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Joshua R Vest, PhD, MPH Director, Center for Health Policy

Using EHR and HIE data to identify patients ’ need for services that address the social determinants of health. Joshua R Vest, PhD, MPH Director, Center for Health Policy Associate Professor, Health Policy & Management

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Joshua R Vest, PhD, MPH Director, Center for Health Policy

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  1. Using EHR and HIE data to identify patients’ need for services that address the social determinants of health Joshua R Vest, PhD, MPH Director, Center for Health Policy Associate Professor, Health Policy & Management Indiana University Richard M Fairbanks School of Public Health at IUPUI Investigator Regenstrief Institute, Inc. This work was supported by the Robert Wood Johnson Foundation through the Systems for Action National Coordinating Center, ID 73485. Vest JRet al. International Journal of Medical Informatics. 107:101-106; 2017. doi: 10.1016/j.ijmedinf.2017.09.008.

  2. Acknowledgements • Shaun Grannis • Jennifer Williams • Dawn Haut • Nir Menachemi • AbdulazizBako • Suranga N Kasthurirathne • Paul Halverson • Anna Roberts • Robert Wood Johnson Foundation

  3. Increasingly, health care organizations are offering services to address patients’ social determinants of health (SDH). www.chelseajewish.org/celebrating-social-work-month-senior-care/ guide.berkeley.edu/undergraduate/degree-programs/legal-studies/ Pplay.google.com http://cchci.org/_services/behavioral-health/

  4. However, identifying patients in need of SDH services is challenging. www.recoveryhub.com/addiction-stigma-deserves-attention/ pmiconline.stores.yahoo.net /www.research-live.com// www.hec.usace.army.mil/software/hecdssvue/whats_new.aspx Time

  5. Objective 1: Identify the need for for SDH services in an urban, safety-net primary care setting using multiple data sources. Objective 2: Compare estimates of need obtained from structured with unstructured data.

  6. How did we conceptualize “need for SDH services”? • Social work • Behavioral health • Nutrition counseling • Respiratory therapy • Financial planning • Medical-legal partnership • Patient navigation • Pharmacist consultation Need defined as any documentation that a health care professional judged that any of the aforementioned services were appropriate, recommended, or potentially beneficial to the patient. All services offered onsite by Eskenazi. -No referrals to other service providers.

  7. Sample, data & measures • Eskenazi Health FQHC patients • Indianapolis urban safety-net provider • 73,085 adults (≥one outpatient visit) • 2012-2016 • Billing Codes • From G3 (RI developed EHR) and INPC HIE • ICD9, ICD10, CPT codes • Appointments • 4 different scheduling systems • kept, canceled, and “no show” • Orders & Notes • Orders for SDH services (keywords from literature) • Progress notes (keywords from literature) • Measures: • “In Need” as binary indicator • Demographics, diagnoses, prior utilization, comorbidity scores

  8. Methods • Cross-sectional analysis of need and factors associated with need • Descriptive statistics • Cross-sectional analysis of factors associated with need documented by unstructured data only • Regression model comparing SDH services need documented by unstructured data only to structured data sources

  9. Results: More than half of patients were in need of a SDH service.

  10. Results: Those with SDH service needs were generally more complex.

  11. Results: Patients with SDH need identified by unstructured data were more complex than those patients identified by structured data only.

  12. Limitations • Limited generalizability • Urban safety-net population • Services were all co-located • Unmet need not measured

  13. Need for SDH services can be identified from EHR & HIE. • More than half of adult patients had a SDH service need. • Patients with SDH service needs were associated with complexity and higher utilization of services. • Patients identified by unstructured data only tended to be more complex than those identified by structured data only. • Both both are necessary to identify SDH need. Joshua R Vest, PhD, MPH joshvest@iu.edu

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