Journal of General Internal Medicine

, Volume 34, Issue 6, pp 796–798 | Cite as

Validation of Administrative Measures of Social and Behavioral Risk in Veterans Affairs Medical Records

  • Charlie M. WrayEmail author
  • Marzieh Vali
  • Ann Abraham
  • Alysandra Zhang
  • Louise C. Walter
  • Salomeh Keyhani
Concise Research Reports


A growing body of research indicates that social and behavioral risk factors, such as social isolation and marginal housing, influence health outcomes.1 Unfortunately, obtaining such risk factors from administrative records remains a challenge.2 We assessed the fidelity of administrative coding of six social and behavioral risk factors (lives alone, marginal housing, alcohol and drug abuse, use of substance abuse services, and violence) through chart validation of hospitalized patients within the Veterans Health Administration (VA).


We identified older Veterans (≥ 65) who were hospitalized in the VA from 2009 to 2012 with either: congestive heart failure, acute myocardial infarction, or pneumonia. Using national VA data, we created six measures of social and behavioral risk using International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes, VA clinic description codes, and laboratory data (Table 1). After determining the prevalence of each risk...

Key Words

social risk factors health policy veterans affairs 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    NQF: Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors. Accessed October 31, 2018.
  2. 2.
    Steventon A. Making the best use of administrative data. BMJ 2013;346:f1284. CrossRefPubMedGoogle Scholar
  3. 3.
    Determinants of Health and Longevity | Agency for Healthcare Research & Quality. Published September 15, 2015. Accessed October 31, 2018.
  4. 4.
    Barnett ML, Hsu J, McWilliams JM. Patient characteristics and differences in hospital readmission rates. JAMA Intern Med. 2015;175(11):1803–1812. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Gottlieb L, Tobey R, Cantor J, Hessler D, Adler NE. Integrating social and medical data to improve population health: opportunities and barriers. Health Aff (Millwood). 2016;35(11):2116–2123. CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Charlie M. Wray
    • 1
    • 2
    Email author
  • Marzieh Vali
    • 3
  • Ann Abraham
    • 3
  • Alysandra Zhang
    • 3
  • Louise C. Walter
    • 4
  • Salomeh Keyhani
    • 1
    • 5
  1. 1.Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Division of Hospital MedicineSan Francisco Veterans Affairs Medical CenterSan FranciscoUSA
  3. 3.Northern California Institute for Research and EducationSan Francisco Veterans Affairs Medical CenterSan FranciscoUSA
  4. 4.Division of GeriatricsSan Francisco Veterans Affairs Medical CenterSan FranciscoUSA
  5. 5.Division of General Internal MedicineSan Francisco Veterans Affairs Medical CenterSan FranciscoUSA

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