Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.
UF Health Cancer Center, University of Florida, Gainesville, Florida, USA.
Popul Health Manag. 2022 Jun;25(3):362-366. doi: 10.1089/pop.2021.0212. Epub 2021 Oct 11.
Identifying patients' social determinants of health (SDoH) can improve patient outcomes but may increase clinicians' documentation time. However, there is limited evidence of how many physicians document SDoH and the associated burden. To address this gap, this study examines documentation of SDoH and after-hours electronic health record (EHR) work among a nationally representative sample of US office-based physicians. This was a cross-sectional analysis of the 2018-2019 National Electronic Health Records Survey. A survey design-adjusted bivariate analysis was used to estimate the prevalence of SDoH documentation and compare this activity between physicians' and practices' characteristics. A modified multivariable Poisson model was used to estimate prevalence ratios of SDoH documentation and after-hours work. The study sample included a weighted sample of 303,389 US physicians (31.5%, female; 72.5%, aged ≥50 years; 48.8% primary care specialty). Of those, 84.3% reported documenting patients' SDoH information. Physicians documenting patients' SDoH tend to be younger (<50 years). Prevalence estimates of after-hours EHR documentation were comparable between physicians recording patients' SDoH and those not (33.7% vs. 33.0%) and this difference did not reach statistical significance in adjusted analysis (adjusted prevalence ratio, 0.94, 95% confidence interval, 0.64-1.39). Thus, documenting patients' SDoH appears to be common among US physicians, and this activity is not associated with after-hours EHR documentation. Future studies should examine how patients' SDoH information is used and its association with patient health outcomes.
识别患者的健康社会决定因素（SDoH）可以改善患者的预后，但可能会增加临床医生的文档记录时间。然而，关于有多少医生记录 SDoH 及其相关负担的证据有限。为了解决这一差距，本研究考察了美国基于办公室的医生中具有代表性的样本中 SDoH 的文档记录和非工作时间电子健康记录（EHR）工作。这是对 2018-2019 年国家电子健康记录调查的横断面分析。使用调查设计调整的双变量分析来估计 SDoH 文档记录的流行率，并比较医生和实践特征之间的这种活动。使用修改后的多变量泊松模型估计 SDoH 文档记录和非工作时间工作的患病率比。研究样本包括 303389 名美国医生的加权样本（31.5%为女性；72.5%年龄≥50 岁；48.8%为初级保健专业）。其中，84.3%报告记录了患者的 SDoH 信息。记录患者 SDoH 的医生往往更年轻（<50 岁）。记录患者 SDoH 的医生和未记录患者 SDoH 的医生之间，非工作时间 EHR 文档记录的患病率估计值相似（33.7%与 33.0%），调整后分析差异无统计学意义（调整后的患病率比，0.94，95%置信区间，0.64-1.39）。因此，在美国医生中，记录患者的 SDoH 似乎很常见，而且这项活动与非工作时间的 EHR 文档记录无关。未来的研究应该检查如何使用患者的 SDoH 信息及其与患者健康结果的关系。
