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Research ArticleSpecial Communications

Integrating Community and Clinical Data to Assess Patient Risks with A Population Health Assessment Engine (PHATE)

Pavela G. Bambekova, Winston Liaw, Robert L. Phillips and Andrew Bazemore
The Journal of the American Board of Family Medicine May 2020, 33 (3) 463-467; DOI: https://doi.org/10.3122/jabfm.2020.03.190206
Pavela G. Bambekova
From Long School of Medicine, University of Texas Health San Antonio, San Antonio (PGB); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine (WL); American Board of Family Medicine, Lexington, KY (RLP, AB).
BS
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Winston Liaw
From Long School of Medicine, University of Texas Health San Antonio, San Antonio (PGB); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine (WL); American Board of Family Medicine, Lexington, KY (RLP, AB).
MD, MPH
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Robert L. Phillips Jr.
From Long School of Medicine, University of Texas Health San Antonio, San Antonio (PGB); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine (WL); American Board of Family Medicine, Lexington, KY (RLP, AB).
MD, MSPH
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Andrew Bazemore
From Long School of Medicine, University of Texas Health San Antonio, San Antonio (PGB); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine (WL); American Board of Family Medicine, Lexington, KY (RLP, AB).
MD, MPH
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References

  1. 1.↵
    1. Tong ST,
    2. Liaw WR,
    3. Kashiri PL,
    4. et al
    . Clinician experiences on screening for social needs in primary care. J Am Board Fam Med 2018;31:351–63.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Phillips RL,
    2. Liaw W,
    3. Crampton P,
    4. et al
    . How other countries use deprivation indices—and why the United States desperately needs one. Health Aff (Millwood) 2016;35:1991–8.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Bazemore AW,
    2. Cottrell EK,
    3. Gold R,
    4. et al
    . “Community vital signs”: incorporating geocoded social determinants into electronic records to promote patient and population health. J Am Med Inform Assoc 2016;23:407–12.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Tollman SM
    . The Pholela Health Centre—the origins of community-oriented primary health care (COPC). An appreciation of the work of Sidney and Emily Kark. S Afr Med J 1994;84:653–8.
    OpenUrlPubMedWeb of Science
  5. 5.↵
    1. Mullan F,
    2. Phillips RL,
    3. Kinman EL
    . Geographic retrofitting: a method of community definition in community-oriented primary care practices. Fam Med 2004;36:440–6.
    OpenUrlPubMedWeb of Science
  6. 6.↵
    Office of the Assistant Secretary for Planning and Evaluation. Social risk factors and performance under Medicare's value-based purchasing programs. Washington, DC: US Department of Health and Human Services; 2016.
  7. 7.↵
    Community Health Assessment. City of Cincinnati Health Commissioner's Accreditation Lead Team. 2017. Community Health Assessment. Available from: https://www.cincinnati-oh.gov/health/assets/File/EDIT%20THIS%20CHA_12_21_17%20FINAL.pdf.
  8. 8.↵
    1. Lichkus J,
    2. Liaw WR,
    3. Phillips RL
    . Utilizing PHATE: a population health-mapping tool to identify areas of food insecurity. Ann Fam Med 2019;17:372.
    OpenUrlFREE Full Text
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The Journal of the American Board of Family     Medicine: 33 (3)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 3
May/June 2020
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Integrating Community and Clinical Data to Assess Patient Risks with A Population Health Assessment Engine (PHATE)
Pavela G. Bambekova, Winston Liaw, Robert L. Phillips, Andrew Bazemore
The Journal of the American Board of Family Medicine May 2020, 33 (3) 463-467; DOI: 10.3122/jabfm.2020.03.190206

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Integrating Community and Clinical Data to Assess Patient Risks with A Population Health Assessment Engine (PHATE)
Pavela G. Bambekova, Winston Liaw, Robert L. Phillips, Andrew Bazemore
The Journal of the American Board of Family Medicine May 2020, 33 (3) 463-467; DOI: 10.3122/jabfm.2020.03.190206
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Jump to section

  • Article
    • Abstract
    • Introduction
    • Using PHATE to Practice Community-Oriented Primary Care
    • A New Paradigm for Care Delivery Built on COPC
    • Preparing the Workforce for a New Paradigm
    • Conclusions
    • Acknowledgments
    • Notes
    • References
  • Figures & Data
  • References
  • Info & Metrics
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Keywords

  • Electronic Health Records
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  • Population Health
  • Public Health Surveillance
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  • Social Determinants of Health

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