Using health information technology to bring social determinants of health into primary care: a conceptual framework to guide research
Open accessAbstract
Several recent national initiatives have called for increased efforts to integrate social determinants of health (SDH) into health care settings using health information technology (HIT). However, there is limited evidence to guide the implementation of these recommendations in practice. Research is needed to understand what SDH information is most important to collect, how SDH information can be used to inform clinical care and referrals, and ultimately, whether and how integrating SDH screening and action into primary care affects individual and population health. We recently proposed a conceptual framework to illustrate how HIT can be used to bring SDH information into primary care. In this paper, we describe how we are putting this conceptual model into practice within the OCHIN network of community health centers by highlighting examples of ongoing research, identifying knowledge gaps, and outlining a roadmap of future research to move the field forward.
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The literature on social risk factor documentation is hampered by a lack of data about the true prevalence of social risks in the clinical populations being studied.
“But this literature is hampered by a lack of data about the true prevalence of social risks in the clinical populations being studied.[6][7][8][9]”
From Structured and unstructured social risk factor documentation in the electronic health record underestimates patients’ self-reported risks (2024) · cites this paper as [9]
The Abstract (page unavailable) says evidence is limited on how to implement social-determinants screening in primary care. The OCHIN research-portfolio section (page unavailable) discusses collecting patient-reported data, but neither passage says that documentation research is hampered by a lack of data on the true prevalence of social risks in the clinical populations studied. Searches for prevalence and that specific data gap found no passage addressing it. (LLM, conf=0.72)
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Cites
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Cited by
Sorted by citations
Cottrell, E. K., Hendricks, M., Dambrun, K., Cowburn, S., Pantell, M., Gold, R., & Gottlieb, L. M. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.16852 · Cited by 126 · see citing works
Self-citationIott, B. E., Rivas, S., Gottlieb, L. M., Adler-Milstein, J., & Pantell, M. S. (2024) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocad261 · Cited by 17 · see citing works
Self-citation
- Authors
- Cottrell, E. K., Gold, R., Likumahuwa, S., Angier, H., Huguet, N., Cohen, D. J., Clark, K. D., Gottlieb, L. M., & DeVoe, J. E.
- Affiliations
- Oregon Health & Science University (US)
- Kaiser Permanente (US)
- ORCID
- Venue
- Journal of Health Care for the Poor and Underserved
- Publisher
- Project MUSE
- Published
- 2018
- Volume
- 29
- Issue
- 3
- Pages
- 949-963
- ISSN
- 1049-2089 (ISSN-L)
- 1548-6869
- PMC
- PMC6779030
- OpenAlex
- W2885581354
- Cited by
- 41
- References
- 2
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 6 · 2019: 5
- FWCI
- 5.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Health Care for the Poor and Underserved (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Project Muse (Johns Hopkins University) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 HS023324)
- National Cancer Institute (R01CA181452)
- National Institute of Diabetes and Digestive and Kidney Diseases (R18DK105463)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- social determinants of health, health information technology, primary care, conceptual framework, community health centers, clinical decision support, referral, population health, research roadmap
- MeSH terms
- Humans, Medical Informatics, Primary Health Care, Research, Models, Organizational, Social Determinants of Health
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