JOA - 2026-06-12 - Journal Article
Social Determinants of Health Z-Codes are Associated with Low Compliance with Patient-Reported Outcome Measures after Total Hip Arthroplasty.
Parry M, Ozdag Y, Kloc A, Salvato J, Mercuri JJ
Topics
Key Takeaway
Only 25.8% of PROMs were completed at 2 years post-THA, with non-English speakers showing the largest independent reduction in compliance (OR 0.202).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This single-institution retrospective cohort examined SDOH Z-codes, demographic, and surgical factors as predictors of PROM compliance in 3,392 elective THA cases from 2017–2022. Multivariate regression identified any Z-code (OR 0.355), non-English language (OR 0.202), and male sex (OR 0.845) as independent predictors of non-compliance, while married (OR 1.540) and employed (OR 1.445) status predicted compliance. Overall PROM completion was only 25.8%, with 47.5% of patients completing zero surveys.
Key Limitation
Single-institution design limits generalizability, and Z-code documentation is known to be inconsistent and undercoded in administrative data, likely underestimating the true prevalence and impact of SDOH on compliance.
Original Abstract
INTRODUCTION
There is limited literature on compliance rates for completing patient-reported outcome measures (PROMs) after elective total hip arthroplasty (THA). Social Determinants of Health (SDOH) refers to social factors that are not classifiable elsewhere that can have major impact on healthcare outcomes. The purpose of this investigation was to assess the relationship between SDOH codes, demographic and surgical factors, and compliance rates for filling out PROMs after THA.
METHODS
This was a retrospective cohort study of elective THA cases performed between 2017 and 2022 at a single institution. Patients less than 18 years of age and patients who had less than two years of follow-up were excluded. The SDOH codes ("Z" codes), mental health codes ("F" codes), and compliance rates were recorded. The study population was binarized into two cohorts: any compliance (greater than 0%) versus no compliance (0%). Bivariate and multivariate regression (MRA) analyses were performed to assess compliance with PROMs against SDOH, demographic, and surgical factors. A total of 3,392 cases were included, of which 1,779 (52.5%) had completed at least one set of PROM questionnaires while 1,613 (47.5%) were non-compliant. Overall survey completion in the study period was 25.8%.
RESULTS
Results of the MRA indicated that having any Z-codes (odds ratio (OR) 0.355 [95% CI (confidence interval) 0.123 to 0.842], P = 0.045), being a non-English speaker (OR 0.202 [95% CI 0.065 to 0.631], P = 0.006), and men (OR 0.845 [95% CI [0.731 to 0.977], P = 0.023) were all independent risk factors for non-compliance. Conversely, married (OR 1.540 [95% CI 1.329 to 1.784], P = 0.001) or employed patients (OR 1.445 [95% CI [1.216 to 1.717], P = 0.001) had higher odds of being compliant.
CONCLUSION
Overall, only 25.8% of PROMs are completed after THA at two years postoperatively. While Z-codes adversely affected compliance rates, not being an English speaker was the biggest factor for PROM non-compliance. Employed or married patients were more likely to be compliant with completing one PROM.