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Cited by 126Health disparities and outcomesFood Security and Health in Diverse PopulationsPublic Health and Social Inequalities

Comparison of community-level and patient-level social risk data in a network of community health centers

Open access
Cottrell, Erika K., Hendricks, Michelle, Dambrun, Katie, Cowburn, Stuart, Pantell, Matthew, Gold, Rachel, Gottlieb, Laura M.·2020·JAMA Network Open
DOI 10.1001/jamanetworkopen.2020.16852PMC PMC7596576
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Abstract

Importance: Responding to the substantial research on the relationship between social risk factors and health, enthusiasm has grown around social risk screening in health care settings, and numerous US health systems are experimenting with social risk screening initiatives. In the absence of standard social risk screening recommendations, some health systems are exploring using publicly available community-level data to identify patients who live in the most vulnerable communities as a way to characterize patient social and economic contexts, identify patients with potential social risks, and/or to target social risk screening efforts. Objective: To explore the utility of community-level data for accurately identifying patients with social risks by comparing the social deprivation index score for the census tract where a patient lives with patient-level social risk screening data. Design, Setting, and Participants: Cross-sectional study using patient-level social risk screening data from the electronic health records of a national network of community health centers between June 24, 2016, and November 15, 2018, linked to geocoded community-level data from publicly available sources. Eligible patients were those with a recorded response to social risk screening questions about food, housing, and/or financial resource strain, and a valid address of sufficient quality for geocoding. Exposures: Social risk screening documented in the electronic health record. Main Outcomes and Measures: Community-level social risk was assessed using census tract-level social deprivation index score stratified by quartile. Patient-level social risks were identified using food insecurity, housing insecurity, and financial resource strain screening responses. Results: The final study sample included 36 578 patients from 13 US states; 22 113 (60.5%) received public insurance, 21 181 (57.9%) were female, 17 578 (48.1%) were White, and 10 918 (29.8%) were Black. Although 6516 (60.0%) of those with at least 1 social risk factor were in the most deprived quartile of census tracts, patients with social risk factors lived in all census tracts. Overall, the accuracy of the community-level data for identifying patients with and without social risks was 48.0%. Conclusions and Relevance: Although there is overlap, patient-level and community-level approaches for assessing patient social risks are not equivalent. Using community-level data to guide patient-level activities may mean that some patients who could benefit from targeted interventions or care adjustments would not be identified.

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  • The accuracy of community-level data for identifying patients with and without social risks was 48.0%.

    “They found that “the accuracy of the community-level data for identifying patients with and without social risks was 48.0%.””

    From The quality of social determinants data in the electronic health record: a systematic review (2021) · cites this paper as [52]

  • Use of community-level data for patient risk stratification may heighten the risk of ecologic fallacy, wherein incorrect assumptions are made about an individual based on aggregate-level information about a group.

    “The authors noted that the use of these data for patient risk stratification “may heighten the risk of ecologic fallacy, wherein incorrect assumptions are made about an individual based on aggregate-level information about a group.”52”

    From The quality of social determinants data in the electronic health record: a systematic review (2021) · cites this paper as [52]

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Authors
Cottrell, E. K., Hendricks, M., Dambrun, K., Cowburn, S., Pantell, M., Gold, R., & Gottlieb, L. M.
Affiliations
  • Oregon Health & Science University (US)
  • Ochin (US)
  • University of California, San Francisco (US)
  • Kaiser Permanente (US)
Corresponding author
Cottrell, Erika K.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2020-10-29
Volume
3
Issue
10
Pages
e2016852
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2020.16852
PMC
PMC7596576
OpenAlex
W3095119350
Cited by
126
References
35
Citations by year
2026: 20 · 2025: 21 · 2024: 24 · 2023: 29 · 2022: 21 · 2021: 11
FWCI
8.44
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Patient-Centered Outcomes Research Institute
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
social risk screening, food insecurity, housing insecurity, financial stress, community health centers, social determinants of health, screening accuracy
MeSH terms
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Child, Preschool, Community Health Centers, Cross-Sectional Studies, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Residence Characteristics, Risk Factors, Sex Factors, Socioeconomic Factors, United States, Risk Assessment, Young Adult, Social Determinants of Health

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