Using ICD-10-based Social Determinants of Health Categories to Assess Patients Risk for Acute Care Utilization

Objective: Social determinants of health (SDoH) play a pivotal role in health care utilization and adverse health outcomes. However, the optimal method to identify SDoH remains debatable. We ascertained SDoH based on International Classification of Disease 10 (ICD-10) codes in patient electronic health records (EHR) to assess the correlation with acute care utilization, and determine if social services interventions reduced care utilization. Methods: We analyzed retrospective data for active patients at a Department of Veterans Affairs Medical Center (VAMC) from 2015-2017. Eleven categories of SDoH were developed based on existing literature of the social determinants; the relevant ICD-10 codes were divided among these categories. Emergency Room (ER) visits, hospital admissions, and social work visits were determined for each patient in the cohort. Results: In a cohort of 44,401 patients, the presence of ICD-10 codes within the EHR in the 11 SDoH categories was positively correlated with increased acute care utilization. Veterans with at least one SDoH risk factor were 71% (95%CI: 68% - 75%) more likely to use the ED and 71% (95%CI: 65%-77%) more likely to be admitted to the hospital. Utilization decreased with social service interventions. Conclusion: This project demonstrates a potentially meaningful method to capture patient social risk profiles through existing EHR data in the form of ICD-10 codes, which can be used to identify the highest risk patients for intervention with the understanding that not all SDoH codes are uniformly used and some SDoHs may not be captured.