Hospital Readmission and Social Risk Factors Identified from Physician Notes

When predictive algorithms are being developed from clinical data, nurses can contribute with practice-based perspectives to technical teams to understand why some data elements are missing or incomplete.

“For example, when predictive algorithms are being developed from clinical data, nurses can contribute with practice‐based perspectives to technical teams (often consisting of engineers, computer scientists, user interface design experts, etc.) to understand why some data elements are missing or incomplete (e.g. poor documentation of social risk factors) (Navathe et al., 2018) and offer potential”

SDoH which are less commonly targeted for extraction have been shown to impact healthcare.

“In addition to our technical innovations, our work adds to prior efforts by investigating SDoH which are less commonly targeted for extraction but nonetheless have been shown to impact healthcare43–51.”

Prior work investigating social risk factor documentation using ICD-10 codes has suggested that these codes are underutilized, and one study found that ICD codes were used less frequently to document social risk factors when compared to note narratives (unstructured data).

“Prior work investigating social risk factor documentation using International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, specifically, has suggested that these codes are underutilized, 3,4 and 1 study found that ICD codes were used less frequently to document social risk factors when compared to note narratives (unstructured data).5”

Clinicians may not be aware of structured SDH documentation tools, and prior work has shown that free-text notes were more commonly used for SDH documentation.

“Alternatively, clinicians may not be aware of structured SDH documentation tools, 18 and prior work has shown that free-text notes were more commonly used for SDH documentation. 5”

Prior studies reveal the value of measuring different approaches to SDOH documentation in the EHR but do not offer a generalizable set of measures that can be used to compare different EHR-based SDOH documentation options.

“These studies reveal the value of measuring different approaches to SDOH documentation in the EHR but do not offer a generalizable set of measures that can be used to compare different EHR-based SDOH documentation options.”

A small set of studies has measured the extent to which specific social risk factors are documented in EHRs in different types of fields.

“A small set of studies has measured the extent to which specific social risk factors are documented in EHRs in different types of fields.11,12”

Prior studies do not include measures that reflect whether SDOH data are reviewed after being documented.

“They also do not include measures that reflect whether SDOH data are reviewed after being documented.”

Adding Z-codes to the EHR's problem list did not result in high levels of SDOH data documentation even many years after these codes were released.

“We (and others11,12) have found that another structured approach—adding Z-codes to the EHR's problem list—also did not result in high levels of SDOH data documentation even many years after these codes were released.”