Capturing Social and Behavioral Domains in Electronic Health Records Phase 1 (2014) / Chapter Skim
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2 Selection of Domains for Consideration
2 Selection of Domains for Consideration
Pages 29-40
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A National Institutes of Health (NIH) 2011 report titled Identifying Core Behavioral and Psychosocial Data Elements for the Electronic Health Record provided the committee with a helpful description of the goals of including social and behavioral health domains in EHRs and standardizing them to maximize harmonization across systems and populations.
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FRAMEWORKS FOR DOMAIN SELECTION In deciding which social and behavioral domains to consider for inclusion in EHRs, the committee identified and applied several frameworks that capture the range of health determinants, and using the criteria described below narrowed the list to a candidate set best suited for inclusion in all EHRs throughout the life course. Several conceptual frameworks provide lists of key health determinants and indicate ways in which they are linked to disease onset and progression.
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. Finally, Figure 2-4, the MacArthur Research Network on Socioeconomic Status and Health's model moves beyond identifying determinants at various levels to positing some of the interrelationships among them (Adler and Stewart, 2010)
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(2003) illustrates how social determinants of health are usually put into Figure 2-2 four categories (social determinants, health care system attributes, health outcomes, and disease inducing behaviors)
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outcomes that the model aims to explain are integrative measures of health that take into account disability. Although the MacArthur Research Network model focuses on those determinants associated with socioeconomic status, it comes up with a similar set of pathways to health involving access to care, health behaviors, exposure to toxins and pathogens, and responses to stressors.
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For example, changes in smoking behavior have occurred not only as a result of research findings on the harms of tobacco, but also as a result of policy changes affecting the cost of cigarettes, encouragement by health care providers to quit smoking, media campaigns, the existence of smoke-free environments, and changing social norms. SOCIAL AND BEHAVIORAL HEALTH DOMAINS This section outlines the full set of domains that the committee reviewed as an initial step in identifying the set of candidate domains to be considered for inclusion in EHRs.
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esearch to conduct clinical and population health research to R learn about the causes of health, the predictors of outcomes of care, and the impact of interventions at multiple levels.
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Individual Factors Conditions III. Neighborhoods/Communities Sociodemographics Behavioral Social Engagement Compositional Characteristics Sexual Orientation Dietary Patterns Marital Status/Family Socioeconomic and Racial/Ethnic Gender Identity Activity Structure Characteristics Racial Identity Sedentary behavior Religious Involvement Contextual Characteristics Ethnic Identity Physical activity Civic, Sports, and Community Air Pollution Country of Origin/Migration Sleep Involvement Allergens History Substance Abuse Social Isolation Other Hazardous Exposures Language Tobacco use and exposure Land Use, Urban Design, Education Alcohol use Social Connections Walkability Occupation/Employment Abuse of other substances Instrumental Support Nutritious Food Options Financial Resource Strain Sexual Practices Emotional Support Public Transportation, Parks, Open Food and housing Exposure to Firearms Spaces insecurity Risk-Taking Behavior Exposure to Violence Health Care and Social Services Parental Level of Education Distractive driving Educational and Job Opportunities Type of Insurance Helmet use Housing Safety/Violence Seat belt use Stability Social Cohesion Quality and Safety Social Organization/Collective Efficacy Work Conditions
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into one domain. The original publication in Phase 1 had several editorial errors regarding the shading of the candidate set of domains and the labeling of domains/subdomains.
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• Allows the individual to record information • Allows the appropriate information to be summarized in an EHR Domain-specific • Assesses state or • Health-related quality of measurement instruments progression life • Allows the appropriate information to be summarized in an EHR Community datasets • Analysis of population • Community resources samples • Analysis of patterns and trends National surveys • Analysis of population • Health interview survey samples • Analysis of patterns and trends Table 2-2 provides a brief summary of the purposes of the EHR along with the purpose of data from other data sources to inform thinking about what is needed in the EHR and if linkages to other surveys or electronic storage of health information have potential use. After the committee's first meeting, an expert consensus process was used so that the committee could promptly complete its first task: to identify a set of candidate domains for consideration for inclusion in all EHRs.
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The committee did discuss feasibility in the context of variables included under geocoding because some of those variables are not consistently defined and measured in current datasets and would require costly and time-intensive efforts to develop linkages to individual EHRs. The committee debated whether it was better to consider each variable as a domain or to treat the domain of "geocoding" as a single category, of which specific measures (e.g., the composition of a neighborhood or community by socioeconomic status or race/ethnicity and the level of air pollution and density of housing in a neighborhood or community)
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2011. Identifying core behavioral and psychosocial data elements for the electronic health record.
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