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Scherbakov D, Mollalo A, Lenert L. Stressful life events in electronic health records: a scoping review. J Am Med Inform Assoc 2024; 31:1025-1035. [PMID: 38349862 PMCID: PMC10990522 DOI: 10.1093/jamia/ocae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/19/2024] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer 2 major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care. MATERIALS AND METHODS Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by 2 independent reviewers. RESULTS Five hundred fifty-seven unique papers were retrieved, and of these 70 were eligible for data extraction. Most articles (n = 36, 51.4%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n = 15, 21.4%), extraction of events from free-text notes (n = 12, 17.1%), discussing privacy and other issues of storing life events (n = 5, 7.1%), and new EHR features related to life events (n = 4, 5.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, and divorce/relationship breakup. Almost half of the papers (n = 7, 46.7%) that analyzed clinical utility of stressful events were focused on decision support systems for child abuse, while others (n = 7, 46.7%) were discussing interventions related to social determinants of health in general. DISCUSSION AND CONCLUSIONS Few citations are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storing of stressful life events.
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Affiliation(s)
- Dmitry Scherbakov
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC 29403, United States
| | - Abolfazl Mollalo
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC 29403, United States
| | - Leslie Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC 29403, United States
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2
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Hendricks-Sturrup RM, Yankah SE, Lu CY. Social determinants of health Z-code documentation practices in mental health settings: a scoping review. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae046. [PMID: 38756172 PMCID: PMC11050653 DOI: 10.1093/haschl/qxae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/18/2024]
Abstract
Mental health remains an urgent global priority, alongside efforts to address underlying social determinants of health (SDoH) that contribute to the onset or exacerbate mental illness. SDoH factors can be captured in the form of International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM), SDoH Z codes. In this scoping review, we describe current SDoH Z-code documentation practices, with a focus on mental health care contexts. Among 2 743 061 374 health care encounters noted across 12 studies in the United States, SDoH Z-code documentation rates ranged from 0.5% to 2.4%. Documentation often involved patients under 64 years of age who are publicly insured and experience comorbidities, including depression, bipolar disorder and schizophrenia, chronic pulmonary disease, and substance abuse disorders. Documentation varied across hospital types, number of beds per facility, patient race/ethnicity, and geographic region. Variation was observed regarding patient sex/gender, although SDoH Z codes were more frequently documented for males. Documentation was most observed in government, nonfederal, and private not-for-profit hospitals. From these insights, we offer policy and practice recommendations, as well as considerations for patient data privacy, security, and confidentiality, to incentivize more routine documentation of Z codes to better assist patients with complex mental health care needs.
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Affiliation(s)
| | - Sandra E Yankah
- Duke-Robert J. Margolis, MD, Institute for Health Policy, Washington, DC 20004, United States
| | - Christine Y Lu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02215, United States
- Faculty of Medicine and Health, Kolling Institute, The University of Sydney and the Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW 2050, Australia
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3
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Li C, Mowery DL, Ma X, Yang R, Vurgun U, Hwang S, Donnelly HK, Bandhey H, Akhtar Z, Senathirajah Y, Sadhu EM, Getzen E, Freda PJ, Long Q, Becich MJ. Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.04.24302242. [PMID: 38370703 PMCID: PMC10871446 DOI: 10.1101/2024.02.04.24302242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Social determinants of health (SDoH) like socioeconomics and neighborhoods strongly influence outcomes, yet standardized SDoH data is lacking in electronic health records (EHR), limiting research and care quality. Methods We searched PubMed using keywords "SDOH" and "EHR", underwent title/abstract and full-text screening. Included records were analyzed under five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions. Results We identified 685 articles, of which 324 underwent full review. Key findings include tailored screening instruments implemented across settings, census and claims data linkage providing contextual SDoH profiles, rule-based and neural network systems extracting SDoH from notes using NLP, connections found between SDoH data and healthcare utilization/chronic disease control, and integrated care management programs executed. However, considerable variability persists across data sources, tools, and outcomes. Discussion Despite progress identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical to fulfill the potential of SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
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Affiliation(s)
- Chenyu Li
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Danielle L. Mowery
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Xiaomeng Ma
- University of Toronto, Institute of Health Policy Management and Evaluations
| | - Rui Yang
- Duke-NUS Medical School, Centre for Quantitative Medicine
| | - Ugurcan Vurgun
- University of Pennsylvania, Institute for Biomedical Informatics
| | - Sy Hwang
- University of Pennsylvania, Institute for Biomedical Informatics
| | | | - Harsh Bandhey
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Zohaib Akhtar
- Northwestern University, Kellogg School of Management
| | - Yalini Senathirajah
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Eugene Mathew Sadhu
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Emily Getzen
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Qi Long
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Michael J. Becich
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
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Compton MT, Frimpong EY, Ehntholt A, Zhu H, Chaudhry S, Ferdousi W, Rowan GA, Radigan M, Smith TE, Rotter M. Associations between Social Adversities and Chronic Medical Conditions in a Statewide Sample of Individuals in Treatment for Mental Illnesses. Community Ment Health J 2024; 60:251-258. [PMID: 37395820 DOI: 10.1007/s10597-023-01165-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
Individuals with mental illnesses experience disproportionately high rates of social adversities, chronic medical conditions, and early mortality. We analyzed a large, statewide dataset to explore associations between four social adversities and the presence of one or more, and then two or more, chronic medical conditions among individuals in treatment for mental illnesses in New York State. In Poisson regression models adjusting for multiple covariates (e.g., gender, age, smoking status, alcohol use), the presence of one or more adversities was associated with the presence of at least one medical condition (prevalence ratio (PR) = 1.21) or two or more medical conditions (PR = 1.46), and two or more adversities was associated with at least one medical condition (PR = 1.25) or two or more medical conditions (PR = 1.52) (all significant at p < .0001). Greater attention to primary, secondary, and tertiary prevention of chronic medical conditions is needed in mental health treatment settings, especially among those experiencing social adversities.
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Affiliation(s)
- Michael T Compton
- New York State Psychiatric Institute, New York, NY, USA.
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | | | - Amy Ehntholt
- New York State Psychiatric Institute, New York, NY, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Huilin Zhu
- New York State Office of Mental Health, Albany, NY, USA
| | | | | | - Grace A Rowan
- New York State Office of Mental Health, Albany, NY, USA
| | | | - Thomas E Smith
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Merrill Rotter
- New York State Office of Mental Health, Albany, NY, USA
- Albert Einstein College of Medicine, New York, NY, USA
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5
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Chang JE, Smith N, Lindenfeld Z, Weeks WB. Hospital use of common Z-codes for Medicare fee-for-service beneficiaries, 2017-2021. HEALTH AFFAIRS SCHOLAR 2024; 2:qxad086. [PMID: 38756404 PMCID: PMC10986262 DOI: 10.1093/haschl/qxad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 05/18/2024]
Abstract
Recognizing the impact of the social determinants of health (SDOH) on health outcomes, in 2016, the Centers for Medicare and Medicaid Services recommended the use of International Classification of Diseases, 10th Revision (ICD-10), Z-codes to capture patients' health-related social needs. We examined changes in Z-code utilization to document health-related social needs for Medicare fee-for-service recipients among US hospitals between 2017 and 2021 across 5 common SDOH domains. We found that, while 56.9% of hospitals had at least 1 Z-code recorded in at least 1 patient per year, apart from those referring to housing needs, rates of Z-code adoption were low. Additionally, hospitals that were general medical, part of a teaching institution, affiliated with larger health systems, and of medium to large size had greater odds of utilizing Z-codes. Findings from this study highlight the need for continued efforts in promoting the consistent use of standardized SDOH capturing methods like Z-code documentation, such as provider training.
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Affiliation(s)
- Ji E Chang
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY 10003, United States
| | - Nate Smith
- CareJourney, Arlington, VA 22203, United States
| | - Zoe Lindenfeld
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY 10003, United States
| | - William B Weeks
- AI for Good Lab, Microsoft Corporation, Redmond, WA 98052, United States
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6
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Mazur L, Tian Z, Shedlock K, Zurca AD, Zhou S, Thomas NJ, Krawiec C. A Multicenter Retrospective Database Evaluation of Pediatric Patients Diagnosed With Tinea Capitis. Perm J 2023; 27:82-89. [PMID: 37771272 PMCID: PMC10723100 DOI: 10.7812/tpp/23.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
PURPOSE Tinea capitis is a common pediatric superficial dermatophyte infection associated with lower socioeconomic status, overcrowded environments, and poor hygiene internationally. Nevertheless, to the authors' knowledge, no studies in the United States have reported an association between tinea capitis diagnoses and diagnostic codes for social determinants of health (SDOH). The objectives of the present study were to analyze the diagnostic and treatment approach and frequency of SDOH diagnostic codes in order to assess the presence of racial disparities in the treatment of pediatric patients aged 0 to 18 years diagnosed with tinea capitis. METHODS This study comprised a retrospective analysis using the TriNetX electronic health record database of de-identified pediatric tinea capitis data in ambulatory and emergency settings. The data evaluated demographics, SDOH diagnostic codes, medication codes, and procedure codes. RESULTS Analysis of 19,677 patients (17,471 [88.8%] ambulatory and 2206 [11.2%] emergency encounters) demonstrated that a low frequency of patients had a confirmatory test for tinea capitis (ie, potassium hydroxide prep or fungal culture; 5.5%), prescription for dual therapy (25.2%), or SDOH diagnostic codes (5.5%). Patients with races classified as Black (odds ratio = 0.48, 95% confidence interval = 0.41-0.57, p < 0.001) and "other" (odds ratio = 0.52, 95% confidence interval = 0.33-0.81, p = 0.004) had a lower likelihood of having an ambulatory encounter, but a higher likelihood of receiving dual therapy. CONCLUSIONS This study found that diagnostic testing, dual therapy, and SDOH diagnostic codes were underutilized for pediatric patients diagnosed with tinea capitis. In addition, patients of races classified as Black and "other" were more likely to be diagnosed in emergency encounters, but had a higher likelihood of receiving dual therapy regardless of encounter type. Further research is needed to determine how to improve the management of tinea capitis and better understand its relationship with SDOH.
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Affiliation(s)
- Lauren Mazur
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Zizhong Tian
- Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Katherine Shedlock
- Academic Pediatrics, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Adrian D Zurca
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Shouhao Zhou
- Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Neal J Thomas
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Conrad Krawiec
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA
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7
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Scherbakov D, Mollalo A, Lenert L. Stressful life events in electronic health records: a scoping review. RESEARCH SQUARE 2023:rs.3.rs-3458708. [PMID: 37886439 PMCID: PMC10602151 DOI: 10.21203/rs.3.rs-3458708/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Objective Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer two major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care. Materials and Methods Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by two independent reviewers. Results 557 unique papers were retrieved, and of these 70 were eligible for data extraction. Most articles (n=36, 51.4%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n=15, 21.4%), extraction of events from free-text notes (n=12, 17.1%), discussing privacy and other issues of storing life events (n=5, 7.1%), and new EHR features related to life events (n=4, 5.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, and divorce/relationship breakup. Almost half of the papers (n=7, 46.7%) that analyzed clinical utility of stressful events were focused on decision support systems for child abuse, while others (n=7, 46.7%) were discussing interventions related to social determinants of health in general. Discussion and Conclusions Few citations are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storing of stressful life events.
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Affiliation(s)
- Dmitry Scherbakov
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina
| | - Abolfazl Mollalo
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina
| | - Leslie Lenert
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina
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8
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Scherbakov D, Mollalo A, Lenert L. Stressful life events in electronic health records: a scoping review. RESEARCH SQUARE 2023:rs.3.rs-3458708. [PMID: 37886439 PMCID: PMC10602151 DOI: 10.21203/rs.3.rs-3458708/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Objective Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer two major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care. Materials and Methods Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by two independent reviewers. Results 557 unique papers were retrieved, and of these 70 were eligible for data extraction. Most articles (n=36, 51.4%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n=15, 21.4%), extraction of events from free-text notes (n=12, 17.1%), discussing privacy and other issues of storing life events (n=5, 7.1%), and new EHR features related to life events (n=4, 5.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, and divorce/relationship breakup. Almost half of the papers (n=7, 46.7%) that analyzed clinical utility of stressful events were focused on decision support systems for child abuse, while others (n=7, 46.7%) were discussing interventions related to social determinants of health in general. Discussion and Conclusions Few citations are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storing of stressful life events.
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Affiliation(s)
- Dmitry Scherbakov
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina
| | - Abolfazl Mollalo
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina
| | - Leslie Lenert
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina
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9
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Gibbons JB, Cram P, Meiselbach MK, Anderson GF, Bai G. Comparison of social determinants of health in Medicaid vs commercial health plans. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad074. [PMID: 38756365 PMCID: PMC10986275 DOI: 10.1093/haschl/qxad074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 05/18/2024]
Abstract
Incorporating the measurement of social determinants of health (SDOH) into health care practice and US health policy reforms is a promising approach to improving population health nationwide. One way health care practitioners have started to incorporate consideration of SDOH in clinical care is by using International Classification of Diseases, Tenth Revision (ICD-10), Z-codes, a set of diagnosis codes spanning a range of social and economic circumstances. Our study summarizes Z-codes used by code type, setting, and patient demographics between Medicaid and commercial insurance to help identify strategies to optimize their use within each program and understand their differences. Overall, Z-code use was highly limited nationwide in Medicaid and commercial insurance between 2020 and 2021. Still, we found notable differences in the use of Z-codes between the programs; Medicaid beneficiaries were more likely to receive Z-codes related to financial and economic issues, while commercially insured beneficiaries were more likely to receive Z-codes indicating problems with social and familial relationships. Policy efforts focused on increasing the rate and ease of patient SDOH screening will potentially expand SDOH measurement and facilitate actions to address patient social needs.
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Affiliation(s)
- Jason Brian Gibbons
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Peter Cram
- Department of Internal Medicine, The University of Texas Medical Branch School of Public and Population Health, Galveston, TX 77555, United States
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Mark K Meiselbach
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Gerard F Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Ge Bai
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Johns Hopkins Carey Business School, Baltimore, MD 21202, United States
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10
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Yelton B, Rumthao JR, Sakhuja M, Macauda MM, Donelle L, Arent MA, Yang X, Li X, Noblet S, Friedman DB. Assessment and Documentation of Social Determinants of Health Among Health Care Providers: Qualitative Study. JMIR Form Res 2023; 7:e47461. [PMID: 37399064 PMCID: PMC10365596 DOI: 10.2196/47461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Research clearly demonstrates social determinants of health (SDOH) impact health outcomes. Provider consideration of patient SDOH in prevention and treatment planning is critical for improved health care quality and health equity. Despite awareness of the connections between SDOH and improved population health, research demonstrates few providers document patient SDOH. OBJECTIVE This qualitative study aimed to better understand the barriers and facilitators of SDOH assessment, documentation, and referral in different health care settings and roles. METHODS Individual semistructured interviews were conducted with practicing health care providers in South Carolina between August 25, 2022, and September 2, 2022. Participants were recruited via community partners' web-based newsletters or listservs using a purposive sampling design. An interview guide with 19 questions was used to explore the following research question: How do SDOH impact patient health and what are the facilitators and barriers experienced by multidisciplinary health care providers assessing and documenting patient SDOH? RESULTS Participants (N=5) included a neonatal intensive care unit registered nurse, a nurse practitioner, a certified nurse midwife, a family and preventive medicine physician, and a counselor (licensed clinical social worker) with careers spanning 12 to 32 years. Participant responses are presented according to the following 5 themes: participants' understanding of SDOH for the patient population, assessment and documentation practices, referrals to other providers and community-based resources, barriers and facilitators of SDOH assessment and documentation, and SDOH assessment and documentation training preferences. Overall, participants were aware of the importance of including patient SDOH in assessment and intervention but noted a variety of institutional and interpersonal barriers to assessment and documentation, including time constraints, perceptions of stigma around discussion of SDOH, and limited referral protocols. CONCLUSIONS Incentivizing inclusion of patient SDOH in health care must be facilitated from the top down, so assessment and documentation can be universally implemented in a pragmatic way that works for providers in a variety of roles and settings for the betterment of health care quality, health equity, and improved population health outcomes. Partnering with community organizations can serve to augment health care organizations' resource and referral availability for addressing patients' social needs.
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Affiliation(s)
- Brooks Yelton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jancham Rachel Rumthao
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Mayank Sakhuja
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Mark M Macauda
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Center for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Lorie Donelle
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Michelle A Arent
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xueying Yang
- SC SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- SC SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Samuel Noblet
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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11
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DeVetter N, Westfall JM, Carrozza M, Westfall E. Calling Your Aunt Bertha for Social Assets: Family Medicine and Social Determinants of Health. J Prim Care Community Health 2022; 13:21501319221131405. [PMID: 36300432 PMCID: PMC9623389 DOI: 10.1177/21501319221131405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The sociopolitical determinants of health drive health outcomes and inequities in the United States. Primary care practices are, increasingly, expected by payers and policy makers to assess patients' social needs. Resource referral platforms provide physicians with information and referral systems for community resources. One commonly used platform is Aunt Bertha/Find Help (AB/FH). The American Academy of Family Physicians (AAFP) Neighborhood Navigator (NN) tool allows physicians and laypeople to search for resources using AB/FH. We sought to describe what users were searching for and to identify patterns to inform resource allocation. METHODS This was a descriptive study of the AAFP's NN tool. Searches of NN were analyzed to describe what users were searching for. RESULTS From 2018 to April 2022 there were 168 135 searches. The most common searches were for food and housing insecurity (22%, 21%) and health care referral (20.6%) with 22% more searches in the winter than the spring. There was a 119% increase in searches between 2018 and 2022, and a 47% increase in searches during the COVID-19 Pandemic. In the "Health" category the top 20 subcategories accounted for over 77% of searches. CONCLUSIONS Family physicians and their patients use NN to search AB/FH for community resources to address adverse social determinants of health (SDOH). As expected, searches increased during the COVID-19 pandemic. This type of analysis may help individual clinicians, practices, and health systems prepare for the most common social needs of their patients. Social resource platforms might serve as a robust measure for primary care practice screening and referral for SDOH.
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Affiliation(s)
- Nick DeVetter
- Mayo Clinic Family Medicine
Residency—Mankato, MN, USA,Robert Graham Center—Washington, DC,
USA,Nick DeVetter, Mayo Clinic Family Medicine
Residency—Mankato, 101 Martin Luther King Jr Drive, Mankato, MN 56001, USA.
| | | | | | - Erin Westfall
- Mayo Clinic Family Medicine
Residency—Mankato, MN, USA
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