Documenting social determinants of health-related clinical activities using standardized medical vocabularies.
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ABSTRACT:
SUBMITTER: Arons A
PROVIDER: S-EPMC6951949 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveNatural language processing (NLP) engines such as the clinical Text Analysis and Knowledge Extraction System are a solution for processing notes for research, but optimizing their performance for a clinical data warehouse remains a challenge. We aim to develop a high throughput NLP architecture using the clinical Text Analysis and Knowledge Extraction System and present a predictive model use case.Materials and methodsThe CDW was comprised of 1 103 038 patients across 10 years. The architecture was constructed using the Hadoop data repository for source data and 3 large-scale symmetric processing servers for NLP. Each named entity mention in a clinical document was mapped to the Unified Medical Language System concept unique identifier (CUI).ResultsThe NLP architecture processed 83 867 802 clinical documents in 13.33 days and produced 37 721 886 606 CUIs across 8 standardized medical vocabularies. Performance of the architecture exceeded 500 000 documents per hour across 30 parallel instances of the clinical Text Analysis and Knowledge Extraction System including 10 instances dedicated to documents greater than 20 000 bytes. In a use-case example for predicting 30-day hospital readmission, a CUI-based model had similar discrimination to n-grams with an area under the curve receiver operating characteristic of 0.75 (95% CI, 0.74-0.76).Discussion and conclusionOur health system's high throughput NLP architecture may serve as a benchmark for large-scale clinical research using a CUI-based approach.
| S-EPMC7647210 | biostudies-literature
Project description:BackgroundAlthough a number of studies have investigated how consumers use social media for health-related purposes, there is a paucity of studies in the Australian context.ObjectiveThis study aimed to explore how Australian consumers used social media for health-related purposes, specifically how they identified social media platforms, which were used, and which health-related activities commonly took place.MethodsA total of 5 focus groups (n=36 participants), each lasting 60 to 90 minutes, were conducted in the Sydney metropolitan area. The group discussions were audiorecorded and transcribed verbatim. The transcripts were coded line-by-line and thematically analyzed.ResultsParticipants used general search engines to locate health-related social media platforms. They accessed a wide range of social media on a daily basis, using several electronic devices (in particular, mobile phones). Although privacy was a concern, it did not prevent consumers from fully engaging in social media for health-related purposes. Blogs were used to learn from other people's experiences with the same condition. Facebook allowed consumers to follow health-related pages and to participate in disease-specific group discussions. Wikipedia was used for factual information about diseases and treatments. YouTube was accessed to learn about medical procedures such as surgery. No participant reported editing or contributing to Wikipedia or posting YouTube videos related to health topics. Twitter was rarely used for health-related purposes. Social media allowed consumers to obtain and provide disease and treatment-related information and social and emotional support for those living with the same condition. Most considered their participation as observational, but some also contributed (eg, responded to people's questions).ConclusionsParticipants used a wide range of social media for health-related purposes. Medical information exchange (eg, disease and treatment) and social and emotional support were the cornerstones of their online activities. Social media appears to be used as a key tool to support disease self-management.
| S-EPMC5660293 | biostudies-literature
Project description:IntroductionTransgender individuals experience pronounced disparities in health (e.g., mood disorders, suicide risk) and in the prevalence of social determinants of housing instability, financial strain, and violence. The objectives of this study were to understand the prevalence of social determinants among transgender veterans and assess their associations with medical conditions.MethodsThis project was a records review using administrative data from the U.S. Department of Veterans Affairs databases for 1997-2014. Transgender veterans (N=6,308) were defined as patients with any of four ICD-9 diagnosis codes associated with transgender status. Social determinants were operationalized using ICD-9 codes and Department of Veterans Affairs clinical screens indicating violence, housing instability, or financial strain. Multiple logistic regression was used to assess the associations of social determinants with medical conditions: mood disorder, post-traumatic stress disorder, alcohol abuse disorder, illicit drug abuse disorder, tobacco use disorder, suicidal risk, HIV, and hepatitis C.ResultsAfter adjusting for sociodemographic variables, housing instability and financial strain were significantly associated with all medical conditions except for HIV, and violence was significantly associated with all medical conditions except for tobacco use disorder and HIV. There was a dose response-like relationship between the increasing number of forms of social determinants being associated with increasing odds for medical conditions.ConclusionsSocial determinants are prevalent factors in transgender patients' lives, exhibiting strong associations with medical conditions. Documenting social determinants in electronic health records can help providers to identify and address these factors in treatment goals.
| S-EPMC8256921 | biostudies-literature
Project description:BackgroundTo provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients' well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance.ObjectiveThis review's objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME).MethodsIn 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics.ResultsThe authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2).ConclusionsThe abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education.
| S-EPMC6502919 | biostudies-literature
Project description:IntroductionMedical students rarely learn about the intersection of socioeconomic and environmental effects on access to health care and maintenance of health. Case-based discussion can cohesively highlight the social determinants of health to complement preclinical education. Our modules can foster future interest in working with vulnerable populations, help students recognize barriers to care, and identify strategies to help these patients.MethodsThe Social Determinants of Health Orientation Program (SDHOP) introduced students to the nonbiomedical factors that contribute to patients' health. Key topics were presented in small discussion groups led by faculty facilitators. The subjects addressed included access to care; immigration/language barriers; lesbian, gay, bisexual, and transgender health; human trafficking; race/ethnicity; and women's health.ResultsThe SDHOP initiative was integrated into the formal curriculum and successfully implemented in its first year at our institution. Pre- and postsurveys were administered to assess student satisfaction with the course, as well as changes in knowledge and attitude regarding the topics covered. Of the 186 SDHOP participants, 111 medical students responded to both surveys and reported improvements in both knowledge of and comfort level with these topics and specific related terms. Ninety-one percent rated the overall quality of SDHOP and its individual modules as good or excellent.DiscussionSDHOP contributes to medical education by providing an all-inclusive model for teaching students about the social determinants of health. Our results suggest that presenting these topics in a small-group discussion model improves medical student cultural competency and comfort level with patients of diverse backgrounds.
| S-EPMC6342337 | biostudies-literature
Project description:ObjectiveThis paper compares the accuracy of predicting suicide from Social Determinants of Health (SDoH) or history of illness.Population studied5 313 965 Veterans who at least had two primary care visits between 2008 and 2016.Study designThe dependent variable was suicide or intentional self-injury. The independent variables were 10 495 International Classification of Disease (ICD) Version 9 codes, age, and gender. The ICD codes included 40 V-codes used for measuring SDoH, such as family disruption, family history of substance abuse, lack of education, legal impediments, social isolation, unemployment, and homelessness. The sample was randomly divided into training (90 percent) and validation (10 percent) sets. Area under the receiver operating characteristic (AROC) was used to measure accuracy of predictions in the validation set.Principal findingsSeparate analyses were done for inpatient and outpatient codes; the results were similar. In the hospitalized group, the mean age was 67.2 years, and 92.1 percent were male. The mean number of medical diagnostic codes during the study period was 37; and 12.9 percent had at least one SDoH V-code. At least one episode of suicide or intentional self-injury occurred in 1.89 percent of cases. SDoH V-codes, on average, elevated the risk of suicide or intentional self-injury by 24-fold (ranging from 4- to 86-fold). An index of 40 SDoH codes predicted suicide or intentional self-injury with an AROC of 0.64. An index of 10 445 medical diagnoses, without SDoH V-codes, had AROC of 0.77. The combined SDoH and medical diagnoses codes also had AROC of 0.77.ConclusionIn predicting suicide or intentional self-harm, SDoH V-codes add negligible information beyond what is already available in medical diagnosis codes.Implications for practicePolicies that affect SDoH (eg, housing policies, resilience training) may not have an impact on suicide rates, if they do not change the underlying medical causes of SDoH.
| S-EPMC7518826 | biostudies-literature
Project description:ObjectiveExisting research on social determinants of health (SDoH) predominantly focuses on physician notes and structured data within electronic medical records. This study posits that social work notes are an untapped, potentially rich source for SDoH information. We hypothesize that clinical notes recorded by social workers, whose role is to ameliorate social and economic factors, might provide a complementary information source of data on SDoH compared to physician notes, which primarily concentrate on medical diagnoses and treatments. We aimed to use word frequency analysis and topic modeling to identify prevalent terms and robust topics of discussion within a large cohort of social work notes including both outpatient and in-patient consultations.Materials and methodsWe retrieved a diverse, deidentified corpus of 0.95 million clinical social work notes from 181 644 patients at the University of California, San Francisco. We conducted word frequency analysis related to ICD-10 chapters to identify prevalent terms within the notes. We then applied Latent Dirichlet Allocation (LDA) topic modeling analysis to characterize this corpus and identify potential topics of discussion, which was further stratified by note types and disease groups.ResultsWord frequency analysis primarily identified medical-related terms associated with specific ICD10 chapters, though it also detected some subtle SDoH terms. In contrast, the LDA topic modeling analysis extracted 11 topics explicitly related to social determinants of health risk factors, such as financial status, abuse history, social support, risk of death, and mental health. The topic modeling approach effectively demonstrated variations between different types of social work notes and across patients with different types of diseases or conditions.DiscussionOur findings highlight LDA topic modeling's effectiveness in extracting SDoH-related themes and capturing variations in social work notes, demonstrating its potential for informing targeted interventions for at-risk populations.ConclusionSocial work notes offer a wealth of unique and valuable information on an individual's SDoH. These notes present consistent and meaningful topics of discussion that can be effectively analyzed and utilized to improve patient care and inform targeted interventions for at-risk populations.
| S-EPMC10788143 | biostudies-literature
Project description:PurposeSocial determinants of health (SDH) are recognized as important factors that affect health and well-being. Medical schools are encouraged to incorporate the teaching of SDH. This study investigated the level of commitment to teaching SDH; learning objectives/goals regarding student knowledge, skills, and attitudes; location in the curriculum and teaching strategies; and perceived barriers to teaching SDH.MethodsA team from the American Medical Association’s Accelerating Change in Medical Education Consortium developed a 23-item inventory survey to document consortium school SDH curricula. The 32 consortium schools were invited to participate.ResultsTwenty-nine (94%) schools responded. Most respondents indicated the teaching of SDH was low priority (10, 34%) or high priority (12, 41%). Identified learning objectives/goals for student knowledge, skills, and attitudes regarding SDH were related to the importance of students developing the ability to identify and address SDH and recognizing SDH as being within the scope of physician practice. Curricular timing and teaching strategies suggested more SDH education opportunities were offered in the first and second undergraduate medical education years. Barriers to integrating SDH in curricula were identified: addressing SDH is outside the realm of physician responsibility, space in curriculum is limited, faculty lack knowledge and skills to teach material, and concepts are not adequately represented on certifying examinations.ConclusionDespite the influence of SDH on individual and population health, programs do not routinely prioritize SDH education on par with basic or clinical sciences. The multitude of learning objectives and goals related to SDH can be achieved by increasing the priority level of SDH and employing better teaching strategies in all years. The discordance between stated objectives/goals and perceived barriers, as well as identification of the variety of strategies utilized to teach SDH during traditional “preclinical” years, indicates curricular areas in need of attention.
| S-EPMC7250290 | biostudies-literature
Project description:ObjectiveTo understand the frequency of social determinants of health (SDOH) diagnosis codes (Z-codes) within the electronic health record (EHR) for patients with prediabetes and diabetes and examine factors influencing the adoption of SDOH documentation in clinical care.Data sourcesEHR data and qualitative interviews with health care providers and stakeholders.Study designAn explanatory sequential mixed methods design first examined the use of Z-codes within the EHR and qualitatively examined barriers to documenting SDOH. Data were integrated and interpreted using a joint display. This research was informed by the Framework for Dissemination and Utilization of Research for Health Care Policy and Practice.Data collection/extraction methodsWe queried EHR data for patients with a hemoglobin A1c > 5.7 between October 1, 2015 and September 1, 2020 (n = 118,215) to examine the use of Z-codes and demographics and outcomes for patients with and without social needs. Semi-structured interviews were conducted with 23 participants (n = 15 health care providers; n = 7 billing and compliance stakeholders). The interview questions sought to understand how factors at the innovation-, individual-, organizational-, and environmental-level influence SDOH documentation. We used thematic analysis to analyze interview data.Principal findingsPatients with social needs were disproportionately older, female, Black, uninsured, living in low-income and high unemployment neighborhoods, and had a higher number of hospitalizations, obesity, prediabetes, and type 2 diabetes than those without a Z-code. Z-codes were not frequently used in the EHR (<1% of patients), and there was an overall lack of congruence between quantitative and qualitative results related to the prevalence of social needs. Providers faced barriers at multiple levels (e.g., individual-level: discomfort discussing social needs; organizational-level: limited time, competing priorities) for documenting SDOH and identified strategies to improve documentation.ConclusionsProviders recognized the impact of SDOH on patient health and had positive perceptions of screening for and documenting social needs. Implementation strategies are needed to improve systematic documentation.
| S-EPMC9836948 | biostudies-literature
Project description:This work is an implementation science study that examines different aspects of implementing a single intervention. The intervention consists of asking community health centers to implement an outreach strategy to screen patients for colorectal cancer and for social determinants of health in community health centers at the same contact point. These are both clinical targets that the CHCs feel that their patients need and want to offer at a higher rate. The intervention consists of outreach to patients in need of colorectal cancer screening (CRC) to offer fecal immunochemical test (FIT) screening and screening for social determinants of health (SDOH). In this implementation science study, the intervention is an evidence-based intervention being implemented in real-world clinical practice. The intervention is the outreach to offer FIT and SDOH, conducted by clinic staff. Both evidence-based screening activities-FIT and SDOH screening-are used in the practices included in the study but pairing them is intended to increase efficiency and patient-centeredness by addressing health related social needs that may impact patients’ ability to engage in cancer screening. The study aims to test the effect of implementing the intervention on clinical and process outcomes. Clinical outcomes are CRC screening and SDOH screening. Analysis of process outcomes includes measuring what organizational factors influence implementation.
| 2354406 | ecrin-mdr-crc