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Manning ER, Duan Q, Taylor S, Ray S, Corley AMS, Michael J, Gillette R, Unaka N, Hartley D, Beck AF, Brokamp C. Development of a multimodal geomarker pipeline to assess the impact of social, economic, and environmental factors on pediatric health outcomes. J Am Med Inform Assoc 2024; 31:1471-1478. [PMID: 38733117 PMCID: PMC11187418 DOI: 10.1093/jamia/ocae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/05/2024] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES We sought to create a computational pipeline for attaching geomarkers, contextual or geographic measures that influence or predict health, to electronic health records at scale, including developing a tool for matching addresses to parcels to assess the impact of housing characteristics on pediatric health. MATERIALS AND METHODS We created a geomarker pipeline to link residential addresses from hospital admissions at Cincinnati Children's Hospital Medical Center (CCHMC) between July 2016 and June 2022 to place-based data. Linkage methods included by date of admission, geocoding to census tract, street range geocoding, and probabilistic address matching. We assessed 4 methods for probabilistic address matching. RESULTS We characterized 124 244 hospitalizations experienced by 69 842 children admitted to CCHMC. Of the 55 684 hospitalizations with residential addresses in Hamilton County, Ohio, all were matched to 7 temporal geomarkers, 97% were matched to 79 census tract-level geomarkers and 13 point-level geomarkers, and 75% were matched to 16 parcel-level geomarkers. Parcel-level geomarkers were linked using our exact address matching tool developed using the best-performing linkage method. DISCUSSION Our multimodal geomarker pipeline provides a reproducible framework for attaching place-based data to health data while maintaining data privacy. This framework can be applied to other populations and in other regions. We also created a tool for address matching that democratizes parcel-level data to advance precision population health efforts. CONCLUSION We created an open framework for multimodal geomarker assessment by harmonizing and linking a set of over 100 geomarkers to hospitalization data, enabling assessment of links between geomarkers and hospital admissions.
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Affiliation(s)
- Erika Rasnick Manning
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Qing Duan
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Stuart Taylor
- Office of Population Health, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Sarah Ray
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, United States
| | - Alexandra M S Corley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, United States
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Joseph Michael
- James M Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Ryan Gillette
- Office of Population Health, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Ndidi Unaka
- Office of Population Health, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, United States
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
| | - David Hartley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, United States
- James M Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Andrew F Beck
- Office of Population Health, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, United States
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
- James M Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
- Michael Fisher Child Health Equity Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, United States
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Chakraborty O, Dragan KL, Ellen IG, Glied SA, Howland RE, Neill DB, Wang S. Housing-Sensitive Health Conditions Can Predict Poor-Quality Housing. Health Aff (Millwood) 2024; 43:297-304. [PMID: 38315928 DOI: 10.1377/hlthaff.2023.01008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Improving housing quality may improve residents' health, but identifying buildings in poor repair is challenging. We developed a method to improve health-related building inspection targeting. Linking New York City Medicaid claims data to Landlord Watchlist data, we used machine learning to identify housing-sensitive health conditions correlated with a building's presence on the Watchlist. We identified twenty-three specific housing-sensitive health conditions in five broad categories consistent with the existing literature on housing and health. We used these results to generate a housing health index from building-level claims data that can be used to rank buildings by the likelihood that their poor quality is affecting residents' health. We found that buildings in the highest decile of the housing health index (controlling for building size, community district, and subsidization status) scored worse across a variety of housing quality indicators, validating our approach. We discuss how the housing health index could be used by local governments to target building inspections with a focus on improving health.
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Affiliation(s)
| | - Kacie L Dragan
- Kacie L. Dragan, Harvard University, Cambridge, Massachusetts
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Mollalo A, Hamidi B, Lenert L, Alekseyenko AV. Application of Spatial Analysis for Electronic Health Records: Characterizing Patient Phenotypes and Emerging Trends. RESEARCH SQUARE 2024:rs.3.rs-3443865. [PMID: 37886509 PMCID: PMC10602163 DOI: 10.21203/rs.3.rs-3443865/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Electronic health records (EHR) commonly contain patient addresses that provide valuable data for geocoding and spatial analysis, enabling more comprehensive descriptions of individual patients for clinical purposes. Despite the widespread use of EHR in clinical decision support and interventions, no systematic review has examined the extent to which spatial analysis is used to characterize patient phenotypes. Objective This study reviews advanced spatial analyses that employed individual-level health data from EHR within the US to characterize patient phenotypes. Methods We systematically evaluated English-language peer-reviewed articles from PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases from inception to August 20, 2023, without imposing constraints on time, study design, or specific health domains. Results Only 49 articles met the eligibility criteria. These articles utilized diverse spatial methods, with a predominant focus on clustering techniques, while spatiotemporal analysis (frequentist and Bayesian) and modeling were relatively underexplored. A noteworthy surge (n = 42, 85.7%) in publications was observed post-2017. The publications investigated a variety of adult and pediatric clinical areas, including infectious disease, endocrinology, and cardiology, using phenotypes defined over a range of data domains, such as demographics, diagnoses, and visits. The primary health outcomes investigated were asthma, hypertension, and diabetes. Notably, patient phenotypes involving genomics, imaging, and notes were rarely utilized. Conclusions This review underscores the growing interest in spatial analysis of EHR-derived data and highlights knowledge gaps in clinical health, phenotype domains, and spatial methodologies. Additionally, this review proposes guidelines for harnessing the potential of spatial analysis to enhance the context of individual patients for future clinical decision support.
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DeMass R, Gupta D, Self S, Thomas D, Rudisill C. Emergency department use and geospatial variation in social determinants of health: a pilot study from South Carolina. BMC Public Health 2023; 23:1527. [PMID: 37563566 PMCID: PMC10416539 DOI: 10.1186/s12889-023-16136-2] [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] [Received: 02/24/2023] [Accepted: 06/16/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Health systems are increasingly addressing patients' social determinants of health (SDoH)-related needs and investigating their effects on health resource use. SDoH needs vary geographically; however, little is known about how this geographic variation in SDoH needs impacts the relationship between SDoH needs and health resource use. METHODS This study uses data from a SDoH survey administered to a pilot patient population in a single health system and the electronic medical records of the surveyed patients to determine if the impact of SDoH needs on emergency department use varies geospatially at the US Census block group level. A Bayesian zero-inflated negative binomial model was used to determine if emergency department visits after SDoH screening varied across block groups. Additionally, the relationships between the number of emergency department visits and the response to each SDoH screening question was assessed using Bayesian negative binomial hurdle models with spatially varying coefficients following a conditional autoregressive (CAR) model at the census block group level. RESULTS Statistically important differences in emergency department visits after screening were found between block groups. Statistically important spatial variation was found in the association between patient responses to the questions concerning unhealthy home environments (e.g. mold, bugs/rodents, not enough air conditioning/heat) or domestic violence/abuse and the mean number of emergency department visits after the screen. CONCLUSIONS Notable spatial variation was found in the relationships between screening positive for unhealthy home environments or domestic violence/abuse and emergency department use. Despite the limitation of a relatively small sample size, sensitivity analyses suggest spatially varying relationships between other SDoH-related needs and emergency department use.
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Affiliation(s)
- Reid DeMass
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St., Columbia, SC, 29208, USA
| | - Deeksha Gupta
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Stella Self
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 300 E. McBee Ave. Greenville, Columbia, SC, 29601, USA.
| | - Darin Thomas
- Addiction Medicine Center, Prisma Health, 605 Grove Road Greenville, Columbia, SC, 29605, USA
| | - Caroline Rudisill
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 300 E. McBee Ave. Greenville, Columbia, SC, 29601, USA
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Nazario S, González-Sepúlveda L, Telón-Sosa B, Rivas-Tumanyan S. Place of death from asthma differs by age, race, and ethnicity. Ann Allergy Asthma Immunol 2023; 131:268-269. [PMID: 37225001 DOI: 10.1016/j.anai.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Sylvette Nazario
- Allergy-Immunology Section, Internal Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Lorena González-Sepúlveda
- Hispanic Alliance for Clinical & Translational Research, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Bonnie Telón-Sosa
- Allergy-Immunology Section, Internal Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Sona Rivas-Tumanyan
- Hispanic Alliance for Clinical & Translational Research, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
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Hollenbach JP, Collins MS, Wasser C, Fedele D. Implementation of standardized asthma management programs in outpatient settings. Ann Allergy Asthma Immunol 2023; 130:571-576. [PMID: 36702245 DOI: 10.1016/j.anai.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW This article reviews new approaches, facilitators, barriers, and opportunities to increasing adoption of standardized asthma management programs in the outpatient care setting. RECENT FINDINGS Primary care clinicians providing asthma care in the outpatient setting are challenged by the complexity of guidelines and want standardization of tools that are easy to use and that can be integrated within their practice's workflow. Programs that integrate clinical decision support tools within a practice's electronic health record and provide support from specialists may enhance uptake of asthma management programs in the outpatient setting and reduce asthma morbidity. Lack of an implementation science framework, consideration for organizational context, and clinician buy-in are recently recognized barriers to adoption of asthma programs and improved asthma outcomes. In addition, many of these interventions are labor intensive, costly, and may not be capable of wide dissemination because of the EHR interoperability problem. CONCLUSION Programs that simplify the guidelines, integrate clinical decision support within the EHR, and ground their approach with an implementation science framework may improve the quality of asthma care provided in the outpatient setting.
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Affiliation(s)
- Jessica P Hollenbach
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut.
| | - Melanie Sue Collins
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut; Division of Pediatric Pulmonary and Sleep Medicine, Connecticut Children's Medical Center, Hartford, Connecticut; Central Connecticut Cystic Fibrosis Center, Hartford, Connecticut
| | - Caleb Wasser
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut
| | - David Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
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