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There is relatively little data on the role of health-related social needs (HRSNs) in post-discharge healthcare utilization (HCU). We investigated the association between HRSNs documented using Z-codes and unplanned 30- and 90-day HCU in older adults with heart failure (HF) and\/or chronic obstructive pulmonary disease (COPD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study analyzed electronic health record (EHR) data from a regional health information exchange for individuals aged\u2009\u2265\u200965 with HF and\/or COPD hospitalized at least once between 2019 and 2022. HRSNs were identified using ICD-10 Z-codes (Z55-Z65, Z75; Z61 for problems related to negative life events in childhood was excluded). The primary outcome, unplanned HCU, was defined as a composite of emergency department visits and unplanned inpatient admissions within 30- and 90-day post-discharge. Logistic regression models assessed associations between Z-code documentation and HCU, adjusting for demographic and clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 19,536 older adults, 4.01% had Z-codes documented. The most frequently documented Z-code was \u201cMedical Facilities\/Other Health Care\u201d (Z75) (31.1% of cases with Z-codes). Unplanned HCU occurred in 23.3% and 39.5% of individuals within 30 and 90\u00a0days, respectively. Z-code documentation was significantly associated with greater odds of HCU in univariable and multivariable models. After adjustment, individuals with Z-codes had a 17.7% greater odds of 30-day HCU (OR 1.18, 95% CI 1.00\u20131.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044) and 31.0% greater odds of 90-day HCU (OR 1.31, 95% CI 1.13\u20131.52,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HRSNs documented by Z-codes were associated with increased post-discharge HCU even after adjusting for demographic and clinical factors. The low documentation rate suggests that social needs may be underrecognized in EHRs, potentially limiting their use for identifying high-risk patients and informing post-discharge care. Future efforts should focus on improving Z-code utilization to enhance the integration of social risk factors into healthcare decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-025-09887-8","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T20:57:54Z","timestamp":1761253074000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Z-Code Health-Related Social Needs and Their Association with Post-Discharge Healthcare Utilization in Older Adults with Heart Failure and COPD"],"prefix":"10.1007","author":[{"given":"Haowen","family":"Hsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Durdana","family":"Iqbal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Feuerstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debanjan","family":"Paul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Wahler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Daly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjit","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9240-7067","authenticated-orcid":false,"given":"David M.","family":"Jacobs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"9887_CR1","unstructured":"Centers for Medicare and Medicaid Services. 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