Research ArticleOriginal Research

Factors Associated with Documenting Social Determinants of Health in Electronic Health Records

Jeongyoung Park, Yalda Jabbarpour, Robert L. Phillips, Andrew W. Bazemore and Nathaniel Hendrix
The Journal of the American Board of Family Medicine March 2025, 38 (2) 290-301; DOI: https://doi.org/10.3122/jabfm.2024.240279R1

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Self-reported frequency and method of documenting social determinants of health in electronic health records by family physicians from 2022 American Board of Family Medicine Continuous Certification Questionnaire (n = 2,089).

  • Figure 2.
    Figure 2.

    Factors associated with documenting social determinants of health in electronic health records by family physicians from 2022 American Board of Family Medicine Continuous Certification Questionnaire.

Tables

  • Table 1.

    Characteristics of Family Physicians from 2022 American Board of Family Medicine Continuous Certification Questionnaire (n = 2,089)

    No. (%) or Mean (SD)
    Physician characteristics
     Age48.6 (9.4)
     Gender, n = 2,086
      Woman1,013 (49)
      Man1,073 (51)
     Race, n = 2,088
      White1,343 (64)
      American Indian or Alaska Native17 (1)
      Asian389 (19)
      Black or African American167 (8)
      Native Hawaiian or Other Pacific Islander15 (1)
      Other157 (8)
     Ethnicity, n = 2088
      Hispanic or Latino213 (10)
      Non-Hispanic1,875 (90)
     Community trained (THC or RTT)
      Yes88 (4)
      No2,001 (96)
    Practice characteristics
     Type
      Academic157 (8)
      Government278 (13)
      Hospital/HMO907 (43)
      Independent552 (26)
      Other195 (9)
     Size
      Solo189 (9)
      2 to 5 Providers680 (33)
      6 to 20 Providers642 (31)
      >20 Providers578 (28)
     Participation in VBP
      Yes1,400 (67)
      No689 (33)
     SDOH Resources, n = 2,0396.6 (2.6)
     Health professionals: Social worker
      Yes623 (30)
      No1,466 (70)
     Health professionals: Care coordinator
      Yes631 (30)
      No1,458 (70)
     Agency collaboration: Local government
      Yes920 (44)
      No1,169 (56)
     Agency collaboration: Neighborhood organizations
      Yes690 (33)
      No1,399 (67)
     Agency collaboration: Transit
      Yes531 (25)
      No1,558 (75)
    Community characteristics
     ZCTA SDI Scores, n = 2,085
      Q1 (lowest scores)12.7 (7.0)
      Q235.2 (6.4)
      Q358.3 (7.1)
      Q4 (highest scores)85.4 (8.8)
     Rurality, n = 2086
      Rural269 (13)
      Urban1,817 (87)

    • Abbreviations: THC, Teaching Health Center; RTT, Rural Training Track; HMO, Health Maintenance Organization; VBP, Value-Based Program; SDOH, Social Determinants of Health; ZCTA, Zip Code Tabulation Area; SDI, Social Deprivation Index.

  • Survey Questions from the 2022 American Board of Family Medicine Continuing Certification Questionnaire

    QuestionsTransformation
    Documenting social needs
    Button “How often do you document screening for social needs (such as transportation, housing, food insecurity) in your primary outpatient EHR by checking a box/button within the EHR?”
    Note “How often do you document screening for social needs (such as transportation, housing, food insecurity) in your primary outpatient EHR by writing it in a note?”
    Z-codes “How often do you document screening for social needs (such as transportation, housing, food insecurity) in your primary outpatient EHR by entering it as a diagnosis (i.e., ICD-10-CM Z codes)?”

    • Often/Sometimes = 1

    • Rarely/Never = 0

    • Don’t know=missing

    Principal practice site
    “Which of the following describes your principal practice site?”

    • Academic Health Center/Faculty Practice=Academic

    • Government Clinic, Federal or Non-Federal/Federally Qualified Health Center or Look-Alike/Rural Health Clinic (Federally Qualified)= Government

    • Hospital or Health System Owned Medical Practice/Managed Care or HMO Practice=Hospital/HMO

    • Independently Owned Medical Practice=Independent

    • Indian Health Service/Work Site Clinic=Other

    Value-Based Care Incentive(s)
    “Does your organization participate in one or more value-based care initiative(s), such as a patient centered medical home, accountable care organization or pay-for-performance arrangement?”

    • Yes = 1

    • No = 0

    • Don’t know=missing

    Social determinants of health resources
    “My clinic has the resources and tools, such as dedicated staff and linkages to community programs, to address patients' social needs”1 (Strongly Disagree)
    2
    3
    4
    5
    6
    7
    8
    9
    10 (Strongly Agree)
    Health professionals
    “Which of the following types of health professionals work collaboratively with you at your principal practice site?”

    • Licensed Social Worker

    • Care Coordinator/Patient Navigator

    Agency collaboration
    Local Government “Does your practice collaborate with any of the following types of agencies: Local govt agencies (health related and non-health related)?”
    Neighborhood Organizations “Does your practice collaborate with any of the following types of agencies: Neighborhood organizations?”
    Transit “Does your practice collaborate with any of the following types of agencies: Transit?”

    • Yes = 1

    • No = 0

    • Don’t know=missing

  • Full Logistic Regression Results

     ButtonNoteZ-Codes
    Variablesβ(SE)β(SE)β(SE)
    Age0.00509 (0.00535)0.00318 (0.00540)0.00612 (0.00563)
    Female−0.103 (0.101)0.294** (0.104)0.0447 (0.103)
    Race_c = 1, While (reference)
    Race_c = 2, American Indian or Alaska Native0.169 (0.522)1.538 (0.787)−0.353 (0.573)
    Race_c = 3, Asian0.225 (0.129)0.220 (0.135)0.350** (0.132)
    Race_c = 4, Black or African American0.210 (0.182)−0.0964 (0.193)−0.0356 (0.183)
    Race_c = 5, Native Hawaiian or Other Pacific Islander−0.331 (0.767)0.524 (0.608)0.00738 (0.679)
    Race_c = 6, Other0.409* (0.195)0.481* (0.202)0.658*** (0.191)
    Hispanic−0.0851 (0.167)−0.142 (0.167)0.153 (0.164)
    Community Trained−0.0437 (0.254)0.0208 (0.255)−0.000173 (0.244)
    Mainsite_c = 1, Academic0.183 (0.215)0.413 (0.242)−0.150 (0.216)
    Mainsite_c = 2, Government0.423* (0.191)0.128 (0.199)−0.0666 (0.186)
    Mainsite_c = 3, Hospital/HMO0.162 (0.128)−0.270* (0.129)−0.298* (0.133)
    Mainsite_c = 4, Independent (reference)
    Mainsite_c = 5, Other0.153 (0.205)−0.337 (0.198)−0.257 (0.206)
    Site_size_c = 1, Solo (reference)
    Site_size_c = 2, 2 to 5 Providers0.161 (0.196)−0.186 (0.193)0.137 (0.197)
    Site_size_c = 3, 6 to 20 Providers0.140 (0.206)−0.144 (0.205)0.0854 (0.208)
    Site_size_c = 4, >20 Providers−0.161 (0.212)−0.365 (0.211)0.0831 (0.215)
    Value0.473*** (0.110)0.324** (0.110)0.0916 (0.112)
    Resource0.101*** (0.0205)0.0783*** (0.0207)0.0787*** (0.0213)
    Health Professionals: Social Worker0.0763 (0.130)0.129 (0.136)0.0401 (0.130)
    Health Professionals: Care Coordinator0.307** (0.117)−0.0162 (0.123)0.0301 (0.118)
    Agency Collaboration: Local Government0.0236 (0.117)0.0419 (0.119)0.0746 (0.120)
    Agency Collaboration: Neighborhood Organizations0.422*** (0.119)0.365** (0.126)0.508*** (0.120)
    Agency Collaboration: Transit0.181 (0.127)0.269* (0.135)0.174 (0.128)
    4 quantiles of zcta_sdi = 1 (reference)
    4 quantiles of zcta_sdi = 2−0.0428 (0.135)0.108 (0.137)0.0354 (0.140)
    4 quantiles of zcta_sdi = 30.0118 (0.138)0.239 (0.140)0.312* (0.141)
    4 quantiles of zcta_sdi = 4−0.0661 (0.140)0.316* (0.145)0.310* (0.143)
    Rural−0.188 (0.150)0.0473 (0.153)−0.0467 (0.151)
    Constant−1.743*** (0.384)−0.558 (0.377)−1.878*** (0.396)
    Observations1,9071,9271,905

    • Robust standard errors in parentheses.

    • ↵***P < .001, **P < .01, *P < .05.

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