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Li C, Mowery DL, Ma X, Yang R, Vurgun U, Hwang S, Donnelly HK, Bandhey H, Akhtar Z, Senathirajah Y, Sadhu EM, Getzen E, Freda PJ, Long Q, Becich MJ. Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.04.24302242. [PMID: 38370703 PMCID: PMC10871446 DOI: 10.1101/2024.02.04.24302242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Social determinants of health (SDoH) like socioeconomics and neighborhoods strongly influence outcomes, yet standardized SDoH data is lacking in electronic health records (EHR), limiting research and care quality. Methods We searched PubMed using keywords "SDOH" and "EHR", underwent title/abstract and full-text screening. Included records were analyzed under five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions. Results We identified 685 articles, of which 324 underwent full review. Key findings include tailored screening instruments implemented across settings, census and claims data linkage providing contextual SDoH profiles, rule-based and neural network systems extracting SDoH from notes using NLP, connections found between SDoH data and healthcare utilization/chronic disease control, and integrated care management programs executed. However, considerable variability persists across data sources, tools, and outcomes. Discussion Despite progress identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical to fulfill the potential of SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
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Affiliation(s)
- Chenyu Li
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Danielle L. Mowery
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Xiaomeng Ma
- University of Toronto, Institute of Health Policy Management and Evaluations
| | - Rui Yang
- Duke-NUS Medical School, Centre for Quantitative Medicine
| | - Ugurcan Vurgun
- University of Pennsylvania, Institute for Biomedical Informatics
| | - Sy Hwang
- University of Pennsylvania, Institute for Biomedical Informatics
| | | | - Harsh Bandhey
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Zohaib Akhtar
- Northwestern University, Kellogg School of Management
| | - Yalini Senathirajah
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Eugene Mathew Sadhu
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Emily Getzen
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Qi Long
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Michael J. Becich
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
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Yang B, He H, Nie Q, Yang Y. Exploring the relationship between depression and multimorbidity in Chinese middle-aged and older people based on propensity score matching. J Psychosom Res 2023; 174:111490. [PMID: 37713765 DOI: 10.1016/j.jpsychores.2023.111490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND This study aimed to explore the relationship between depression and multimorbidity among middle-aged and older people in China. METHODS The cross-sectional study used the 2018 China Longitudinal Study of Health and Retirement and included a sample of 19,761 middle-aged and older adults aged 45 years and above. Propensity score matching was used to match samples of individuals with and without depression symptoms. The association between depression symptoms and multimorbidity and dose-response relationships were analyzed using logistic regression and restricted cubic spline (RCS) models for matched samples. RESULTS Logistic regression analysis showed that the prevalence of multimorbidity was 1.49 times higher among middle-aged and older adults in the depression symptom group compared to the non-depression group (95% CI:1.24, 1.80). The RCS curves for the relationship between depression and multimorbidity showed an overall increasing trend (P = 0.028). And prevalence of arthritis and digestive disease in the depressed and non-depressed groups is 3.6% and 3.9%, respectively. LIMITATIONS It was difficult to draw conclusions about causation since the study was cross-sectional, and CESD-10 scores do not represent the population study finally diagnosed with depression, the conclusions should be promoted with caution. CONCLUSIONS Middle-aged and older people with depressive symptoms are more likely to have multimorbidity than non-depressed individuals. Furthermore, the likelihood of multimorbidity increases with higher depression scores, and the binary combinations were similarly distributed. Therefore, attention should be paid to the management of mental health in the middle-aged and older adult population to alleviate and prevent any mental health issues they might face.
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Affiliation(s)
- Bei Yang
- Department of Plastic, Aesthetic, Reparative and Reconstructive Unit Nursing, West China Second Hospital, Sichuan University/West China School of Nursing, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Hua He
- Department of Obstetrics and Gynecology Intensive Care Unit Nursing, West China Second Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Qiao Nie
- Department of Obstetrics and Gynecology Intensive Care Unit Nursing, West China Second Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yi Yang
- Department of Plastic, Aesthetic, Reparative and Reconstructive Unit Nursing, West China Second Hospital, Sichuan University/West China School of Nursing, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
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Rogers HE, Hershey JA, Morone J, Lipman TH, Wilson-Hall L, Anderson K, Hawkes CP. Perspectives of Pediatric Community Health Workers: Roles, Successes, and Challenges. Health Promot Pract 2023; 24:1206-1214. [PMID: 35876335 DOI: 10.1177/15248399221112866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This multicenter qualitative study described the roles of 10 pediatric community health workers (CHWs) in their own words through exploration of the role features, successes, and challenges in pediatric health care settings across three urban U.S. cities (Philadelphia, New York City, and Cincinnati). Individual, semi-structured telephone interviews were conducted. Interviews described prominent features of the pediatric CHW role, which included taking a family-centered approach to goal setting and determining support needed, ensuring family goals stayed at the center of the work, and acting as a trusted figure for families to talk openly with. CHWs described their role as rewarding, believing in the work, and feeling a sense of fulfillment, and felt successful when families had positive outcomes, including when barriers were eliminated, resources were obtained, or independence was demonstrated by families. Challenges CHWs faced in their roles included establishing trust with families, managing the ever-changing family circumstances many families experience due to socioeconomic barriers, and managing limitations of protocol and restrictions within their roles. This study demonstrated numerous considerations for CHW practice in pediatric health care settings, in addition to considerations for pediatric-specific CHW program development and management. The primary policy implication of this study included a basis for increased funding for CHW programs in pediatric health care settings. This study also demonstrated a need for further research on the change CHWs effect within child and family systems outside of health care, such as schools and child welfare agencies.
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Affiliation(s)
- Hanna E Rogers
- Evaluation Strategies, Ypsilanti, MI, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jennifer Morone
- Yale University School of Medicine, New Haven, CT, USA
- Veterans Administration Health Services Research & Development, Washington, DC, USA
| | - Terri H Lipman
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | - Colin P Hawkes
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University College Cork, Cork, Ireland
- University of Pennsylvania, Philadelphia, PA, USA
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Kiely B, Croke A, O'Shea M, Boland F, O'Shea E, Connolly D, Smith SM. Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review. BMJ Open 2022; 12:e062951. [PMID: 36253037 PMCID: PMC9644316 DOI: 10.1136/bmjopen-2022-062951] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To establish the evidence base for the effects on health outcomes and costs of social prescribing link workers (non-health or social care professionals who connect people to community resources) for people in community settings focusing on people experiencing multimorbidity and social deprivation. DESIGN Systematic review and narrative synthesis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES Cochrane Database, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, EU Clinical Trials Register, CINAHL, Embase, Global Health, PubMed/MEDLINE, PsycInfo, LILACS, Web of Science and grey literature were searched up to 31 July 2021. A forward citation search was completed on 9 June 2022. ELIGIBILITY CRITERIA Controlled trials meeting the Cochrane Effectiveness of Practice and Organisation of Care (EPOC) guidance on eligible study designs assessing the effect of social prescribing link workers for adults in community settings on any outcomes. No language restrictions were applied. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data, evaluated study quality using the Cochrane EPOC risk of bias tool and judged certainty of the evidence. Results were synthesised narratively. RESULTS Eight studies (n=6500 participants), with five randomised controlled trials at low risk of bias and three controlled before-after studies at high risk of bias, were included. Four included participants experiencing multimorbidity and social deprivation. Four (n=2186) reported no impact on health-related quality of life (HRQoL). Four (n=1924) reported mental health outcomes with three reporting no impact. Two US studies found improved ratings of high-quality care and reduced hospitalisations for people with multimorbidity experiencing deprivation. No cost-effectiveness analyses were identified. The certainty of the evidence was low or very low. CONCLUSIONS There is an absence of evidence for social prescribing link workers. Policymakers should note this and support evaluation of current programmes before mainstreaming. PROSPERO REGISTRATION NUMBER CRD42019134737.
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Affiliation(s)
- Bridget Kiely
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Croke
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Muireann O'Shea
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eamon O'Shea
- School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
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Drake C, Reiter K, Weinberger M, Eisenson H, Edelman D, Trogdon JG, Shea CM. The Direct Clinic-Level Cost of the Implementation and Use of a Protocol to Assess and Address Social Needs in Diverse Community Health Center Primary Care Clinical Settings. J Health Care Poor Underserved 2021; 32:1872-1888. [PMID: 34803048 PMCID: PMC9996544 DOI: 10.1353/hpu.2021.0171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Social determinants of health, including food insecurity, housing instability, social isolation, and unemployment are important drivers of health outcomes and utilization. To inform implementation of social needs screening and response protocols, there is a need to identify the associated costs in routine primary care encounters. METHODS We interviewed key stakeholders in four diverse community health centers that had adopted a widely used social needs screening and response protocol. We evaluated costs using an activity-based costing tool across both the initial implementation phase and ongoing maintenance phase. RESULTS Clinic costs were associated with workforce development, planning, and electronic health record integration. These initial implementation costs varied by site ($6,644-$49,087). On a per-patient basis, ongoing maintenance costs ranged from $9.76 to $47.98. CONCLUSION Our findings can aid in designing reimbursement mechanisms tied to social needs screening and response to accelerate translational efforts and promote health equity.
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