Z Code Utilization in Critical Access Hospitals in Arizona

Abstract

Specific Aims: To evaluate the prevalence, frequency, and barriers to Z code utilization in critical access hospitals in Arizona. Methods: Critical access hospitals who are part of Arizona’s Medicare Rural Hospital Flexibility Program were initially contacted over email to find willingness to participate in a verbal, over-the-phone survey. This survey had questions to determine the utilization of Z codes in these facilities, as well as questions on the barriers for each facility. This survey was voluntary, and facilities could opt out at any time. Results: The frequency of utilization of Z codes varied widely among the facilities surveyed, (1-90 of 100 patients). There was no specific Z code used more frequently among the facilities than others; these included homelessness, history of nicotine dependence, long term use of anticoagulants and inhaled steroids, and ongoing long term drug therapy. There is often no designated role for who is to collect this information among hospitals who do utilize Z codes. Of the many barriers to utilizing Z codes, lack of knowledge and resources were of the top barriers among facilities surveyed, both those who use and those who do not use Z codes. Conclusions: Z codes are underutilized in critical access hospitals in Arizona. More data needs to be collected to further understand all barriers to the utilization of Z codes in order to address the vast and various social determinants of health in Arizona’s rural populations.