Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Karen Wang

Second Advisor

Carol R. Oladele


The 10th revision of the International Classification of Diseases (ICD-10) allows healthcare professionals to document social needs with ICD-10 Z-codes. Data derived from documentation of ICD-10 Z-codes can be leveraged to identify at-risk populations for targeted intervention. However, there remains concern for underutilization of these codes particularly in the pediatric population. We sought to examine the documentation of ICD-10 Z-codes in the pediatric outpatient setting of the largest Connecticut hospital network by specialty type and age group. We examined deidentified electronic health records of pediatric outpatient patients from 2019-2020. We used descriptive statistics to measure the proportion of patients with at least one social needs-related ICD-10 Z-code. We compared the rates of documentation across different specialty types and age groups. We also identified nine categories of ICD-10 Z-codes and compared differences in the distribution of Z-codes categories across age groups. 1164 out of 59867 pediatric outpatient patients (1.9%) from 2019 to 2020 had at least 1 documented ICD-10 Z-code. Across all ages, the specialty type with the highest rate of documentation was school based clinics (10.6%) followed by pediatric primary care (5.3%). Within the school-based clinics group, we found that patients aged 0-5 were significantly more likely than all other age groups to have a documented Z-code. Furthermore, within the pediatric primary care group, we found that patients aged 22 to 30 were significantly more likely than all other age groups to have an ICD-10 Z-code documented. The most common types of Z-codes documented were those relating to issues in upbringing as well as housing and economic circumstances. We demonstrate that social needs documentation with ICD-10 Z-codes in the pediatric department of this health system is very low and likely unreflective of the true social needs of the population. We hypothesize that these low rates are due to health care accessibility issues and/or a lack of provider willingness to document social needs.

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