Article Figures & Data
Figures
- Supplementary Figure 1.
Map of Michigan Health Centers.
- Figure 1.
Percentages of health centers screening for core domains.
- Figure 2.
Health center data collection survey results. Categories are not mutually exclusive and may total >100%. EHR, electronic health record; MA, medical assistant; RN, registered nurse.
Tables
Uniform Data System 2014 Data HC Organizations, by Geographic Region All HC Organizations Northern (n = 5) Middle (n = 6) Southern (n = 5) Detroit Metro (n = 7) Total Mean HC Characteristics Delivery sites, n 37 61 41 28 167 7.26 Rural, n (%) (based on zip code) 33 (89) 18 (30) 0 (0) 0 (0) 51 (31) Total FTEs, n Primary care* 38.0 42.2 31.0 34.8 146.0 6.64 Physicians† 44.8 56.2 50.5 47.0 198.6 9.0 Mental health‡ 17.1 64.2 21.4 13.6 116.3 5.3 Visits Medical services 258,472 377,146 311,797 171,142 1,118,557 50,844 Mental health services 14,694 55,073 17,645 8,965 96,377 4,381 Patient population characteristics Patients served, n 82,705 159,406 130,440 86,762 459,313 20,878 Race, n (%) Asian 399 (1) 1,797 (1) 2,502 (2) 712 (1) 5,410 (1) 246 Native Hawaiian/other Pacific Islander 49 (0) 508 (0) 807 (1) 392 (1) 1,756 (0) 80 Black/African American 445 (1) 37,636 (24) 34,826 (27) 51,022 (59) 123,929 (27) 5,633 American Indian/Alaskan Native 325 (0) 678 (0) 424 (0) 193 (0) 1,620 (0) 74 White 78,492 (95) 96,843 (61) 66,558 (51) 15,926 (18) 257,819 (56) 11,719 >1 race 453 (1) 8,272 (9) 1,619 (1) 535 (1) 10,879 (2) 495 Other 2,542 (3) 13,672 (9) 23,704 (18) 17,982 (21) 57,900 (13) 2,632 Hispanic/Latino ethnicity 691 (1) 35,843 (23) 22,476 (17) 15,903 (18) 74,913 (16) 3,405 Female sex, % (mean ± SD) 53.9 ± 1 55.4 ± 4 57.8 ± 2 56.0 ± 8 55.8 ± 1 Primary language is English, % (mean ± SD) 99.8 ± 0 88.4 ± 13 92.0 ± 8 86.4 ± 19 39,193 ± 92 Special populations, n (%) Agricultural workers or dependents 199 (0) 3,808 (2) 8,678 (7) 492 (1) 13,177 (3) 599 Homeless 380 (1) 9,185 (6) 7,033 (5) 3,594 (4) 20,192 (4) 918 Veterans 1,272 (2) 2,613 (2) 1,163 (1) 281 (0) 5,329 (1) 242 Public housing patients 2 (0) 66 (0) 534 (0) 2,522 (3) 3,124 (1) 142 School-based patients 2,593 (3) 12,033 (8) 8,506 (7) 371 (0) 23,503 (5) 1,068 Total§ 4,446 (5) 27,705 (17) 25,914 (20) 7,260 (8) 65,325 (14) 2,969 Income ≤200% of the federal poverty level, n (%) 49,078 (59) 109,944 (69) 99,285 (76) 64,299 (74) 322,606 (70) 14,664 Insurance Medicaid/CHIP/other public insurance 22,065 (27) 82,772 (52) 76,170 (58) 54,115 (62) 235,122 (51) 10,687 Uninsured 6,840 (8) 40,432 (25) 26,858 (21) 21,733 (25) 95,863 (21) 4,357 Medicare 19,449 (24) 15,369 (10) 11,785 (9) 4,071 (5) 50,674 (11) 2,302 Private 34,351 (42) 20,827 (13) 15,615 (12) 6,520 (8) 77,313 (17) 3,514 Data are number, number (%), or mean ± standard deviation, unless otherwise indicated. Based on Uniform Data System (UDS) and Michigan Health Center organizations grouped by geographic region (see Supplementary Figure 1).
↵* Includes family physicians, internists, and general practitioners.
↵† Includes total primary care and pediatric physicians, obstetricians/gynecologists, and other specialty physicians.
↵‡ Includes substance use disorder counselors, psychiatrists, licensed clinical psychologists, licensed clinical social workers, other licensed mental health providers, and other mental health staff.
↵§ Total special populations include agricultural workers or dependents, homeless population, school-based patients (HCs located within a school, often a partnership between a community HC and school), veterans, and public housing patients.
CHIP, Children's Health Insurance Program; FTE, full-time equivalent.
- Table 2.
Comparison of Empirically Identified Social Determinant of Health (SDH) Domains from Health Center Screening Documents Compared with Other Recommended SDH Data Collection Domains
Empirically Identified Domains from Health Centers* NAM† HP2020‡ National Quality Forum§ USPSTF‖ WHO¶ UDS# #Meaningful Use Stages 2/3** Culture (religious/spiritual affiliations or practices) Demographics (gender/sex, place of birth, sexual orientation, race/ethnicity) x x x x x x Economic indicators (income, assets, assistance programs, indebtedness) x x x x x Education (educational attainment, basic literacy, health literacy, numeracy) x x x x x Employment status (unemployment, OSHA, migrant/seasonal or farm worker, day laborers, disability status, mobility status, retirement status, student, unpaid caretaker, active military) x x x x x Family/living arrangements (marital status, dependents, children, elders, who lives in the home) x Functional status (ADLs/IADLs, frailty) x Health-related behaviors (alcohol use, caffeine use, drug use, tobacco use, secondhand smoke, physical activity, sexual activity, diet, safety, bike helmets, baby-proof, seat belts, smoke detectors, guns in the home, driving safety, screen time) x x x x Health care access (insurance status, affordability, usual source of care) x x x Language (primary language, English proficiency, interpreter, other language proficiency) x x x x Material hardship (food insecurity, housing insecurity, utilities, transportation, medication affordability, access to technology, child care, legal services) x x x x x x Mental health (depression, anxiety, PTSD, ADD/ADHD, suicide risk, stress, caregiver stress, burnout, sleep behaviors) x x x x Social support (community activities, safe environment, environmental exposures, personal safety, bullying, public spaces, racism, discrimination, distrust, school culture) x x x x x Trauma/violence (intimate partner violence, trauma, physical abuse, sexual abuse, mental abuse, child abuse) x x Veteran status (history of military trauma, combat veteran) x ↵* Bold items represent the core domains; subdomains are set in parentheses.
↵† National Academy of Medicine (NAM) Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2.7
↵‡ Healthy People 2020.9
↵§ National Quality Forum, Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors.21
↵‖ U.S. Preventive Services Task Force (USPSTF) published recommendations.29
↵¶ World Health Organization (WHO), A Conceptual Framework for Action on the Social Determinants of Health.22
↵# Uniform Data System (UDS) reporting measures.19
↵** Secretary of Health and Human Services, Health Information Technology Certification Criteria, 2015 edition.30
ADD, attention deficit disorder; ADHD, attention deficit and hyperactivity disorder; ADL, activity of daily living; HP2020, Healthy People 2020; IADLs, instrumental activity of daily living; OSHA, Occupation Safety and Health Administration; PTSD, posttraumatic stress disorder.
- Supplementary Table 1.
Variation in Sub-Domain Screening Across Participating Health Centers
Culture (n = 9) Demographics (n = 23) Economic Indicators (n = 21) Employment (n = 23) Education (n = 21) Family/Living Arrangements (n = 23) Functional Status (n = 8) Health-Related Behaviors (n = 17) % % % % % % % % General Code* 67 Gender Sex 100 General Code 14 General Code 91 General Code 19 General Code 9 General Code 50 General Code 26 Religion 89 Place of Birth 22 Income 100 Unemployment 87 Educational Attainment 100 Marital Status 52 ADL/IADL‡ 75 Alcohol 70 Sexual Orientation 13 Assets 5 Under-employment 4 Basic Literacy 24 Dependents 17 Frailty 63 Drug Use 70 Race, Ethnicity 100 Assistance Programs 29 OSHA† 22 Health Literacy 24 Children 30 Tobacco 65 Indebtedness 10 Migrant/Seasonal or Farm Worker 78 Numeracy 5 Elders 4 Secondhand Smoke 26 Who Lives in the Home 100 Caffeine 48 Disability 83 Physical Activity 57 Mobility Status 4 Sexual Activity 43 Retirement Status 87 Diet 52 Student 91 Safety General 22 Unpaid Caretaker 74 Bike Helmet Use 26 Active military 78 Baby Proofing 4 Seat Belt Use 43 Smoke Detectors 30 Guns in the House 30 Driving Safety, other 26 Health Care Access (n = 22) Language (n = 22) Material Hardship (n = 21) Mental Health (n = 23) Social Support/Isolation (n = 21) Trauma, Violence (n = 21) Veteran Status (n = 22) % % % % % % % General Code 22 General Code 9 General Code 74 General Code 30 General Code 95 General Code 19 General Code 100 Insurance Status 96 Primary Language 96 Food Insecurity 78 Mental Health Screening 43 Community Activities 24 Intimate Partner Violence 90 Military Trauma History 5 Affordability 78 English Proficiency 26 Housing Insecurity 96 Depression 70 Safe Environment 95 Usual Source of Care 74 Interpreter 26 Utilities 78 Anxiety 43 Environmental Exposures 14 Trauma 14 % % % % % % % Other Language Proficiency 17 Transportation 78 PTSD§ 4 Personal Safety 24 Physical Abuse 33 Medication Affordability 78 ADD, ADHD‖ 13 Bullying 24 Sexual Abuse 33 Access to Technology 74 Suicide 35 Public Space 5 Mental Abuse 38 Child Care 74 Stress 78 Racism 5 Child Abuse 19 Clothing 78 Sleep Behaviors 30 Discrimination 5 Legal Services 78 Distrust 5 School Culture 10 ↵* General Code refers to screening question that was considered a general question under the Core Domain.
↵† Occupational Health & Safety.
↵‡ Activities of Daily Living, Instrumental Activities of Daily Living.
↵§ Post Traumatic Stress Disorder.
↵‖ Attention Deficit Disorder, Attention Deficit and Hyperactivity Disorder.
Note: All numbers provided are percentage of total (n) of HCs that screened for each core domain. Documents could receive multiple codes and therefore percentages do not sum to 100%.
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