Social Determinants of Health (SDoH)

Submitted by: Tamara D. Rodriguez, FHIMA Director

Z93.1, this is the ICD-10-CM code to classify patient noncompliance with medical treatment and regimen. On the surface, it seems clear that the patient is not taking medications as prescribed or is not following the doctor’s orders related to the treatment plan. However, this may not be the bottom line to the story. The patient may have many other extenuating circumstances that lead to non-compliance and poor health outcomes. These extenuating circumstances are Social Determinants of Health.

Social determinants of health (SDoH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks (U.S. Department of Health and Human Services, 2021). SDoH also contribute to wide health disparities and inequities. For example, people who do not have access to grocery stores with healthy foods are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes, and obesity — and even lowers life expectancy relative to people who do have access to healthy foods (U.S. Department of Health and Human Services, 2021). Access to food is just one domain of SDoH. The other domains include economic stability, neighborhood and physical environment, education, community and social context, and health care system. Figure 1 details the subdomains of SDoH (American Medical Association, 2018). 

Figure 1: Social Determinants of health. (American Medical Association, 2018)

Over two decades of research indicates that SDoH have up to a six-fold greater impact on health outcomes than clinical care (American Medical Association, 2018). As a result, the healthcare industry is taking great measures to address them along with clinical interventions by integrating this data into EHR. Health Plans are also now including benefits that address SDoH. For example, meal delivery plans for patients with special diets or gym memberships for patients with cardiovascular conditions. 

As an HIM Professional, how might you be impacted by SDoH? There are ICD-10-CM Z codes related to SDoH. Many healthcare facilities are encouraging increased usage of these codes. Also, you can expect to see SDoH data incorporated into the electronic health record (EHR). Many Health IT vendors have products to support SDoH; including but not limited to Cerner, Epic, and Optum. Furthermore, in December 2020, AHIMA released a new policy statement regarding SDoH. AHIMA President/Chair Ginna Evans, MBA, RHIA, CPC, CRC, FAHIMA, who serves on the AHIMA Board of Directors, said, “AHIMA is the leading voice of health information and I’m proud of the work we have done and will continue to do to educate, align, and advocate for purposeful and informed SDoH strategies.Health information professionals can offer a unique perspective on how to use and share SDoH data, and I’m excited to see how it will lead to improved patient care in the coming years.” (American Health Information Management Association, 2020) 

If you would like more information on SDoH, more resources are included below:

• CDC- Social Determinants of Health: Know What Affects Health
• Healthy People 2030- Social Determinants of Health
• ONC- Social Determinants of Health
• WHO- Social Determinants of Health

References

American Health Information Management Association. (2020, December 7). AHIMA Releases New Policy Statement Regarding Social Determinants of Health. Retrieved from AHIMA.org: https://www.ahima.org/news-publications/press-room-press-releases/2020-press-releases/ahima-releases-new-policy-statement-regarding-social-determinants-of-health/

American Medical Association. (2018, August 30). Addressing Social Determinants of Health (SDoH). Retrieved from AMA Steps Forward: https://edhub.ama-assn.org/steps-forward/module/2702762

U.S. Department of Health and Human Services. (2021, March 9). Healthy People 2030- Social Determinants of Health. Retrieved from U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion: https://health.gov/healthypeople/objectives-and-data/social-determinants-health