Kaiser Permanente Center for Health Research, Portland, Oregon
OCHIN, Inc, Portland, Oregon.
Ann Fam Med. 2018 Sep;16(5):399-407. doi: 10.1370/afm.2275.
This pilot study assessed the feasibility of implementing electronic health record (EHR) tools for collecting, reviewing, and acting on patient-reported social determinants of health (SDH) data in community health centers (CHCs). We believe it is the first such US study.
We implemented a suite of SDH data tools in 3 Pacific Northwest CHCs in June 2016, and used mixed methods to assess their adoption through July 2017. We modified the tools at clinic request; for example, we added questions that ask if the patient wanted assistance with SDH needs.
Social determinants of health data were collected on 1,130 patients during the study period; 97% to 99% of screened patients (n = 1,098) had ≥1 SDH need documented in the EHR, of whom 211 (19%) had an EHR-documented SDH referral. Only 15% to 21% of patients with a documented SDH need indicated wanting help. Examples of lessons learned on adoption of EHR SDH tools indicate that clinics should: consider how to best integrate tools into existing workflow processes; ensure that staff tasked with SDH efforts receive adequate tool training and access; and consider that timing of data entry impacts how and when SDH data can be used.
Our results indicate that adoption of systematic EHR-based SDH documentation may be feasible, but substantial barriers to adoption exist. Lessons from this study may inform primary care providers seeking to implement SDH-related efforts, and related health policies. Far more research is needed to address implementation barriers related to SDH documentation in EHRs.
本初步研究评估了在社区卫生中心（CHC）中实施电子健康记录（EHR）工具来收集、审查和处理患者报告的健康社会决定因素（SDH）数据的可行性。我们认为这是美国首例此类研究。
我们于 2016 年 6 月在 3 家太平洋西北地区的 CHC 中实施了一套 SDH 数据工具，并使用混合方法评估了截至 2017 年 7 月的采用情况。我们根据诊所的要求对工具进行了修改；例如，我们添加了询问患者是否需要帮助满足 SDH 需求的问题。
在研究期间，共收集了 1130 名患者的 SDH 数据；97%至 99%的筛查患者（n=1098）的 EHR 中有≥1 项 SDH 需求记录，其中 211 名（19%）有 EHR 记录的 SDH 转介。仅有 15%至 21%的有记录的 SDH 需求患者表示希望得到帮助。关于采用 EHR SDH 工具的经验教训包括：诊所应考虑如何将工具最佳地整合到现有工作流程中；确保负责 SDH 工作的员工接受充分的工具培训和访问；并考虑数据录入的时间如何影响 SDH 数据的使用方式和时间。
我们的结果表明，采用基于 EHR 的系统 SDH 文档记录可能是可行的，但仍存在采用的重大障碍。本研究的经验教训可为寻求实施 SDH 相关工作的初级保健提供者以及相关卫生政策提供参考。还需要进行更多的研究来解决 EHR 中与 SDH 文档记录相关的实施障碍。
