ArticleJournal of general internal medicine2025
Z-Code Health-Related Social Needs and Their Association with Post-Discharge Healthcare Utilization in Older Adults with Heart Failure and COPD.
Article in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundReadmission rates are widely recognized indicators of healthcare quality, particularly for older adults. There is relatively little data on the role of health-related social needs (HRSNs) in post-discharge healthcare utilization (HCU). We investigated the association between HRSNs documented using Z-codes and unplanned 30- and 90-day HCU in older adults with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD).
methodsThis retrospective cohort study analyzed electronic health record (EHR) data from a regional health information exchange for individuals aged ≥ 65 with HF and/or COPD hospitalized at least once between 2019 and 2022. HRSNs were identified using ICD-10 Z-codes (Z55-Z65, Z75; Z61 for problems related to negative life events in childhood was excluded). The primary outcome, unplanned HCU, was defined as a composite of emergency department visits and unplanned inpatient admissions within 30- and 90-day post-discharge. Logistic regression models assessed associations between Z-code documentation and HCU, adjusting for demographic and clinical factors.
resultsAmong 19,536 older adults, 4.01% had Z-codes documented. The most frequently documented Z-code was "Medical Facilities/Other Health Care" (Z75) (31.1% of cases with Z-codes). Unplanned HCU occurred in 23.3% and 39.5% of individuals within 30 and 90 days, respectively. Z-code documentation was significantly associated with greater odds of HCU in univariable and multivariable models. After adjustment, individuals with Z-codes had a 17.7% greater odds of 30-day HCU (OR 1.18, 95% CI 1.00-1.38, p = 0.044) and 31.0% greater odds of 90-day HCU (OR 1.31, 95% CI 1.13-1.52, p < 0.001).
conclusionsHRSNs documented by Z-codes were associated with increased post-discharge HCU even after adjusting for demographic and clinical factors. The low documentation rate suggests that social needs may be underrecognized in EHRs, potentially limiting their use for identifying high-risk patients and informing post-discharge care. Future efforts should focus on improving Z-code utilization to enhance the integration of social risk factors into healthcare decision-making.
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