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Recommended Social and Behavioral Domains and Measures for Electronic Health Records

Recommended Social and Behavioral Domains and Measures for Electronic Health Records. Robert S. Kahn, MD MPH Cincinnati Children’s Hospital Medical Center November 25, 2013. Unemployment Lack of high school degree Ex-offender reentry issues. Distressed/depressed parents

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Recommended Social and Behavioral Domains and Measures for Electronic Health Records

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  1. Recommended Social and Behavioral Domains and Measures for Electronic Health Records Robert S. Kahn, MD MPH Cincinnati Children’s Hospital Medical Center November 25, 2013

  2. Unemployment • Lack of high school degree • Ex-offender reentry issues • Distressed/depressed parents • Lack of parenting role models • Inadequate education services • Domestic violence • Adult mental health issues • Food insecurity • Denial/delay of public benefits • Utility shut offs • Poor housing conditions Henize, Kahn

  3. Social Risk Screening Benefits Housing Parental Depression Domestic Violence Food Insecurity

  4. School Related Screening

  5. EHR Referrals: Legal Aid Society

  6. Tracking of EHR-based Legal Aid Referrals

  7. Referrals to the Health Department

  8. Change in physician behavior

  9. Change in physician behavior Percent with household food insecurity identified

  10. EHR data driving focus on broader social risks

  11. Broader social risks informing clinical care: Census tract-level risks and asthma reutilization risk 2-3 risks Days from the index admission *Risks: census tract extreme poverty, adult educational attainment, median home value

  12. Intergenerational information from parents’ EHR Prenatal/obstetric history Family history (e.g., smoking, obesity) Information from school’s database Grades, missed school days, suspensions Additional considerations

  13. EHR-related studies in social determinants • Beck AF, Sauers H, Kahn RS, Yau C, Weiser J, Simmons JM. Improved documentation and care planning with an asthma-specific history and physical. Hospital Pediatrics 2012; 2:194-201. • Beck AF, Simmons JM, Huang B, Kahn RS. Geomedicine: area-based socioeconomic measures for assessing risk of hospital reutilization among children admitted for asthma. American journal of public health 2012;102:2308-2314. • Burkhardt MC, Beck AF, Conway PH, Kahn RS, Klein MD. Enhancing accurate identification of food insecurity using quality-improvement techniques. Pediatrics. Feb 2012;129:e504-510. • Beck AF, Klein MD, Schaffzin J, Tallent V, Gillam M, Kahn RS. Identifying and treating a cluster of substandard housing using a medical-legal partnership. Pediatrics. 2012; 130:831-8. • Beck AF, Simmons JM, Sauers HS, Sharkey K, Alam M, Jones C, Kahn RS. Connecting at-risk inpatient asthmatics to a community-based program to reduce home environmental risks: care system redesign using quality improvement methods. Hospital Pediatrics 2013;3:326-334. • Klein MK, Beck AF, Henize AW, Parrish DS, Fink EE, Kahn RS. Doctors and lawyers collaborating to HeLP children – outcomes from a successful partnership between professions. Journal of Health Care for the Poor and Underserved. 2013; 24:1063-1073.

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