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Williams S, Hill K, Mathew MS, Messiah SE. Disparities in Patient Family Social Determinants of Health in a Large Urban Pediatric Health System. J Pediatr Health Care 2024; 38:172-183. [PMID: 38429029 DOI: 10.1016/j.pedhc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This analysis sought to identify disparities in social determinants of health (SDOH) outcomes at a Texas pediatric hospital. METHODS This retrospective study used electronic health records of pediatric patients families surveyed August -December 2022. Outcomes for health literacy, social support, food, transportation, energy, digital, and housing insecurity, and tobacco exposure were analyzed across demographic categories. RESULTS Among 15,294 respondents to the survey (mean child age, 8.73 years; 43.68% Hispanic, 29.73% non-Hispanic White, 18.27% non-Hispanic Black, 6.79% other race/ethnicity; 53.95% male), 50.25% of respondents reported at least one SDOH, whereas 23.39% reported two or more SDOH. The most prevalent SDOH was lack of social support (3,456, 23.91%). Hispanic, non-Hispanic Black, and other race/ethnicity respondents, non-English speakers, and public insurance users had higher odds of reporting almost all SDOH in logistic regression models adjusted for age, race/ethnicity, language, gender, and insurance type. DISCUSSION Race/ethnicity, language, and insurance type disparities were identified for all SDOH.
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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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Xie SJ, Kapos FP, Mooney SJ, Mooney S, Stephens KA, Chen C, Hartzler AL, Pratap A. Geospatial divide in real-world EHR data: Analytical workflow to assess regional biases and potential impact on health equity. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2023; 2023:572-581. [PMID: 37350875 PMCID: PMC10283143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Real-world data (RWD) like electronic health records (EHR) has great potential for secondary use by health systems and researchers. However, collected primarily for efficient health care, EHR data may not equitably represent local regions and populations, impacting the generalizability of insights learned from it. We assessed the geospatial representativeness of regions in a large health system EHR data using a spatial analysis workflow, which provides a data-driven way to quantify geospatial representation and identify adequately represented regions. We applied the workflow to investigate geospatial patterns of overweight/obesity and depression patients to find regional "hotspots" for potential targeted interventions. Our findings show the presence of geospatial bias in EHR and demonstrate the workflow to identify spatial clusters after adjusting for bias due to the geospatial representativeness. This work highlights the importance of evaluating geospatial representativeness in RWD to guide targeted deployment of limited healthcare resources and generate equitable real-world evidence.
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Affiliation(s)
| | | | | | | | | | | | | | - Abhishek Pratap
- University of Washington, Seattle, WA
- Center for Addiction and Mental Health, Toronto, Canada
- King's College London, London, United Kingdom
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Páscoa R, Teixeira A, Henriques TS, Monteiro H, Monteiro R, Martins C. Characterization of an obese population: a retrospective longitudinal study from real-world data in northern Portugal. BMC PRIMARY CARE 2023; 24:99. [PMID: 37061669 PMCID: PMC10105387 DOI: 10.1186/s12875-023-02023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 02/28/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Obesity is a serious and largely preventable global health problem. Obesity-related electronic health records can be a useful resource to identify and address obesity. The analysis of real-world data from T82-coded (International Classification of Primary Care coding, for obesity) primary care individuals can be an excellent national source of data on obesity's prevalence, characteristics, and impact on the National Health Service. METHODS Retrospective longitudinal study, based on a database of electronic medical records, from the Regional Health Administration of northern Portugal. The study objectives were to determine the prevalence of obesity and to characterize an adult obese population in northern Portugal from a bio-demographic point of view along with profiles of comorbidities and the use of health resources. This study used a database of 266,872 patients in December 2019 and screened for diagnostic code T82 from the International Classification of Primary Care. RESULTS The prevalence of obesity was 10.2% and the highest prevalence of obesity was in the 65-74 age group (16.1%). The most prevalent morbidities in patients with obesity as coded through ICPC-2 were K86 (uncomplicated hypertension), T90 (non-insulin-dependent diabetes), and K87 (complicated hypertension). Descriptive information showed that T82 subjects used more consultations, medications, and diagnostic tests than non-T82 subjects. CONCLUSIONS Routine recording of weight and height deserves special attention to allow obesity recognition at an early stage and move on to the appropriate intervention. Future work is necessary to automate the codification of obesity for subjects under 18 years of age, to raise awareness and anticipate the prevention of problems associated with obesity. Practical strategies need to be implemented, such as the creation of a specific program consultation with truly targeted approaches to obesity.
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Affiliation(s)
- Rosália Páscoa
- Faculty of Medicine, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal.
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal.
- Administração Regional de Saúde do Norte IP, Health Centre Grouping Porto Ocidental, Family Health Unit Homem do Leme, Porto, Portugal.
| | - Andreia Teixeira
- Faculty of Medicine, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Instituto Politécnico de Viana do Castelo (IPVC), ADiT-LAB, Viana do Castelo, Portugal
| | - Teresa S Henriques
- Faculty of Medicine, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Hugo Monteiro
- Studies and Planning Department, Administração Regional de Saúde do Norte IP, Porto, Portugal
| | - Rosário Monteiro
- Faculty of Medicine, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Administração Regional de Saúde do Norte IP, Health Centre Grouping Porto Ocidental, Family Health Unit Homem do Leme, Porto, Portugal
| | - Carlos Martins
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- #H4A Primary Healthcare Research Network, Porto, Portugal
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Berg K, Doktorchik C, Quan H, Saini V. Automating data collection methods in electronic health record systems: a Social Determinant of Health (SDOH) viewpoint. Health Syst (Basingstoke) 2022; 12:472-480. [PMID: 38235302 PMCID: PMC10791104 DOI: 10.1080/20476965.2022.2075796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/26/2022] [Indexed: 10/18/2022] Open
Abstract
Social Determinant of Health (SDOH) data are important targets for research and innovation in Health Information Systems (HIS). The ways we envision SDOH in "smart" information systems will play a considerable role in shaping future population health landscapes. Current methods for data collection can capture wide ranges of SDOH factors, in standardised and non-standardised formats, from both primary and secondary sources. Advances in automating data linkage and text classification show particular promise for enhancing SDOH in HIS. One challenge is that social communication processes embedded in data collection are directly related to the inequalities that HIS attempt to measure and redress. To advance equity, it is imperative thatcare-providers, researchers, technicians, and administrators attend to power dynamics in HIS standards and practices. We recommend: 1. Investing in interdisciplinary and intersectoral knowledge generation and translation. 2. Developing novel methods for data discovery, linkage and analysis through participatory research. 3. Channelling information into upstream evidence-informed policy.
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Affiliation(s)
- Kelsey Berg
- Alberta Health Services, University of Lethbridge
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Salinas JJ, Sheen J, Shokar N, Wright J, Vazquez G, Alozie O. An electronic medical records study of population obesity prevalence in El Paso, Texas. BMC Med Inform Decis Mak 2022; 22:46. [PMID: 35193581 PMCID: PMC8861479 DOI: 10.1186/s12911-022-01781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, we determine the feasibility of using electronic medical record (EMR) data to determine obesity prevalence at the census tract level in El Paso County, Texas, located on the U.S.-Mexico border. METHODS 2012-2018 Body Mass Index (BMI kg/m2) data from a large university clinic system in was geocoded and aggregated to a census tract level. After cleaning and removing duplicate EMR and unusable data, 143,524 patient records were successful geocoded. Maps were created to assess representativeness of EMR data across census tracts, within El Paso County. Additionally, maps were created to display the distribution of obesity across the same geography. RESULTS EMR data represented all but one El Paso census tract. Representation ranged from 0.7% to 34.9%. Greatest representation were among census tracts in and around clinics. The mean EMR data BMI (kg/m2) was 30.1, this is approximately 6% less than the 36.0% estimated for El Paso County using the Behavioral Risk Factor Surveillance Study (BRFSS) estimate. At the census tract level, obesity prevalence ranged from 26.6 to 57.6%. The highest obesity prevalence were in areas that tended to be less affluent, with a higher concentration of immigrants, poverty and Latino ethnic concentration. CONCLUSIONS EMR data use for obesity surveillance is feasible in El Paso County, Texas, a U.S.-Mexico border community. Findings indicate substantial obesity prevalence variation between census tracts within El Paso County that may be associated with population distributions related to socioeconomics.
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Affiliation(s)
- Jennifer J Salinas
- Department of Molecular and Translational Medicine, Texas Tech Health Sciences Center El Paso, 5001 El Paso Dr., El Paso, TX, 79905, USA.
| | - Jon Sheen
- Department of Molecular and Translational Medicine, Texas Tech Health Sciences Center El Paso, 5001 El Paso Dr., El Paso, TX, 79905, USA
| | - Navkiran Shokar
- Department of Family and Community Medicine, Texas Tech Health Sciences Center El Paso, El Paso, TX, USA
| | - Justin Wright
- Department of Family and Community Medicine, Texas Tech Health Sciences Center El Paso, El Paso, TX, USA
| | - Gerardo Vazquez
- Department of Family and Community Medicine, Texas Tech Health Sciences Center El Paso, El Paso, TX, USA
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Wark K, Cheung K, Wolter E, Avey JP. "Engaging stakeholders in integrating social determinants of health into electronic health records: a scoping review". Int J Circumpolar Health 2021; 80:1943983. [PMID: 34252016 PMCID: PMC8276667 DOI: 10.1080/22423982.2021.1943983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 10/27/2022] Open
Abstract
Social, environmental, and behavioural factors impact human health. Integrating these social determinants of health (SDOH) into electronic health records (EHR) may improve individual and population health. But how these data are collectedand their use in clinical settings remain unclear. We reviewed efforts to integrate SDOH into EHR in the U.S. and Canada, especially how this implementation serves Indigenous peoples. We followed an established scoping review process, performing iterative keyword searches in subject-appropriate databases, reviewing identified works' bibliographies, and soliciting recommendations from subject-matter experts. We reviewed 20 articles from an initial set of 2,459. Most discussed multiple SDOH indicator standards, with the National Academy of Medicine's (NAM) the most frequently cited (n = 10). Common SDOH domains were demographics, economics, education, environment, housing, psychosocial factors, and health behaviours. Twelve articles discussed project acceptability and feasibility; eight mentioned stakeholder engagement (none specifically discussed engaging ethnic or social minorities); and six adapted SDOH measures to local cultures . Linking SDOH data to EHR as related to Indigenous communities warrants further exploration, especially how to best align cultural strengths and community expectations with clinical priorities. Integrating SDOH data into EHR appears feasible and acceptable may improve patient care, patient-provider relationships, and health outcomes.
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Affiliation(s)
- Kyle Wark
- Southcentral Foundation, Research Department, Anchorage, AK, USA
| | - Karen Cheung
- Southcentral Foundation, Research Department, Anchorage, AK, USA
| | - Erika Wolter
- Southcentral Foundation, Research Department, Anchorage, AK, USA
| | - Jaedon P. Avey
- Southcentral Foundation, Research Department, Anchorage, AK, USA
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Oyedapo HA, Ayeni O, Afolabi NB, Akinyemi OJ. Quantile regression methods for determination of factors associated with nutritional status of women of reproductive age in Nigeria. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chen M, Tan X, Padman R. Social determinants of health in electronic health records and their impact on analysis and risk prediction: A systematic review. J Am Med Inform Assoc 2021; 27:1764-1773. [PMID: 33202021 DOI: 10.1093/jamia/ocaa143] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This integrative review identifies and analyzes the extant literature to examine the integration of social determinants of health (SDoH) domains into electronic health records (EHRs), their impact on risk prediction, and the specific outcomes and SDoH domains that have been tracked. MATERIALS AND METHODS In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a literature search in the PubMed, CINAHL, Cochrane, EMBASE, and PsycINFO databases for English language studies published until March 2020 that examined SDoH domains in the context of EHRs. RESULTS Our search strategy identified 71 unique studies that are directly related to the research questions. 75% of the included studies were published since 2017, and 68% were U.S.-based. 79% of the reviewed articles integrated SDoH information from external data sources into EHRs, and the rest of them extracted SDoH information from unstructured clinical notes in the EHRs. We found that all but 1 study using external area-level SDoH data reported minimum contribution to performance improvement in the predictive models. In contrast, studies that incorporated individual-level SDoH data reported improved predictive performance of various outcomes such as service referrals, medication adherence, and risk of 30-day readmission. We also found little consensus on the SDoH measures used in the literature and current screening tools. CONCLUSIONS The literature provides early and rapidly growing evidence that integrating individual-level SDoH into EHRs can assist in risk assessment and predicting healthcare utilization and health outcomes, which further motivates efforts to collect and standardize patient-level SDoH information.
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Affiliation(s)
- Min Chen
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, USA
| | - Xuan Tan
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, USA
| | - Rema Padman
- The H. John Heinz III College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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Blosnich JR, Montgomery AE, Taylor LD, Dichter ME. Adverse social factors and all-cause mortality among male and female patients receiving care in the Veterans Health Administration. Prev Med 2020; 141:106272. [PMID: 33022319 DOI: 10.1016/j.ypmed.2020.106272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
Social factors account more for health outcomes than medical care, yet health services research in this area is limited due to the lack of social factors data contained within electronic health records (EHR) systems. Few investigations have examined how cumulative burdens of co-occurring adverse social factors impact health outcomes. From 293,872 patients in one region of the Veterans Health Administration (VHA), we examined how increasing numbers of adverse social factors extracted from the EHR were associated with mortality across a one-year period for male and female patients. Adverse social factors were identified using four sources in the EHR: responses to universal VHA screens, International Classification of Disease (ICD) diagnostic codes that indicate social factors, receipt of VHA services related to social factors, and templated social work referrals. Seven types of adverse social factors were coded: violence, housing instability, employment or financial problems, legal issues, social or familial problems, lack of access to care or transportation, and nonspecific psychosocial needs. Overall, each increase in an adverse social factor was associated with 27% increased odds of mortality, after accounting for demographics, medical comorbidity, and military service-related disability. Non-specific psychosocial factors were most strongly associated with mortality, followed by social or familial problems. Although women were more likely than men to have multiple adverse social factors, social factors were not associated with mortality among women as they were among men. By incorporating social factors data, health care systems can better understand patient all-cause mortality and identify potential prevention efforts built around social determinants.
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Affiliation(s)
- John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States of America; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.
| | - Ann Elizabeth Montgomery
- U.S. Department of Veterans Affairs (VA), National Center on Homelessness Among Veterans, Tampa, FL, United States of America; Birmingham VA Medical Center, Birmingham, AL, United States of America; Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Laura D Taylor
- U.S. Department of Veterans Affairs (VA), National Social Work Program Office, Washington, DC, United States of America
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America; School of Social Work, College of Public Health, Temple University, Philadelphia, PA, United States of America
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Identification of temporal condition patterns associated with pediatric obesity incidence using sequence mining and big data. Int J Obes (Lond) 2020; 44:1753-1765. [PMID: 32494036 PMCID: PMC7381422 DOI: 10.1038/s41366-020-0614-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022]
Abstract
Background Electronic health records (EHRs) are potentially important components in addressing pediatric obesity in clinical settings and at the population level. This work aims to identify temporal condition patterns surrounding obesity incidence in a large pediatric population that may inform clinical care and childhood obesity policy and prevention efforts. Methods EHR data from healthcare visits with an initial record of obesity incidence (index visit) from 2009 through 2016 at the Children’s Hospital of Philadelphia, and visits immediately before (pre-index) and after (post-index), were compared with a matched control population of patients with a healthy weight to characterize the prevalence of common diagnoses and condition trajectories. The study population consisted of 49,694 patients with pediatric obesity and their corresponding matched controls. The SPADE algorithm was used to identify common temporal condition patterns in the case population. McNemar’s test was used to assess the statistical significance of pattern prevalence differences between the case and control populations. Results SPADE identified 163 condition patterns that were present in at least 1% of cases; 80 were significantly more common among cases and 45 were significantly more common among controls (p < 0.05). Asthma and allergic rhinitis were strongly associated with childhood obesity incidence, particularly during the pre-index and index visits. Seven conditions were commonly diagnosed for cases exclusively during pre-index visits, including ear, nose, and throat disorders and gastroenteritis. Conclusions The novel application of SPADE on a large retrospective dataset revealed temporally dependent condition associations with obesity incidence. Allergic rhinitis and asthma had a particularly high prevalence during pre-index visits. These conditions, along with those exclusively observed during pre-index visits, may represent signals of future obesity. While causation cannot be inferred from these associations, the temporal condition patterns identified here represent hypotheses that can be investigated to determine causal relationships in future obesity research.
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Liu N, Birstler J, Venkatesh M, Hanrahan LP, Chen G, Funk LM. Weight Loss for Patients With Obesity: An Analysis of Long-Term Electronic Health Record Data. Med Care 2020; 58:265-272. [PMID: 31876663 PMCID: PMC7218679 DOI: 10.1097/mlr.0000000000001277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Numerous studies have reported that losing as little as 5% of one's total body weight (TBW) can improve health, but no studies have used electronic health record data to examine long-term changes in weight, particularly for adults with severe obesity [body mass index (BMI) ≥35 kg/m]. OBJECTIVE To measure long-term weight changes and examine their predictors for adults in a large academic health care system. RESEARCH DESIGN Observational study. SUBJECTS We included 59,816 patients aged 18-70 years who had at least 2 BMI measurements 5 years apart. Patients who were underweight, pregnant, diagnosed with cancer, or had undergone bariatric surgery were excluded. MEASURES Over a 5-year period: (1) ≥5% TBW loss; (2) weight loss into a nonobese BMI category (BMI <30 kg/m); and (3) predictors of %TBW change via quantile regression. RESULTS Of those with class 2 or 3 obesity, 24.2% and 27.8%, respectively, lost at least 5% TBW. Only 3.2% and 0.2% of patients with class 2 and 3 obesity, respectively, lost enough weight to attain a BMI <30 kg/m. In quantile regression, the median weight change for the population was a net gain of 2.5% TBW. CONCLUSIONS Although adults with severe obesity were more likely to lose at least 5% TBW compared with overweight patients and patients with class 1 obesity, sufficient weight loss to attain a nonobese weight class was very uncommon. The pattern of ongoing weight gain found in our study population requires solutions at societal and health systems levels.
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Affiliation(s)
- Natalie Liu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726
| | - Jen Birstler
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI 53726
| | - Manasa Venkatesh
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726
| | - Lawrence P. Hanrahan
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726
| | - Guanhua Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI 53726
| | - Luke M. Funk
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792
- William S. Middleton Memorial VA, 2500 Overlook Terrace, Madison, WI 53705
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Golembiewski E, Allen KS, Blackmon AM, Hinrichs RJ, Vest JR. Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review. JMIR Public Health Surveill 2019; 5:e12846. [PMID: 31593550 PMCID: PMC6803891 DOI: 10.2196/12846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/23/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.
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Affiliation(s)
| | - Katie S Allen
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Amber M Blackmon
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States
| | | | - Joshua R Vest
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
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Implementation of a Regional Perinatal Data Repository from Clinical and Billing Records. Matern Child Health J 2019; 22:485-493. [PMID: 29275460 DOI: 10.1007/s10995-017-2414-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives To describe the implementation of the first phase of a regional perinatal data repository and to provide a roadmap for others to navigate technical, privacy, and data governance concerns in implementing similar resources. Methods Our implementation integrated regional physician billing records with maternal and infant electronic health records from an academic delivery hospital. These records, representing births during 2013-2015, constituted a data core supporting linkage to additional ancillary data sets. Measures obtained from pediatric follow-up, urgent care, emergency, and inpatient encounters were linked at the individual level as were measures obtained by home visitors during pre- and postnatal encounters. Residential addresses were geocoded supporting linkage to area-level measures. Results Integrated data contained regional billing records for 69,290 newborns representing approximately 81% of all regional live births and nearly 95% of live births in the region's most populous county. Billing records linked to 7293 infant delivery hospital records and 7107 corresponding maternal hospital records. Manual review demonstrated 100% validity of matches among audited records. Additionally, 2430 home visiting records were linked to the data core as were pediatric primary care, urgent care, emergency department, and inpatient visits representing 42,541 children. More than 99% of the newborn billing records were geocoded and assigned a census tract identifier. Conclusions for Practice Our approach to methodological and regulatory challenges affords opportunities for expansion of systems to integrate electronic health records originating from additional medical centers as well as individual- and area-level linkage to additional data sets relevant to perinatal health.
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Angier H, Jacobs EA, Huguet N, Likumahuwa-Ackman S, Robert S, DeVoe JE. Progress towards using community context with clinical data in primary care. Fam Med Community Health 2018; 7:e000028. [PMID: 32148692 PMCID: PMC6951248 DOI: 10.1136/fmch-2018-000028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/03/2022] Open
Abstract
Community-level factors have significant impacts on health. There is renewed enthusiasm for integrating these data with electronic health record (EHR) data for use in primary care to improve health equity in the USA. Thus, it is valuable to reflect on what has been published to date. Specifically, we comment on: (1) recommendations about combining community-level factors in EHRs for use in primary care; (2) examples of how these data have been combined and used; and (3) the impact of using combined data on healthcare, patient health and health equity. We found publications discussing the potential of combined data to inform clinical care, target interventions, track population health and spark community partnerships with the goal of reducing health disparities and improving health equity. Although there is great enthusiasm and potential for using these data to inform primary care, there is little evidence of improved healthcare, patient health or health equity.
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Affiliation(s)
- Heather Angier
- Oregon Health & Science University, Portland, Oregon, USA
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16
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Kruse CS, Stein A, Thomas H, Kaur H. The use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature. J Med Syst 2018; 42:214. [PMID: 30269237 PMCID: PMC6182727 DOI: 10.1007/s10916-018-1075-6] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 09/19/2018] [Indexed: 12/16/2022]
Abstract
Electronic health records (EHRs) have emerged among health information technology as "meaningful use" to improve the quality and efficiency of healthcare, and health disparities in population health. In other instances, they have also shown lack of interoperability, functionality and many medical errors. With proper implementation and training, are electronic health records a viable source in managing population health? The primary objective of this systematic review is to assess the relationship of electronic health records' use on population health through the identification and analysis of facilitators and barriers to its adoption for this purpose. Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE (PubMed), 10/02/2012-10/02/2017, core clinical/academic journals, MEDLINE full text, English only, human species and evaluated the articles that were germane to our research objective. Each article was analyzed by multiple reviewers. Group members recognized common facilitators and barriers associated with EHRs effect on population health. A final list of articles was selected by the group after three consensus meetings (n = 55). Among a total of 26 factors identified, 63% (147/232) of those were facilitators and 37% (85/232) barriers. About 70% of the facilitators consisted of productivity/efficiency in EHRs occurring 33 times, increased quality and data management each occurring 19 times, surveillance occurring 17 times, and preventative care occurring 15 times. About 70% of the barriers consisted of missing data occurring 24 times, no standards (interoperability) occurring 13 times, productivity loss occurring 12 times, and technology too complex occurring 10 times. The analysis identified more facilitators than barriers to the use of the EHR to support public health. Wider adoption of the EHR and more comprehensive standards for interoperability will only enhance the ability for the EHR to support this important area of surveillance and disease prevention. This review identifies more facilitators than barriers to using the EHR to support public health, which implies a certain level of usability and acceptance to use the EHR in this manner. The public-health industry should combine their efforts with the interoperability projects to make the EHR both fully adopted and fully interoperable. This will greatly increase the availability, accuracy, and comprehensiveness of data across the country, which will enhance benchmarking and disease surveillance/prevention capabilities.
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Affiliation(s)
- Clemens Scott Kruse
- Texas State University, 601 University Dr, Encino 250, San Marcos, TX, 78666, USA.
| | - Anna Stein
- Texas State University, 601 University Dr, Encino 250, San Marcos, TX, 78666, USA
| | - Heather Thomas
- Texas State University, 601 University Dr, Encino 250, San Marcos, TX, 78666, USA
| | - Harmander Kaur
- Texas State University, 601 University Dr, Encino 250, San Marcos, TX, 78666, USA
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Razmak J, Bélanger C. Using the technology acceptance model to predict patient attitude toward personal health records in regional communities. INFORMATION TECHNOLOGY & PEOPLE 2018. [DOI: 10.1108/itp-07-2016-0160] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to statistically measure (quantify) how a sample of Canadians perceives the usability of electronic personal health records (PHRs) and, in the process, to increase Canadian patients’ awareness of PHRs and improve physicians’ confidence in their patients’ ability to manage their own health information through PHRs.
Design/methodology/approach
The authors surveyed 325 Canadian patients living in Northern Ontario to assess a research model consisting of seven perceptions of PHR systems used to manage personal health information electronically, and to assess their perceived ability to use PHR systems. The survey questions were adapted from the 2014 National Physician Survey in Canada. The authors compared the patients’ results with physicians’ own perceptions of their patients’ ability to use PHR systems.
Findings
First, there was a positive relationship between surveyed patients’ prior experiences, needs, values, and their attitude toward adopting the PHR system. Second, how patients saw a PHR system’s user-friendliness was the strongest predictor of how useful they considered it would be. Finally, of the 243 physician respondents, 90.3 percent believed their patients would not be able to manage their own e-health information via a PHR system, but 54.8 percent of the 325 patient respondents indicated they would be able to do so.
Originality/value
This study is unique in that the authors know of no other Canadian study that purports to predict, using the technology acceptance model factors, people’s attitudes toward adopting a PHR system. As well, this is the first Canadian study to compare the perspectives of healthcare providers and their patients on e-health applications.
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Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV. Using electronic health record data for environmental and place based population health research: a systematic review. Ann Epidemiol 2018; 28:493-502. [PMID: 29628285 DOI: 10.1016/j.annepidem.2018.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE We conducted a systematic review of literature published on January 2000-May 2017 that spatially linked electronic health record (EHR) data with environmental information for population health research. METHODS We abstracted information on the environmental and health outcome variables and the methods and data sources used. RESULTS The automated search yielded 669 articles; 128 articles are included in the full review. The number of articles increased by publication year; the majority (80%) were from the United States, and the mean sample size was approximately 160,000. Most articles used cross-sectional (44%) or longitudinal (40%) designs. Common outcomes were health care utilization (32%), cardiometabolic conditions/obesity (23%), and asthma/respiratory conditions (10%). Common environmental variables were sociodemographic measures (42%), proximity to medical facilities (15%), and built environment and land use (13%). The most common spatial identifiers were administrative units (59%), such as census tracts. Residential addresses were also commonly used to assign point locations, or to calculate distances or buffer areas. CONCLUSIONS Future research should include more detailed descriptions of methods used to geocode addresses, focus on a broader array of health outcomes, and describe linkage methods. Studies should also explore using longitudinal residential address histories to evaluate associations between time-varying environmental variables and health outcomes.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
| | - Amy H Auchincloss
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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Soares N, Dewalle J, Marsh B. Utilizing patient geographic information system data to plan telemedicine service locations. J Am Med Inform Assoc 2018; 24:891-896. [PMID: 28339932 DOI: 10.1093/jamia/ocx011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). Methods This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients' average travel distance (ATD) to the closest clinic site. Results A total of 4027 visits by 2049 unique patients were analyzed. The best travel distances for site groupings of 3, 4, 5, or 6 site locations were ranked based on increasing ATD. Each one-site increase in the number of available telemedicine sites decreased minimum ATD by about 8%. For a given group size, the best groupings were very similar in minimum travel distance. There were significant differences in predicted patient load imbalance between otherwise similar groupings. A majority of the best site groupings used the same small number of sites, and urban sites were heavily used. Discussion With EHR geospatial data at an individual patient level, we can model potential telemedicine sites for specialty access in a rural geographic area. Relatively few sites could serve most of the population. Direct access to patient GIS data from an EHR provides direct knowledge of the client base compared to methods that allocate aggregated data. Conclusion Geospatial data and methods can assist health care location planning, generating data about load, load balance, and spatial accessibility.
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Affiliation(s)
- Neelkamal Soares
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Joseph Dewalle
- Environmental Health Institute, Center for Health Research, Geisinger Health System, Danville, PA, USA
| | - Ben Marsh
- Department of Geography and Program in Environmental Studies, Bucknell University, Lewisburg, PA, USA
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Pantalone KM, Hobbs TM, Chagin KM, Kong SX, Wells BJ, Kattan MW, Bouchard J, Sakurada B, Milinovich A, Weng W, Bauman J, Misra-Hebert AD, Zimmerman RS, Burguera B. Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system. BMJ Open 2017; 7:e017583. [PMID: 29150468 PMCID: PMC5702021 DOI: 10.1136/bmjopen-2017-017583] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/28/2017] [Accepted: 10/18/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis of obesity, via International Classification of Diseases, Ninth Revision (ICD-9) documentation among patients with body mass index (BMI) ≥30 kg/m2. DESIGN The electronic health record system at Cleveland Clinic was used to create a cross-sectional summary of actively managed patients meeting minimum primary care physician visit frequency requirements. Eligible patients were stratified by BMI categories, based on most recent weight and median of all recorded heights obtained on or before the index date of 1July 2015. Relationships between patient characteristics and BMI categories were tested. SETTING A large US integrated health system. RESULTS A total of 324 199 active patients with a recorded BMI were identified. There were 121 287 (37.4%) patients found to be overweight (BMI ≥25 and <29.9), 75 199 (23.2%) had BMI 30-34.9, 34 152 (10.5%) had BMI 35-39.9 and 25 137 (7.8%) had BMI ≥40. There was a higher prevalence of type 2 diabetes, pre-diabetes, hypertension and cardiovascular disease (P value<0.0001) within higher BMI compared with lower BMI categories. In patients with a BMI >30 (n=134 488), only 48% (64 056) had documentation of an obesity ICD-9 code. In those patients with a BMI >40, only 75% had an obesity ICD-9 code. CONCLUSIONS This cross-sectional summary from a large US integrated health system found that three out of every four patients had overweight or obesity based on BMI. Patients within higher BMI categories had a higher prevalence of comorbidities. Less than half of patients who were identified as having obesity according to BMI received a formal diagnosis via ICD-9 documentation. The disease of obesity is very prevalent yet underdiagnosed in our clinics. The under diagnosing of obesity may serve as an important barrier to treatment initiation.
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Affiliation(s)
- Kevin M Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Todd M Hobbs
- Diabetes, Novo Nordisk Inc., Plainsboro, New Jersey, USA
| | - Kevin M Chagin
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sheldon X Kong
- Health Economics and Outcomes Research, Novo Nordisk Inc., Plainsboro, New Jersey, USA
| | - Brian J Wells
- Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael W Kattan
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan Bouchard
- Health Economics and Outcomes Research, Novo Nordisk Inc., Plainsboro, New Jersey, USA
| | - Brian Sakurada
- Medical Affairs, Novo Nordisk Inc., Plainsboro, New Jersey, USA
| | - Alex Milinovich
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wayne Weng
- Health Economics and Outcomes Research, Novo Nordisk Inc., Plainsboro, New Jersey, USA
| | - Janine Bauman
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Robert S Zimmerman
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bartolome Burguera
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
- National Diabetes and Obesity Research Insitute, Tradition, Mississippi, USA
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Electronic Health Record Data Versus the National Health and Nutrition Examination Survey (NHANES): A Comparison of Overweight and Obesity Rates. Med Care 2017; 55:598-605. [PMID: 28079710 DOI: 10.1097/mlr.0000000000000693] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Estimating population-level obesity rates is important for informing policy and targeting treatment. The current gold standard for obesity measurement in the United States-the National Health and Nutrition Examination Survey (NHANES)-samples <0.1% of the population and does not target state-level or health system-level measurement. OBJECTIVE To assess the feasibility of using body mass index (BMI) data from the electronic health record (EHR) to assess rates of overweight and obesity and compare these rates to national NHANES estimates. RESEARCH DESIGN Using outpatient data from 42 clinics, we studied 388,762 patients in a large health system with at least 1 primary care visit in 2011-2012. MEASURES We compared crude and adjusted overweight and obesity rates by age category and ethnicity (white, black, Hispanic, Other) between EHR and NHANES participants. Adjusted overweight (BMI≥25) and obesity rates were calculated by a 2-step process. Step 1 accounted for missing BMI data using inverse probability weighting, whereas step 2 included a poststratification correction to adjust the EHR population to a nationally representative sample. RESULTS Adjusted rates of obesity (BMI≥30) for EHR patients were 37.3% [95% confidence interval (95% CI), 37.1-37.5] compared with 35.1% (95% CI, 32.3-38.1) for NHANES patients. Among the 16 different obesity class, ethnicity, and sex strata that were compared between EHR and NHANES patients, 14 (87.5%) contained similar obesity estimates (ie, overlapping 95% CIs). CONCLUSIONS EHRs may be an ideal tool for identifying and targeting patients with obesity for implementation of public health and/or individual level interventions.
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Data for Community Health Assessment in Rural Colorado: A Comparison of Electronic Health Records to Public Health Surveys to Describe Childhood Obesity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23 Suppl 4 Suppl, Community Health Status Assessment:S53-S62. [DOI: 10.1097/phh.0000000000000589] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Juvanhol LL, Lana RM, Cabrelli R, Bastos LS, Nobre AA, Rotenberg L, Griep RH. Factors associated with overweight: are the conclusions influenced by choice of the regression method? BMC Public Health 2016; 16:642. [PMID: 27461119 PMCID: PMC4962412 DOI: 10.1186/s12889-016-3340-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Different analytical techniques have been used to study the determinants of overweight. However, certain commonly used techniques may be limited by the continuous nature and skewed distribution of body mass index (BMI) data. In this article, different regression models are compared to identify the best approach for analysing predictors of BMI. Methods Data collected on 2270 nurses at 18 public hospitals in Rio de Janeiro, RJ (2010–2011) were analysed (80.6 % of the respondents). The explanatory variables considered were age, marital status, race/colour, mother’s schooling, domestic overload, years worked at night, consumption of fried food, physical inactivity, self-rated health and BMI at age 20 years. In addition to gamma regression, regarded as the reference method for selecting the set of explanatory variables described here, other modelling strategies – including linear, quantile (for the 0.25, 0.50 and 0.75 quantiles), binary and multinomial logistic regression – were compared in terms of final results and measures of fit. Results The variables age, marital status, race/colour, domestic overload, self-rated health, physical inactivity and BMI at age 20 years were significantly associated with BMI, independently of the method used. In the same way, consumption of fried food was significant in all the models, but a dose–response pattern was identified only in the gamma and normal models and the quantile model for the 0.75 quantile. Years worked at night was also associated with BMI in these three models only. The variable mother’s schooling returned significant results only for the category 12 or more years of schooling, except for overweight in the multinomial model and for the 0.50 quantile in the quantile model, in which the two categories were not significant. The results of the quantile regression showed that, generally, the effects of the variables investigated were greater in the upper quantiles of the BMI distribution. Of the models using BMI in its continuous form, the gamma model showed best fit, followed by the quantile models (0.25 and 0.5 quantiles). Conclusions The different strategies used produced similar results for the factors associated with BMI, but differed in the magnitude of the associations and goodness of fit. We recommend using the different approaches in combination, because they furnish complementary information on the problem studied. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3340-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Raquel Martins Lana
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Renata Cabrelli
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Aline Araújo Nobre
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Lúcia Rotenberg
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Unravelling the human genome-phenome relationship using phenome-wide association studies. Nat Rev Genet 2016; 17:129-45. [PMID: 26875678 DOI: 10.1038/nrg.2015.36] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Advances in genotyping technology have, over the past decade, enabled the focused search for common genetic variation associated with human diseases and traits. With the recently increased availability of detailed phenotypic data from electronic health records and epidemiological studies, the impact of one or more genetic variants on the phenome is starting to be characterized both in clinical and population-based settings using phenome-wide association studies (PheWAS). These studies reveal a number of challenges that will need to be overcome to unlock the full potential of PheWAS for the characterization of the complex human genome-phenome relationship.
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Roth C, Payne PRO, Weier RC, Shoben AB, Fletcher EN, Lai AM, Kelley MM, Plascak JJ, Foraker RE. The geographic distribution of cardiovascular health in the stroke prevention in healthcare delivery environments (SPHERE) study. J Biomed Inform 2016; 60:95-103. [PMID: 26828957 DOI: 10.1016/j.jbi.2016.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Community-level factors have been clearly linked to health outcomes, but are challenging to incorporate into medical practice. Increasing use of electronic health records (EHRs) makes patient-level data available for researchers in a systematic and accessible way, but these data remain siloed from community-level data relevant to health. PURPOSE This study sought to link community and EHR data from an older female patient cohort participating in an ongoing intervention at the Ohio State University Wexner Medical Center to associate community-level data with patient-level cardiovascular health (CVH) as well as to assess the utility of this EHR integration methodology. MATERIALS AND METHODS CVH was characterized among patients using available EHR data collected May through July of 2013. EHR data for 153 patients were linked to United States census-tract level data to explore feasibility and insights gained from combining these disparate data sources. Analyses were conducted in 2014. RESULTS Using the linked data, weekly per capita expenditure on fruits and vegetables was found to be significantly associated with CVH at the p<0.05 level and three other community-level attributes (median income, average household size, and unemployment rate) were associated with CVH at the p<0.10 level. CONCLUSIONS This work paves the way for future integration of community and EHR-based data into patient care as a novel methodology to gain insight into multi-level factors that affect CVH and other health outcomes. Further, our findings demonstrate the specific architectural and functional challenges associated with integrating decision support technologies and geographic information to support tailored and patient-centered decision making therein.
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Affiliation(s)
- Caryn Roth
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Philip R O Payne
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Rory C Weier
- Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Abigail B Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Erica N Fletcher
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Albert M Lai
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Marjorie M Kelley
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jesse J Plascak
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Randi E Foraker
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
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Casey JA, Schwartz BS, Stewart WF, Adler NE. Using Electronic Health Records for Population Health Research: A Review of Methods and Applications. Annu Rev Public Health 2015; 37:61-81. [PMID: 26667605 DOI: 10.1146/annurev-publhealth-032315-021353] [Citation(s) in RCA: 311] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The use and functionality of electronic health records (EHRs) have increased rapidly in the past decade. Although the primary purpose of EHRs is clinical, researchers have used them to conduct epidemiologic investigations, ranging from cross-sectional studies within a given hospital to longitudinal studies on geographically distributed patients. Herein, we describe EHRs, examine their use in population health research, and compare them with traditional epidemiologic methods. We describe diverse research applications that benefit from the large sample sizes and generalizable patient populations afforded by EHRs. These have included reevaluation of prior findings, a range of diseases and subgroups, environmental and social epidemiology, stigmatized conditions, predictive modeling, and evaluation of natural experiments. Although studies using primary data collection methods may have more reliable data and better population retention, EHR-based studies are less expensive and require less time to complete. Future EHR epidemiology with enhanced collection of social/behavior measures, linkage with vital records, and integration of emerging technologies such as personal sensing could improve clinical care and population health.
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Affiliation(s)
- Joan A Casey
- Robert Wood Johnson Foundation Health and Society Scholars Program at the University of California, San Francisco, and the University of California, Berkeley, Berkeley, California 94720-7360;
| | - Brian S Schwartz
- Departments of Environmental Health Sciences and Epidemiology, Bloomberg School of Public Health, and the Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205; .,Center for Health Research, Geisinger Health System, Danville, Pennsylvania 17822
| | - Walter F Stewart
- Research, Development and Dissemination, Sutter Health, Walnut Creek, California 94596;
| | - Nancy E Adler
- Center for Health and Community and the Department of Psychiatry, University of California, San Francisco, California 94118;
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Bonney A, Mayne DJ, Jones BD, Bott L, Andersen SEJ, Caputi P, Weston KM, Iverson DC. Area-Level Socioeconomic Gradients in Overweight and Obesity in a Community-Derived Cohort of Health Service Users - A Cross-Sectional Study. PLoS One 2015; 10:e0137261. [PMID: 26317861 PMCID: PMC4552787 DOI: 10.1371/journal.pone.0137261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/13/2015] [Indexed: 11/18/2022] Open
Abstract
Background Overweight and obesity lead to higher probability of individuals accessing primary care but adiposity estimates are rarely available at regional levels to inform health service planning. This paper analyses a large, community-derived clinical database of objectively measured body mass index (BMI) to explore relationships with area-level socioeconomic disadvantage for informing regional level planning activities. Materials and Methods The study included 91776 adults who had BMI objectively measured between 1 July 2009 and 30 June 2011 by a single pathology provider. Demographic data and BMI were extracted and matched to 2006 national census socioeconomic data using geocoding. Adjusted odds-ratios for overweight and obesity were calculated using sex-stratified logistic regression models with socioeconomic disadvantage of census collection district of residence as the independent variable. Results The prevalence of overweight or obesity was 79.2% (males) and 65.8% (females); increased with age to 74 years; and was higher in rural (74%) versus urban areas (71.4%) (p<0.001). Increasing socioeconomic disadvantage was associated with increasing prevalence of overweight (p<0.0001), obesity (p<0.0001) and overweight or obesity (p<0.0001) in women and obesity (p<0.0001) in men. Socioeconomic disadvantage was unrelated to overweight (p = 0.2024) and overweight or obesity (p = 0.4896) in males. Conclusion It is feasible to link routinely-collected clinical data, representative of a discrete population, with geographic distribution of disadvantage, and to obtain meaningful area-level information useful for targeting interventions to improve population health. Our results demonstrate novel area-level socioeconomic gradients in overweight and obesity relevant to regional health service planning.
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Affiliation(s)
- Andrew Bonney
- University of Wollongong, Graduate School of Medicine, Wollongong, New South Wales, 2522, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, 2522, Australia
| | - Darren J. Mayne
- Public Health, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, 2500, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, 2522, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Bryan D. Jones
- Sonic Healthcare Ltd, North Ryde, New South Wales, 2113, Australia
| | - Lawrence Bott
- Southern.IML Pathology, Wollongong, New South Wales, 2500, Australia
| | - Stephen E. J. Andersen
- University of Wollongong, Graduate School of Medicine, Wollongong, New South Wales, 2522, Australia
- Southern.IML Pathology, Wollongong, New South Wales, 2500, Australia
| | - Peter Caputi
- University of Wollongong, Centre for Health Initiatives, Wollongong, New South Wales, 2522, Australia
| | - Kathryn M. Weston
- University of Wollongong, Graduate School of Medicine, Wollongong, New South Wales, 2522, Australia
- * E-mail:
| | - Don C. Iverson
- Swinburne University of Technology, Faculty of Health, Arts and Design, Hawthorne, Victoria, 3122, Australia
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Shay CM, Gooding HS, Murillo R, Foraker R. Understanding and Improving Cardiovascular Health: An Update on the American Heart Association's Concept of Cardiovascular Health. Prog Cardiovasc Dis 2015; 58:41-9. [PMID: 25958016 DOI: 10.1016/j.pcad.2015.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The American Heart Association's 2020 Strategic Impact Goal is "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." To monitor progress towards this goal, a new construct "ideal cardiovascular health" (iCVH) was defined that includes the simultaneous presence of optimal levels of seven health behaviors (physical activity, smoking, dietary intake, and body mass index) and factors (total cholesterol, blood pressure and fasting blood glucose). In this review, we present a summary of major concepts related to the concept of iCVH and an update of the literature in this area since publication of the 2020 Strategic Impact Goal, including trends in iCVH prevalence, new determinants and outcomes related to iCVH, strategies for maintaining or improving iCVH, policy implications of the iCVH model, and the remaining challenges to reaching the 2020 Strategic Impact Goal.
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Affiliation(s)
- Christina M Shay
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Holly S Gooding
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Rosenda Murillo
- Department of Psychological, Health and Learning Sciences, College of Education, University of Houston, Houston, TX, USA
| | - Randi Foraker
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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Pah AR, Rasmussen-Torvik LJ, Goel S, Greenland P, Kho AN. Big Data: What Is It and What Does It Mean for Cardiovascular Research and Prevention Policy. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0424-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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