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2 Selection of Domains for Consideration
Pages 43-54

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From page 43...
... 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.
From page 44...
... 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.
From page 45...
... . 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)
From page 46...
... (2003) illustrates how social determinants of health are usually put into four categories (health care system attributes, social determinants, health outcomes, and disease inducing behaviors)
From page 47...
... 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 1 In Phase 2, the committee added the definition for health system to clarify the term to include the health care system and public health.
From page 48...
... 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.
From page 49...
... Its deliberations were informed by the 2013 IOM report Toward Quality Measures for Population Health and the Leading Health Indicators (IOM, 2013)
From page 50...
... 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 Social Connections Land Use, Urban Design, Education Alcohol use Instrumental Support Walkability Occupation/Employment Abuse of other substances Emotional Support Nutritious Food Options Financial Resource Strain Sexual Practices Exposure to Violence Public Transportation, Parks, Food and housing Exposure to Firearms Housing Open Spaces insecurity Risk-Taking Behavior Stability Health Care and Social Services Parental Level of Education Distractive driving Quality and Safety Educational and Job Opportunities Type of Insurance Helmet use Work Conditions Safety/Violence Seat belt use Social Cohesion Social Organization/Collective Efficacy
From page 51...
... 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.
From page 52...
... • 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 6. Accessibility of data from another source (as shown in Table 2-2, information from external sources may be accessible to meet the needs of patient care, population health, and research; if so, the domains would have less priority for inclusion in the EHR)
From page 53...
... 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)
From page 54...
... 2011. Identifying core behavioral and psychosocial data elements for the electronic health record.


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