A Local Perspective into Electronic Health Record Design, Integration, and Implementation of Screening and Referral for Social Determinants of Health.

The use of the electronic health record (EHR) system to identify and address social determinants of health (SDOH) in vulnerable patients is still lacking, and examples for customizing the EHR to meet the workflows of clinical and administrative professionals are missing. We custom designed and built into the Epic EHR a SDOH screening tool integrated with a community resource network management (CRNM) software-as-a-service (SaaS) platform to systematically identify and address SDOH in Medicare and Medicaid beneficiaries across multiple clinical care settings. We further describe our workflow redesign and EHR implementation process to maximize SDOH screening and referral efficiency. The SDOH EHR solution has been operationally used over three years by staff to screen 111,486 Medicare and Medicaid beneficiaries, identify 7,878 SDOH, and refer 6,103 high-risk beneficiaries to community resources. Transforming an EHR into a catalyst software to support SDOH screening and referral in a clinical setting is an interdisciplinary process that benefits from various technical, administrative, and clinical experts that provide subject matter knowledge into all phases of the build.

An Early Look at the Association Between State Medicaid Expansion and Disparities in Cardiovascular Diseases: A Comprehensive Population Health Management Approach.

Cardiovascular disease (CVD) is one of the most prevalent chronic diseases nationally and disproportionately affects low-income individuals. There are substantial disparities on CVD outcomes that stem from the lack of health insurance among low-income populations. The Affordable Care Act expands Medicaid health insurance to low-income populations, and aims to increase the utilization of health, social, and economic preventive services to reduce health disparities and prevent chronic diseases. The authors analyzed data from the 2014 Behavioral Risk Factor Surveillance System to understand the potential impact of Medicaid expansion on disparities in CVD among low-income populations. Logistic regression models examined the association between CVD self-reported outcomes among low-income adults with incomes at or below 138% of the federal poverty level in states that have chosen to expand Medicaid and those states choosing not to expand, controlling for socioeconomic, demographic, behavioral, social, and health variables that affect CVD. Overall, the results show that adults in Medicaid expansion states have significantly lower odds of experiencing poor heart health compared to those in non-Medicaid expansion states (odds ratio = 0.767, 95% confidence interval 0.667-0.882). Additionally, significant findings were found between the association of CVD and demographic, socioeconomic, health, and health behavioral covariates. Policy makers should consider policies, systems, and interventions that increase access to a comprehensive set of preventive, population health, and socioeconomic services targeting the key determinants of CVD and other outcomes when expanding Medicaid and designing state plans and waivers.

A Contextualized Approach to Faith-Based HIV Risk Reduction for African American Women.

HIV/AIDS has a devastating impact on African Americans, particularly women and young adults. We sought to characterize risks, barriers, and content and delivery needs for a faith-based intervention to reduce HIV risk among African American women ages 18 to 25. In a convergent parallel mixed methods study, we conducted four focus groups (n = 38) and surveyed 71 young adult women. Data were collected across four African American churches for a total of 109 participants. We found the majority of women in this sample were engaged in behaviors that put them at risk for contracting HIV, struggled with religiously based barriers and matters of sexuality, and had a desire to incorporate their intimate relationships, parenting, and financial burdens into faith-based HIV risk-reduction interventions. Incorporating additional social context-related factors into HIV risk-reduction interventions for young African American women is critical to adapting and developing HIV interventions to reduce risk among young adult women in faith settings.