1. James M. Anderson Center for Health Systems Excellence James M. Anderson Center for Health Systems Excellence Recommended Social and Behavioral Domains and Measures for Electronic Health Records Robert S. Kahn, MD MPH Cincinnati Children’s Hospital Medical Center November 25, 2013

2. Achieving Potential Esteem and Respect Belonging Safety and Security Physiological What We See in ClinicHierarchy of Needs How We Respond Unemployment Lack of high school degree Ex-offender reentry issues Food insecurity Denial/delay of public benefits Utility shut offs Poor housing conditions Inadequate education services Domestic violence Adult mental health issues Distressed/depressed parents Lack of parenting role models Henize, Kahn

3. Benefits Housing Parental Depression Domestic Violence Food Insecurity Social Risk Screening

4. School Related Screening

5. EHR Referrals: Legal Aid Society

6. Tracking of EHR-based Legal Aid Referrals

7. Referrals to the Health Department

8. Change in physician behavior

9. Percent with household food insecurity identified Change in physician behavior

10. EHR data driving focus on broader social risks

11. 2-3 risks Days from the index admission *Risks: census tract extreme poverty, adult educational attainment, median home value Risks*Rate of asthma reutilization at 1y 030% 138% 2-345% Broader social risks informing clinical care: Census tract-level risks and asthma reutilization risk

12. Additional considerations Intergenerational information from parents’ EHR –Prenatal/obstetric history –Family history (e.g., smoking, obesity) Information from school’s database –Grades, missed school days, suspensions

13. EHR-related studies in social determinants Beck AF, Sauers H, Kahn RS, Yau C, Weiser J, Simmons JM. Improved documentation and care planning with an asthma-specific history and physical. Hospital Pediatrics 2012; 2:194-201. Beck AF, Simmons JM, Huang B, Kahn RS. Geomedicine: area-based socioeconomic measures for assessing risk of hospital reutilization among children admitted for asthma. American journal of public health 2012;102:2308-2314. Burkhardt MC, Beck AF, Conway PH, Kahn RS, Klein MD. Enhancing accurate identification of food insecurity using quality-improvement techniques. Pediatrics. Feb 2012;129:e504-510. Beck AF, Klein MD, Schaffzin J, Tallent V, Gillam M, Kahn RS. Identifying and treating a cluster of substandard housing using a medical-legal partnership. Pediatrics. 2012; 130:831-8. Beck AF, Simmons JM, Sauers HS, Sharkey K, Alam M, Jones C, Kahn RS. Connecting at-risk inpatient asthmatics to a community-based program to reduce home environmental risks: care system redesign using quality improvement methods. Hospital Pediatrics 2013;3:326-334. Klein MK, Beck AF, Henize AW, Parrish DS, Fink EE, Kahn RS. Doctors and lawyers collaborating to HeLP children – outcomes from a successful partnership between professions. Journal of Health Care for the Poor and Underserved. 2013; 24:1063-1073.