Abstract: TH-PO706
Documentation of Social, Environmental, and Behavioral Determinants of Health in Administrative Claims Data in US Medicare and Commercially Insured Populations
Session Information
- Diversity and Equity in Kidney Health - I
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 800 Diversity and Equity in Kidney Health
Authors
- Han, Yun, University of Michigan, Ann Arbor, Michigan, United States
- Steffick, Diane, University of Michigan, Ann Arbor, Michigan, United States
- Li, Yiting, University of Michigan, Ann Arbor, Michigan, United States
- Bragg-Gresham, Jennifer L., University of Michigan, Ann Arbor, Michigan, United States
- Veinot, Tiffany C., University of Michigan, Ann Arbor, Michigan, United States
- Gillespie, Brenda W., University of Michigan, Ann Arbor, Michigan, United States
- Shahinian, Vahakn, University of Michigan, Ann Arbor, Michigan, United States
- Bullard, Kai McKeever, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background
Attention to social, environmental, and behavioral determinants of health (SEBDOH) is important for addressing health disparities, especially for conditions like chronic kidney disease (CKD). SEBDOH documentation practices may vary by patient factors. We investigate SEBDOH documentation in US claims data in outpatient settings and patient factors associated with such documentation.
Methods
We examined ICD-10 SEBDOH-Z codes in the Medicare 5% sample (Medicare Fee-for-Services plans, FFS,2015-2019) and the Optum data (Medicare Advantage plans and commercial plans,2015- 2020). Patient demographics, CKD, and other conditions predicting SEBDOH were assessed using logistic regression.
Results
SEBDOH documentation in claims was consistently low among people with different insurance: Medicare FFS (3%), Medicare Advantage (4%), and commercial plans (2%). Across insurance groups, tobacco use was the most commonly recorded behavior(33%-59% of the SEBDOH claims); younger age, non-Hispanic Black race, male sex, CKD, hypertension, cardiovascular diseases, and anemia were less likely to have SEBDOH documentation, after adjusting for patient factors (Table). Diabetes is related with more documentation in Medicare FFS (adjusted OR: 1.10, 95% CI 1.08-1.13, p<0.0001) and Medicare Advantage (adjusted OR: 1.13, 1.13-1.14, p<0.0001) but related with less documentation in commercial plans (adjusted OR: 0.97, 0.96-0.98, p<0.0001).
Conclusion
We observed a uniformly low-level uptake of SEBDOH-Z codes in both Medicare and Optum data. The negative association of CKD and other conditions with SEBOH documentation suggests missed opportunities in health care delivery. Increased SEBOH documentation can identify vulnerable CKD patients who may benefit from supplemental services.
Funding
- Other U.S. Government Support