TABLE 3.

Prominent determinants and suggested strategies to facilitate uptake of Z‐codes

Level	Determinants	Strategies
Innovation	Complexity of documentation method Risk of SDOH information being out of date or inaccurate Concern about sensitive information following patients	EHR modifications to streamline documentation and SDOH data visibility EHR reminders Provide information on utility & impact of using Z‐codes
Individual	Lack of awareness of Z‐codes Limited knowledge about social needs Discomfort discussing and documenting patient social needs	Provider training (identifying and discussing SDOH, using Z‐codes) Ongoing online education Use of clinical documentation improvement champions to increase SDOH screening and documentation Brief instruction documents
Interpersonal	Patient level of trust and comfort with provider Patient fear of negative consequences of SDOH documentation	Adaptability and tailoring of screening and documentation procedures Demonstrations of how to discuss and document SDOH information
Organizational	SDOH documentation not a departmental priority Lack of tangible supports for systematic documentation Limited time to address competing priorities	Standardized SDOH screening tool Standardize workflows for documenting SDOH, patient referrals to supportive services Incorporation of SDOH‐focused content in grand rounds Dedicated social work staff to discuss patient social needs Collaboration between billing and compliance department and clinical documentation team to create guidance on Z‐code use
Environmental	Higher rate of reimbursement for medical complexity compared to social complexity	Guidance from professional organizations, such as the American Diabetes Association