Research ArticleOriginal Research

Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health

Rachel Gold, Erika Cottrell, Arwen Bunce, Mary Middendorf, Celine Hollombe, Stuart Cowburn, Peter Mahr and Gerardo Melgar
The Journal of the American Board of Family Medicine July 2017, 30 (4) 428-447; DOI: https://doi.org/10.3122/jabfm.2017.04.170046

References

  1. 1.↵
    Social determinants of health: what are social determinants of health? Geneva: World Health Organization; 2017. Available from: http://www.who.int/social_determinants/sdh_definition/en/. Accessed October 3, 2016.
  2. 2.↵
    US Department of Health & Human Services. Healthy People 2010, 2nd ed. Washington, DC: US Government Printing Office; 2000.
  3. 3.↵
    1. Smedley BD,
    2. Stith AY,
    3. Nelson AR
    , eds; Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2005.
  4. 4.↵
    1. Stringhini S,
    2. Sabia S,
    3. Shipley M,
    4. et al
    . Association of socioeconomic position with health behaviors and mortality. JAMA 2010;303:1159–66.
    OpenUrlCrossRefPubMedWeb of Science
  5. 5.↵
    1. Kann L,
    2. Olsen EO,
    3. McManus T,
    4. et al
    ; Centers for Disease Control and Prevention (CDC). Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9–12–youth risk behavior surveillance, selected sites, United States, 2001–2009. MMWR Surveill Summ 2011;60:1–133.
    OpenUrlPubMed
  6. 6.↵
    1. Tarlov AR
    . Public policy frameworks for improving population health. Ann N Y Acad Sci 2006;896:281–93.
    OpenUrl
  7. 7.↵
    1. Marmot MG,
    2. Shipley MJ
    . Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study. BMJ 1996;313:1177–80.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Frieden TR
    . A framework for public health action: the health impact pyramid. Am J Public Health 2010;100:590–5.
    OpenUrlCrossRefPubMedWeb of Science
  9. 9.↵
    Fenton. Health care's blind side: the overlooked connection between social needs and good health. Princeton, NJ: Robert Wood Johnson Foundation; 2011. Available from: http://www.rwjf.org/en/library/research/2011/12/health-care-s-blind-side.html. Accessed June 21, 2017.
  10. 10.↵
    1. Woolf SH,
    2. Johnson RE,
    3. Phillips RL Jr.,
    4. Philipsen M
    . Giving everyone the health of the educated: an examination of whether social change would save more lives than medical advances. Am J Public Health 2007;97:679–83.
    OpenUrlCrossRefPubMedWeb of Science
  11. 11.↵
    1. Chandola T,
    2. Ferrie J,
    3. Sacker A,
    4. Marmot M
    . Social inequalities in self reported health in early old age: follow-up of prospective cohort study. BMJ 2007;334:990.
    OpenUrlAbstract/FREE Full Text
  12. 12.↵
    1. Galobardes B,
    2. Davey SG,
    3. Jeffreys M,
    4. McCarron P
    . Childhood socioeconomic circumstances predict specific causes of death in adulthood: the Glasgow student cohort study. J Epidemiol Community Health 2006;60:527–9.
    OpenUrlFREE Full Text
  13. 13.↵
    1. Hammig O,
    2. Bauer GF
    . The social gradient in work and health: a cross-sectional study exploring the relationship between working conditions and health inequalities. BMC Public Health 2013;13:1170.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Krieger N,
    2. Kosheleva A,
    3. Waterman PD,
    4. Chen JT,
    5. Beckfield J,
    6. Kiang MV
    . 50-Year trends in US socioeconomic inequalities in health: US-born black and white Americans, 1959–2008. Int J Epidemiol 2014;43:1294–313.
    OpenUrlAbstract/FREE Full Text
  15. 15.↵
    1. Lahiri S,
    2. Moure-Eraso R,
    3. Flum M,
    4. Tilly C,
    5. Karasek R,
    6. Massawe E
    . Employment conditions as social determinants of health. Part I: the external domain. New Solut 2006;16:267–88.
    OpenUrlPubMed
  16. 16.↵
    1. Moure-Eraso R,
    2. Flum M,
    3. Lahiri S,
    4. Tilly C,
    5. Massawe E
    . A review of employment conditions as social determinants of health part II: the workplace. New Solut 2006;16:429–48.
    OpenUrlPubMed
  17. 17.↵
    1. Lahelma E,
    2. Laaksonen M,
    3. Aittomaki A
    . Occupational class inequalities in health across employment sectors: the contribution of working conditions. Int Arch Occup Environ Health 2009;82:185–90.
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Ferrie JE,
    2. Shipley MJ,
    3. Davey SG,
    4. Stansfeld SA,
    5. Marmot MG
    . Change in health inequalities among British civil servants: the Whitehall II study. J Epidemiol Community Health 2002;56:922–6.
    OpenUrlAbstract/FREE Full Text
  19. 19.↵
    1. van Lenthe FJ,
    2. Borrell LN,
    3. Costa G,
    4. et al
    . Neighbourhood unemployment and all cause mortality: a comparison of six countries. J Epidemiol Community Health 2005;59:231–7.
    OpenUrlAbstract/FREE Full Text
  20. 20.↵
    1. Barnett E,
    2. Casper M
    . A definition of “social environment”. Am J Public Health 2001;91:465.
    OpenUrlPubMedWeb of Science
  21. 21.↵
    1. Kawachi I,
    2. Berkman LF
    . Neighborhoods and health. New York: Oxford University Press; 2003.
  22. 22.↵
    Institute of Medicine. Recommended social and behavioral domains and measures for electronic health records. Available from: http://nationalacademies.org/hmd/Reports/2014/EHRdomains2.aspx Accessed June 2017. Published November 2014.
  23. 23.↵
    1. Adler NE,
    2. Stead WW
    . Patients in context–EHR capture of social and behavioral determinants of health. N Engl J Med 2015;372:698–701.
    OpenUrlCrossRefPubMed
  24. 24.↵
    Office of the National Coordinator for Health Information Technology. The federal health IT strategic plan, 2015–2020. Available from: https://www.healthit.gov/sites/default/files/9–5-federalhealthitstratplanfinal_0.pdf. Accessed October 2, 2016.
  25. 25.↵
    Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records, Board on Population Health and Public Health Practice, Institute of Medicine. Capturing social and behavioral domains and measures in electronic health records: phase 2. Washington, DC: National Academies Press; 2014.
  26. 26.↵
    Centers for Disease Control and Prevention. Meaningful use: CMS timeline of important MU dates. Available from: http://www.cdc.gov/ehrmeaningfuluse/timeline.html. Accessed October 9, 2016.
  27. 27.↵
    1. Tagalicod R,
    2. Reider J
    ; Centers for Medicare & Medicaid Services. Progress on adoption of electronic health records. Available from: https://www.cms.gov/eHealth/ListServ_Stage3Implementation.html. Last modified December 13, 2013. Accessed September 12, 2016.
  28. 28.↵
    HealthIT.gov. HITPC meaningful use stage 3 final recommendations. Available from: https://www.healthit.gov/facas/sites/faca/files/HITPC_MUWG_Stage3_Recs_2014-04-01.pdf. Accessed June 1, 2017.
  29. 29.↵
    MACRA: delivery system reform, Medicare payment reform. Baltimore: Centers for Medicare & Medicaid Services; 2016. Available from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html. Accessed September 9, 2016.
  30. 30.↵
    1. Bailey SR,
    2. O'Malley JP,
    3. Gold R,
    4. Heintzman J,
    5. Marino M,
    6. DeVoe JE
    . Receipt of diabetes preventive services differs by insurance status at visit. Am J Prev Med 2015;48:229–33.
    OpenUrlCrossRefPubMed
  31. 31.↵
    1. Gold R,
    2. DeVoe JE,
    3. McIntire PJ,
    4. Puro JE,
    5. Chauvie SL,
    6. Shah AR
    . Receipt of diabetes preventive care among safety net patients associated with differing levels of insurance coverage. J Am Board Fam Med 2012;25:42–9.
    OpenUrlAbstract/FREE Full Text
  32. 32.↵
    1. Gold R,
    2. DeVoe J,
    3. Shah A,
    4. Chauvie S
    . Insurance continuity and receipt of diabetes preventive care in a network of federally qualified health centers. Med Care 2009;47:431–9.
    OpenUrlCrossRefPubMedWeb of Science
  33. 33.↵
    1. Hsu CC,
    2. Lee CH,
    3. Wahlqvist ML,
    4. et al
    . Poverty increases type 2 diabetes incidence and inequality of care despite universal health coverage. Diabetes Care 2012;35:2286–92.
    OpenUrlAbstract/FREE Full Text
  34. 34.↵
    1. Lipton RB,
    2. Liao Y,
    3. Cao G,
    4. Cooper RS,
    5. McGee D
    . Determinants of incident non-insulin-dependent diabetes mellitus among blacks and whites in a national sample. The NHANES I epidemiologic follow-up study. Am J Epidemiol 1993;138:826–39.
    OpenUrlAbstract/FREE Full Text
  35. 35.↵
    1. Lysy Z,
    2. Booth GL,
    3. Shah BR,
    4. Austin PC,
    5. Luo J,
    6. Lipscombe LL
    . The impact of income on the incidence of diabetes: a population-based study. Diabetes Res Clin Pract 2013;99:372–9.
    OpenUrlCrossRefPubMed
  36. 36.↵
    1. Jones-Smith JC,
    2. Karter AJ,
    3. Warton EM,
    4. et al
    . Obesity and the food environment: income and ethnicity differences among people with diabetes: the Diabetes Study of Northern California (DISTANCE). Diabetes Care 2013;36:2697–705.
    OpenUrlAbstract/FREE Full Text
  37. 37.↵
    1. Muennig P,
    2. Franks P,
    3. Jia H,
    4. Lubetkin E,
    5. Gold MR
    . The income-associated burden of disease in the United States. Soc Sci Med 2005;61:2018–26.
    OpenUrlCrossRefPubMedWeb of Science
  38. 38.↵
    1. Li V,
    2. McBurnie MA,
    3. Simon M,
    4. et al
    . Impact of social determinants of health on patients with complex diabetes who are served by national safety-net health centers. J Am Board Fam Med 2016;29:356–70.
    OpenUrlAbstract/FREE Full Text
  39. 39.↵
    1. Frieden TR
    . Forward: CDC health disparities and inequalities report - United States, 2011. MMWR Surveill Summ 2011;60:1–2.
    OpenUrlPubMed
  40. 40.↵
    The Menges Group. Positively impacting social determinants of health: how safety net health plans lead the way. June 2014. Available from: http://www.communityplans.net/Portals/0/Fact%20Sheets/ACAP_Plans_and_Social_Determinants_of_Health.pdf. Accessed June 21, 2017.
  41. 41.↵
    Community health centers leveraging the social determinants of health. Alexandria, VA: Institute for Alternative Futures; 2012. Available from: http://www.altfutures.org/pubs/leveragingSDH/IAF-CHCsLeveragingSDH.pdf. Accessed June 1, 2017.
  42. 42.↵
    1. Bachrach D,
    2. Pfister H,
    3. Wallis K,
    4. Lipson M
    . Addressing patients' social needs: an emerging business case for provider investment. New York: Commonwealth Fund; 2014.
  43. 43.↵
    1. Garg A,
    2. Toy S,
    3. Tripodis Y,
    4. Silverstein M,
    5. Freeman E
    . Addressing social determinants of health at well child care visits: a cluster RCT. Pediatrics 2015;135:e296–304.
    OpenUrlAbstract/FREE Full Text
  44. 44.↵
    1. Chung EK,
    2. Siegel BS,
    3. Garg A,
    4. et al
    . Screening for social determinants of health among children and families living in poverty: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care 2016;46:135–53.
    OpenUrl
  45. 45.↵
    Institute of Medicine. Capturing social and behavioral domains in electronic health records: phase 1. Washington, DC: National Academies Press; 2014.
  46. 46.
    US Preventive Services Task Force. Grade definitions. June 2016. Available from: https://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions. Accessed October 29, 2016.
  47. 47.↵
    1. Karsh BT
    . Beyond usability: designing effective technology implementation systems to promote patient safety. Qual Saf Health Care 2004;13:388–94.
    OpenUrlAbstract/FREE Full Text
  48. 48.↵
    1. Aoyama M
    . Beyond software factories: concurrent-development process and an evolution of software process technology in Japan. Inf Softw Technol 1996;38:133–43.
    OpenUrl
  49. 49.↵
    1. Miller WL,
    2. Crabtree BF,
    3. McDaniel R,
    4. Stange KC
    . Understanding change in primary care practice using complexity theory. J Fam Pract 1998;46:369–76.
    OpenUrlPubMedWeb of Science
  50. 50.↵
    1. Rauterberg M,
    2. Strohm O
    . Work organization and software development. Ann Rev Autom Program 1992;16(Pt 2):121–8.
    OpenUrl
  51. 51.↵
    1. Rauterberg M,
    2. Strohm O
    . Benefits of user-oriented software development based on an iterative cyclic process model for simultaneous engineering. Int JInd Ergon 1995;16:391–410.
    OpenUrl
  52. 52.↵
    1. Boehm B,
    2. Egyed A
    . Optimizing software product integrity through life-cycle process integration. Comput Stand Interfaces 1999;21:63–75.
    OpenUrl
  53. 53.↵
    1. Cooper RG
    . Overhauling the new product process. J Consum Res 1996;25:482.
    OpenUrl
  54. 54.↵
    1. Gurses AP,
    2. Marsteller JA,
    3. Ozok AA,
    4. Xiao Y,
    5. Owens S,
    6. Pronovost PJ
    . Using an interdisciplinary approach to identify factors that affect clinicians' compliance with evidence-based guidelines. Crit Care Med 2010;38:S282–S291.
    OpenUrlCrossRefPubMedWeb of Science
  55. 55.↵
    1. Pronovost PJ,
    2. Goeschel CA,
    3. Marsteller JA,
    4. Sexton JB,
    5. Pham JC,
    6. Berenholtz SM
    . Framework for patient safety research and improvement. Circulation 2009;119:330–7.
    OpenUrlFREE Full Text
  56. 56.↵
    1. Davis FD,
    2. Bagozzi RP,
    3. Warshaw PR
    . User acceptance of computer technology: a comparison of two theoretical models. Manage Sci 1989;35:982–1003.
    OpenUrlCrossRef
  57. 57.↵
    1. Davis FD
    . User acceptance of information technology: system characteristics, user perceptions and behavioral impacts. Int J Man Mach Stud 1993;38:475–87.
    OpenUrlCrossRefWeb of Science
  58. 58.↵
    1. Venkatesh V
    . Determinants of perceived ease of use: integrating control, intrinsic motivation, and emotion into the technology acceptance model. Inform Syst Res 2000;11:342–65.
    OpenUrlCrossRef
  59. 59.
    1. Sherin KM,
    2. Sinacore JM,
    3. Li XQ,
    4. Zitter RE,
    5. Shakil A
    . HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med 1998;30:508–12.
    OpenUrlPubMed
  60. 60.
    1. Shakil A,
    2. Bardwell J,
    3. Sherin K,
    4. Sinacore JM,
    5. Zitter R,
    6. Kindratt TB
    . Development of Verbal HITS for intimate partner violence screening in family medicine. Fam Med 2014;46:180–5.
    OpenUrl
  61. 61.
    1. Puterman E,
    2. Haritatos J,
    3. Adler NE,
    4. Sidney S,
    5. Schwartz JE,
    6. Epel ES
    . Indirect effect of financial strain on daily cortisol output through daily negative to positive affect index in the Coronary Artery Risk Development in Young Adults Study. Psychoneuroendocrinology 2013;38:2883–9.
    OpenUrl
  62. 62.
    1. Hall MH,
    2. Matthews KA,
    3. Kravitz HM,
    4. et al
    . Race and financial strain are independent correlates of sleep in midlife women: the SWAN sleep study. Sleep 2009;32:73–82.
    OpenUrlPubMedWeb of Science
  63. 63.
    1. Manchanda R,
    2. Gottlieb L
    . Upstream risks screening tool and guide version 2.6.. Los Angeles: HealthBegins; 2015.
  64. 64.
    Bureau of Primary Healthcare. 2016 Uniform Data System (UDS) reporting changes. April 12, 2016. Available from: http://bphc.hrsa.gov/datareporting/reporting/2016udsreportingchanges.pdf. Accessed October 20, 2016.
  65. 65.
    1. Caiazza T
    . Statement: new HHS rules require sexual orientation and gender identity data collection in electronic health records program. Center for American Progress, October 7, 2015. Available from: https://www.americanprogress.org/press/statement/2015/10/07/122884/statement-new-hhs-rules-require-sexual-orientation-and-gender-identity-data-collection-in-electronic-health-records-program/. Accessed October 20, 2016.
  66. 66.↵
    1. Harris SK,
    2. Knight JR
    . Putting the screen in screening: technology-based alcohol screening and brief interventions in medical settings. Alcohol Res 2014;36:63–79.
    OpenUrlPubMed
  67. 67.↵
    1. Beadnall HN,
    2. Kuppanda KE,
    3. O'Connell A,
    4. Hardy TA,
    5. Reddel SW,
    6. Barnett MH
    . Tablet-based screening improves continence management in multiple sclerosis. Ann Clin Transl Neurol 2015;2:679–87.
    OpenUrl
  68. 68.↵
    1. Anand V,
    2. McKee S,
    3. Dugan TM,
    4. Downs SM
    . Leveraging electronic tablets for general pediatric care: a pilot study. Appl Clin Inform 2015;6:1–15.
    OpenUrlCrossRefPubMed
  69. 69.↵
    1. Gottlieb LM,
    2. Tirozzi KJ,
    3. Manchanda R,
    4. Burns AR,
    5. Sandel MT
    . Moving electronic medical records upstream: incorporating social determinants of health. Am J Prev Med. 2015;48:215–8.
    OpenUrlCrossRefPubMed
  70. 70.↵
    1. Gottlieb L,
    2. Sandel M,
    3. Adler NE
    . Collecting and applying data on social determinants of health in health care settings. JAMA Intern Med 2013;173:1017–20.
    OpenUrlCrossRefPubMed
  71. 71.↵
    1. Garg A,
    2. Butz AM,
    3. Dworkin PH,
    4. Lewis RA,
    5. Thompson RE,
    6. Serwint JR
    . Improving the management of family psychosocial problems at low-income children's well-child care visits: the WE CARE Project. Pediatrics 2007;120:547–58.
    OpenUrlAbstract/FREE Full Text
  72. 72.↵
    1. Gottlieb L,
    2. Hessler D,
    3. Long D,
    4. Amaya A,
    5. Adler N
    . A randomized trial on screening for social determinants of health: the iScreen study. Pediatrics 2014;134:e1611–8.
    OpenUrlAbstract/FREE Full Text
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools

Jump to section

Related Articles

  • No related articles found.

Cited By...

More in this TOC Section

Similar Articles

Keywords