78– 93. 11900188
  3. [3]McGovern L, Miller G, Hughes-Cromwick P. Health policy brief: the relative contribution of multiple determinants to health outcomes. Health Policy Brief. Health Aff. August 21, 2014. https://www.healthaffairs.org/do/10.1377/hpb20140821.404487/full/. Accessed October 4, 2018. · DOI
  4. [4]Adler NE, Marmot M, McEwen BS, et al Socioeconomic Status and Health in Industrial Nations: Social, Psychological, and Biological Pathways. Washington, DC: National Academy of Sciences; 1999. 10702106
  5. [7]Starfield B. Is US health really the best in the world? JAMA 2000; 284 4: 483– 5. 10904513
  6. [8]Hurtado MP, Swift EK, Corrigan JM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001. 25057539
  7. [9]AAP Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics 2016; 137 (4): e20160339. 26962238
  8. [12]Wyatt R, Laderman M, Botwinick L, et al Achieving Health Equity: A Guide for Health Care Organizations. Cambridge, MA: Institute for Healthcare Improvement; 2016.
  9. [13]Sadowski LS, Kee RA, VanderWeele TJ, et al Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA 2009; 301 17: 1771– 8. 19417194
  10. [14]Larimer ME, Malone DK, Garner MD, et al Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA 2009; 301 13: 1349– 57. 19336710
  11. [15]Shubert V, Bernstine N. Moving from fact to policy: housing is HIV prevention and health care. AIDS Behav 2007; 11 (6 Suppl): 172– 81. 17705094
  12. [16]Gottlieb LM, Wing H, Adler NE. A systematic review of interventions on patients’ social and economic needs. Am J Prev Med 2017; 53 5: 719– 29. 28688725
  13. [17]Institute of Medicine. Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2. Washington, DC: National Academies Press; 2014. 25590118
  14. [18]Gottlieb L, Tobey R, Cantor J, et al Integrating social and medical data to improve population health: opportunities and barriers. Health Aff 2016; 35 11: 2116– 23. 27834254
  15. [20]King RJ, Garrett N, Kriseman J, et al A community health record: improving health through multisector collaboration, information sharing, and technology. Prev Chronic Dis 2016; 13 (9): 160101. PMC5027852 27609300
  16. [21]Navathe AS, Zhong F, Lei VJ, et al Hospital readmission and social risk factors identified from physician notes. Health Serv Res 2018; 53 2: 1110– 36. 28295260 PMC5867172
  17. [22]Torres JM, Lawlor J, Colvin JD, et al ICD social codes: an underutilized resource for tracking social needs. Med Care 2017; 55 9: 810– 6. 28671930
  18. [23]Cantor MN, Thorpe L. Integrating data on social determinants of health into electronic health records. Health Aff (Millwood) 2018; 37 4: 585– 90. 29608369 PMC10995852
  19. [24]Hripcsak G, Forrest CB, Brennan PF, et al Informatics to support the IOM social and behavioral domains and measures. J Am Med Inform Assoc 2015; 22 4: 921– 4. 25914098 PMC4482277
  20. [25]Office of the National Coordinator for Health Information Technology. 2015. Edition Certification Companion Guide: Social, Psychological, and Behavioral Data - 45 CFR 170.315(a)(15) 2017.
  21. [28]Winden TJ, Chen ES, Melton GB. Representing residence, living situation, and living conditions: an evaluation of terminologies, standards, guidelines, and measures/surveys. Proc Am Med Inform Assoc 2016; 2016: 2072. PMC5333311 28269967
  22. [29]Rajamani S, Chen ES, Lindemann E, et al Representation of occupational information across resources and validation of the occupational data for health model. J Am Med Inform Assoc 2018; 25 2: 197– 205. 28444213 PMC6080809
  23. [30]Aldekhyyel R, Chen ES, Rajamani S, et al Content and quality of free-text occupation documentation in the electronic health record. Proc Am Med Inform Assoc 2016; 2016: 1708. PMC5333203 28269929
  24. [33]Hicks A, Hanna J, Welch D, et al The ontology of medically related social entities: recent developments. J Biomed Semantics 2016; 7: 47. 27406187 PMC4942889
  25. [39]Crum RM, Anthony JC, Bassett SS, et al Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 1993; 269 18: 2386– 91. 8479064
  26. [40]Fiscella K, Tancredi D, Franks P. Adding socioeconomic status to Framingham scoring to reduce disparities in coronary risk assessment. Am Heart J 2009; 157 6: 988– 94. 19464408
  27. [42]Sommers BD, Baicker K, Epstein AM. Mortality and access to care among adults after state Medicaid expansions. N Engl J Med 2012; 367 11: 1025– 34. 22830435
  28. [43]Weiner S. I can't afford that! J Gen Intern Med 2001; 16 6: 412– 8. 11422639 PMC1495228
  29. [44]Saha S, Fernandez A, Perez-Stable E. Reducing language barriers and racial/ethnic disparities in health care: an investment in our future. J Gen Intern Med 2007; 22 (S2): 371– 2. 17896164 PMC2040485
  30. [45]Basu A, Kee R, Buchanan D, et al Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care. Health Serv Res 2012; 47 (1 Pt 2): 523– 43. 22098257 PMC3393008
  31. [46]Sandel M, Hansen M, Kahn R, et al Medical-legal partnerships: transforming primary care by addressing the legal needs of vulnerable populations. Health Aff 2010; 29 9: 1697– 705. 20820029
  32. [47]Weintraub D, Rodgers MA, Botcheva L, et al Pilot study of medical-legal partnership to address social and legal needs of patients. J Health Care Poor Underserved 2010; 21 (2 Suppl): 157– 68. 20453383
  33. [48]Fraze T, Lewis VA, Rodriguez HP, et al Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients. Health Aff 2016; 35 11: 2109– 15. PMC5377443 27834253
  34. [50]SNOMED CT Brower (US edition). http://browser.ihtsdotools.org/. Accessed March 2018.

Cited by

Sorted by citations

Authors
Arons, A., DeSilvey, S., Fichtenberg, C., & Gottlieb, L.
Affiliations
  • University of California, San Francisco (US)
  • University of Vermont (US)
Corresponding author
Gottlieb, Laura
ORCID
Venue
JAMIA Open
Publisher
Oxford University Press (OUP)
Published
2018-12-24
Volume
2
Issue
1
Pages
81-88
ISSN
2574-2531 (ISSN-L)
DOI
10.1093/jamiaopen/ooy051
PMC
PMC6951949
OpenAlex
W2906005328
Cited by
64
References
2
Citations by year
2026: 5 · 2025: 7 · 2024: 8 · 2023: 11 · 2022: 17 · 2021: 9 · 2020: 7
FWCI
5.04
Type
journal article
Language
en
Open access
Licence
Locations
  • JAMIA Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
Kaiser Permanente (CRN-5374-7544-15320)
Topics
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
  • Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords
social determinants of health, LOINC, SNOMED CT, ICD-10-CM, CPT codes, social risk screening, clinical documentation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review