TY - JOUR
T1 - Variation in Electronic Health Record Documentation of Social Determinants of Health Across a National Network of Community Health Centers
AU - Cottrell, Erika K.
AU - Dambrun, Katie
AU - Cowburn, Stuart
AU - Mossman, Ned
AU - Bunce, Arwen E.
AU - Marino, Miguel
AU - Krancari, Molly
AU - Gold, Rachel
N1 - Funding Information:
This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
Funding Information:
Publication of this article was supported by the Agency for Healthcare Research and Quality (AHRQ), under HHS contract [1R13HS026664], Kaiser Permanente [CRN5374-7544-15320], and the Robert Wood Johnson Foundation [75922]. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of any of the sponsors. The authors deeply appreciate the contributions of Mary Middendorf, who created the SDH tool in OCHIN Epic, and Marla Dearing, who managed all Epic-related aspects of the study. They also want to thank Nadia Yosuf, who diligently provided necessary project management support for the Approaches to CHC Implementation of SDH Data Collection and Action (ASCEND) study. Lastly, they want to thank OCHIN's Clinical Operations Review Committee for shepherding the development of these tools and OCHIN's member CHCs who are committed to providing care for the nation's most vulnerable patients. This publication was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases , 1R18DK114701–01. RG, EKC, MM, and AB designed the study. RG and EKC directed the project. SC extracted the data and conducted the analyses for the manuscript. EKC, KD, SC, and RG wrote the manuscript with input from all authors. All authors read and approved the final manuscript. Select segments of this manuscript have been previously presented elsewhere. No financial disclosures were reported by the authors of this paper.
Funding Information:
Publication of this article was supported by the Agency for Healthcare Research and Quality (AHRQ), under HHS contract [1R13HS026664], Kaiser Permanente [CRN5374-7544-15320], and the Robert Wood Johnson Foundation [75922]. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of any of the sponsors. The authors deeply appreciate the contributions of Mary Middendorf, who created the SDH tool in OCHIN Epic, and Marla Dearing, who managed all Epic-related aspects of the study. They also want to thank Nadia Yosuf, who diligently provided necessary project management support for the Approaches to CHC Implementation of SDH Data Collection and Action (ASCEND) study. Lastly, they want to thank OCHIN's Clinical Operations Review Committee for shepherding the development of these tools and OCHIN's member CHCs who are committed to providing care for the nation's most vulnerable patients. This publication was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases, 1R18DK114701?01. RG, EKC, MM, and AB designed the study. RG and EKC directed the project. SC extracted the data and conducted the analyses for the manuscript. EKC, KD, SC, and RG wrote the manuscript with input from all authors. All authors read and approved the final manuscript. Select segments of this manuscript have been previously presented elsewhere. No financial disclosures were reported by the authors of this paper.
Publisher Copyright:
© 2019 American Journal of Preventive Medicine
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/12
Y1 - 2019/12
N2 - Introduction: This paper describes the adoption of an electronic health record-based social determinants of health screening tool in a national network of more than 100 community health centers. Methods: In 2016, a screening tool with questions on 7 social determinants of health domains was developed and deployed in the electronic health record, with technical instructions on how to use the tool and suggested clinical workflows. To understand adoption patterns, the study team extracted electronic health record data for any patient with a community health center visit between June 2016 and May 2018. Patients were considered “screened” if a response to at least 1 social determinants of health domain was documented in the electronic health record tool. Results: A total of 31,549 patients (2% of those with a visit in the study period) had a documented social determinants of health screening. The number of screenings increased over time, time; 71 community health centers (67%) conducted at least one screening, but almost 50% took place in only 4 community health centers. Over half (55%) of screenings only included responses for only 1 domain. Screening was most likely to occur during an office visit with an established patient and documented in the electronic health record by a medical assistant. Conclusions: Screening documentation patterns varied widely across the network of community health centers. Despite the growing national emphasis on the importance of screening for social determinants of health, these findings suggest that simply activating electronic health record tools for social determinants of health screening does not lead to widespread adoption. Potential barriers to screening adoption and implementation should be explored further. Supplement information: This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
AB - Introduction: This paper describes the adoption of an electronic health record-based social determinants of health screening tool in a national network of more than 100 community health centers. Methods: In 2016, a screening tool with questions on 7 social determinants of health domains was developed and deployed in the electronic health record, with technical instructions on how to use the tool and suggested clinical workflows. To understand adoption patterns, the study team extracted electronic health record data for any patient with a community health center visit between June 2016 and May 2018. Patients were considered “screened” if a response to at least 1 social determinants of health domain was documented in the electronic health record tool. Results: A total of 31,549 patients (2% of those with a visit in the study period) had a documented social determinants of health screening. The number of screenings increased over time, time; 71 community health centers (67%) conducted at least one screening, but almost 50% took place in only 4 community health centers. Over half (55%) of screenings only included responses for only 1 domain. Screening was most likely to occur during an office visit with an established patient and documented in the electronic health record by a medical assistant. Conclusions: Screening documentation patterns varied widely across the network of community health centers. Despite the growing national emphasis on the importance of screening for social determinants of health, these findings suggest that simply activating electronic health record tools for social determinants of health screening does not lead to widespread adoption. Potential barriers to screening adoption and implementation should be explored further. Supplement information: This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
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U2 - 10.1016/j.amepre.2019.07.014
DO - 10.1016/j.amepre.2019.07.014
M3 - Article
C2 - 31753281
AN - SCOPUS:85075014404
VL - 57
SP - S65-S73
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
SN - 0749-3797
IS - 6
ER -