The DOI matches its Crossref record; 55 of the 55 references it cites were found in a registry or an index; none of the 25 sources its claims cite is checked for support yet.
Adoption of Social Determinants of Health EHR Tools by Community Health Centers
Open accessAbstract
PURPOSE: This pilot study assessed the feasibility of implementing electronic health record (EHR) tools for collecting, reviewing, and acting on patient-reported social determinants of health (SDH) data in community health centers (CHCs). We believe it is the first such US study. METHODS: We implemented a suite of SDH data tools in 3 Pacific Northwest CHCs in June 2016, and used mixed methods to assess their adoption through July 2017. We modified the tools at clinic request; for example, we added questions that ask if the patient wanted assistance with SDH needs. RESULTS: Social determinants of health data were collected on 1,130 patients during the study period; 97% to 99% of screened patients (n = 1,098) had ≥1 SDH need documented in the EHR, of whom 211 (19%) had an EHR-documented SDH referral. Only 15% to 21% of patients with a documented SDH need indicated wanting help. Examples of lessons learned on adoption of EHR SDH tools indicate that clinics should: consider how to best integrate tools into existing workflow processes; ensure that staff tasked with SDH efforts receive adequate tool training and access; and consider that timing of data entry impacts how and when SDH data can be used. CONCLUSIONS: Our results indicate that adoption of systematic EHR-based SDH documentation may be feasible, but substantial barriers to adoption exist. Lessons from this study may inform primary care providers seeking to implement SDH-related efforts, and related health policies. Far more research is needed to address implementation barriers related to SDH documentation in EHRs.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This pilot implemented EHR tools for collecting, reviewing, and acting on patient-reported social determinants of health (SDH) data in 3 Pacific Northwest community health centers. It found systematic EHR-based SDH documentation feasible but identified substantial adoption barriers, with high positive screening rates but low referral and patient-requested-help rates.
Key findings
- SDH data were collected on 1,130 patients, representing 4% to 18% of adult patients with an ambulatory visit at the pilot clinics; 97% to 99% of screened patients had ≥1 SDH need documented, and 211 (19%) had an EHR-documented SDH referral.
- After questions about wanting help were added, 15% of Clinic A patients and 21 of Clinic B patients with a documented SDH need requested help.
- Facilitators included a trusted, EHR-savvy clinic champion, ability to customize EHR views, and reporting requirements; barriers included fragmented patient data, added workflow difficulty, paper-based data entry, time-consuming referrals, and unmanageable follow-up workload before desire-for-help questions were added.
- The clinics successfully documented SDH in the EHR and continued post-study, but referral documentation was especially challenging.
Methods
- Concurrent mixed-methods pilot at 3 OCHIN member community health centers in the Pacific Northwest; Epic-based SDH tools built on PRAPARE were deployed in June 2016 and assessed through July 2017, extended from 12 to 13 months.
- Quantitative EHR data described adult patients with documented SDH data or ≥1 ambulatory visit, including demographics, SDH needs, referrals, and problem list diagnoses.
- Qualitative data included 6 days of workflow observation, 24 interviews with care team members, and observations of clinic decision-maker discussions; analysis used deductive and inductive coding and the constant comparative method.
Limitations
- The paper states it could not calculate SDH screening documentation rates among targeted patients because target populations changed, change dates were unclear, and target criteria were not easily extracted from the EHR; screened vs unscreened differences therefore cannot be interpreted as related to EHR-based SDH screening.
- The paper states screened-patient counts may be low and SDH need prevalence may be higher than in the overall population because some paper surveys were likely not entered into the EHR; referral rates are likely underestimated because referrals were often documented in chart notes rather than discrete fields.
- The paper states it could not assess changes in SDH status, care quality, or biomarkers; could not quantify how often the SDH summary was accessed or by whom; the SDH screening measures have not been validated as predictive of specific outcomes; and the single EHR system limits transferability. Evident from the text: this was a small 3-clinic pilot with clinic-selected pragmatic target groups and no control or comparison group.
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Claims the paper makes
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“(2) could add a layer of difficulty to collecting and acting on SDH data; (eg, due to lack of staff EHR expertise, the tools' customized nature, differences in EHR security access by staff role, and the need for new EHR competencies from some staff)”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > SDH Screening Documentation and Referrals
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only 15% to 21% of patients with a documented SDH need indicated wanting help.”
- Also stated in: § SDH Screening Documentation and Referrals · plain
“15% of Clinic A patients and 21% of Clinic B patients with a documented need requested help.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Abstract
Strength:plain· not yet calibratedn = 182Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § SDH Screening Documentation and Referrals · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“97% to 99% of screened patients (n = 1,098) had ≥1 SDH need documented in the EHR”
- Also stated in: § SDH Screening Documentation and Referrals · hedged
“Most screened patients (97% to 99%) indicated a potential SDH need in ≥1 SDH domain”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Abstract
Strength:plain· not yet calibratedn = 1,098Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § SDH Screening Documentation and Referrals · hedged
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Referral documentation proved especially challenging.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“(3) sought to minimize the primary care provider's role in SDH documentation, and in making SDH-related referrals.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Implementation
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All 3 clinics: (1) adapted their workflows as needed”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Implementation
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“(3) necessitated a data entry step if SDH information were collected on paper.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > SDH Screening Documentation and Referrals
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Making it known that SDH data might address reporting requirements increased staff motivation.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > SDH Screening Documentation and Referrals
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“until questions asking whether patients desired follow-up for SDH needs were added, the high positive screening rate yielded an unmanageable follow-up workload”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > SDH Screening Documentation and Referrals
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Referral workflows varied by clinic, differentially impacting our ability to determine SDH domains associated with referrals.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > SDH Screening Documentation and Referrals
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- It may state two separate claims as one. 26
- Probably not a substantial claim. 23
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Like most CHCs, the study clinics' patient populations are primarily publicly insured or uninsured and aged <65 years; 10% to 31% are non-white and 10% to 30% are of Hispanic ethnicity (Table 2).”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Setting
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Despite the many identified challenges to adopting all of the SDH data tools, the study clinics did successfully document SDH in the EHR, and continued to do so post-study.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Clinics B and C routed most SDH referrals to community health workers or similar staff; these internal referrals generally lacked the information required to match them to a specific SDH need.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > SDH Screening Documentation and Referrals
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“B 379 367 (96.8) 26 (6.8)”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Strength:plain· not yet calibratedn = 379Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A 602 583 (96.8) 141 (23.4)”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Strength:plain· not yet calibratedn = 602Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“C 149 148 (99.3) 44 (29.5)”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Strength:plain· not yet calibratedn = 149Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Facilitators to using EHR tools to document SDH included a clinic champion who was trusted, EHR-savvy, able to customize EHR views to support workflows, and willing to use adoption data to iterate workflows.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > SDH Screening Documentation and Referrals
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Clinic A first tested their workflows with a few randomly chosen patients per day, then added all new patients plus those completing annual insurance reauthorizations, and eventually added patients receiving care coordination, HIV services, and behavioral health services.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Implementation
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Clinic B began with patients in their diabetes and Hepatitis C case management programs, then added patients aged 65 years and older.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Implementation
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Key barriers included perceptions that EHR-based SDH data tools: (1) created a fragmented view of the patient, with relevant data in multiple places, and did not readily support documenting a narrative about a given patient”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > SDH Screening Documentation and Referrals
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Consider that the completed paper form does not reveal how a patient scored on the SDH domains; this scoring is not easily identifiable until the data are in the EHR.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Social determinants of health data were collected on 1,130 patients during the study period”
- Also stated in: § SDH Screening Documentation and Referrals · plain
“Social determinants of health data were collected on 1,130 patients, representing 4% to 18% of adult patients with an ambulatory visit at the pilot clinics during the study period (Table 2 and Table 3).”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Abstract
Strength:plain· not yet calibratedn = 1,130Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Also stated in: § SDH Screening Documentation and Referrals · plain
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Consider using text shortcut tools to document provision of community resource materials or referrals provided by SDH topic (this does not provide agency details, but is a fast and easy way to document SDH referrals).”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“(2) principally used the paper-based SDH screening questionnaire, necessitating a data entry workflow step that impacted when the data were available in the EHR”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Implementation
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Each clinic first screened a limited population of patients, then scaled up.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Implementation
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This pilot study is the first to formally test adoption of EHR-based SDH data documentation, review, and action in CHCs, and is one of the first in any clinical setting.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > CONCLUSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“While some aspects of the tools were not widely adopted, this is common to such efforts [58][59][60][61] ; adoption of new EHR tools can take time.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
What the sources say
- Not matchedcites [58]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [59]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [60]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“however, for the benefits of systematic EHR-based SDH documentation to be realized, barriers to adoption of EHR tools must be addressed.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > CONCLUSION
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
In the paper
“SDH documentation, review, and referral-making in EHRs can be feasible and useful, but is challenging to adopt.63”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
What the sources say
- Not matchedcites [63]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Some barriers to SDH screening are likely to occur regardless of the technology used, for example, staff concerns about SDH screening when little intervention is possible.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Analysis followed the constant comparative method 46 ; new data were compared with previously collected/coded data to detect commonalities/differences, and to develop nuanced understandings of clinic experiences.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Data Collection and Analyses
What the sources say
- Not matchedcites [46]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, some clinic counts of patients screened did not match our quantitative data from the EHR; further, we observed that data entry workflows were not always standardized.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Regular study team meetings and discussions with stakeholders informed each step of analysis and results interpretation.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Data Collection and Analyses
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Social determinants of health documentation in EHRs could enable care plan adjustments/referrals to social services, and tracking such referrals' results.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This study was approved by the Kaiser Permanente Northwest Institutional Review Board.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Data Collection and Analyses
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We could not calculate rates of SDH screening documentation among targeted patients because the study clinics' target populations changed during the study period, the dates of these changes were unclear, and target criteria were not easily extracted from the EHR.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Limitations
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Quantitative and qualitative data were collected simultaneously.Preliminary results from each informed subsequent data collection (eg, discrepancies between interview descriptions of clinic workflows and corresponding quantitative data were further explored in site visits).”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Data Collection and Analyses
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The systematic EHR documentation and management of SDH needs could impact CHC patients' health, but optimizing such EHR tools and integrating them smoothly into clinic workflows will require addressing substantial knowledge gaps.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > CONCLUSION
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“Before benefits can be fully realized, the unique challenges of EHR-based SDH documentation and referral-making must be understood and addressed.1,39,48”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
What the sources say
- Not matchedcites [1]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [39]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [48]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Data collection and analysis were iterative and inductive; emergent understanding and questions from preliminary findings were explored.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Data Collection and Analyses
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, to meet the growing national emphasis on EHR-based SDH documentation and referral, numerous factors must be considered.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
In the paper
“Our findings are consistent with those of a prior case study on EHR-based SDH documentation.62”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
What the sources say
- Not matchedcites [62]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Final results were compared to validate and confirm analytic interpretations.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Data Collection and Analyses
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our results raise important questions about the feasibility of EHR-based SDH documentation per national recommendations.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > DISCUSSION
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Results may be informative to CHCs and other primary care providers seeking to implement SDH-related efforts, especially if SDH documentation becomes required or associated with financial incentives.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > CONCLUSION
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It is possible that our count of screened patients may be low, and prevalence of SDH needs among screened patients may be higher than in the clinics' overall population, as some data from paper surveys were likely not entered into EHRs, especially if no SDH needs were identified.”
§ Adoption of Social Determinants of Health EHR Tools by Community Health Centers > Limitations
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The authors state this as an assumption.
The study is the first US study on the collection of SDH data using EHR-based tools in community health centers.
“We believe it is the first such US study.”
“We believe this is the first US study on the collection of SDH data using EHR-based tools in CHCs.”
The paper relies on this without support.
Most health care systems document and track most patient information in EHRs.
“Since most health care systems document and track most patient information in EHRs, SDH data should also be in EHRs.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“They also do not include measures that reflect whether SDOH data are reviewed after being documented.”
From Documentation and review of social determinants of health data in the EHR: measures and associated insights (2021) · cites this paper as [13]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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.”
From Documentation and review of social determinants of health data in the EHR: measures and associated insights (2021) · cites this paper as [13]
The cited source says what the claim attributes to it.
In the citing paper
“This suggests that simply adding dedicated SDOH fields and tools to EHRs is insufficient to drive increased documentation of social needs, a conclusion consistent with other publications.13,21”
From Documentation and review of social determinants of health data in the EHR: measures and associated insights (2021) · cites this paper as [13]
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“Key barriers included perceptions that EHR-based SDH data tools: (1) created a fragmented view of the patient, with relevant data in multiple places, and did not readily support documenting a narrative about a given patient; (2) could add a layer of difficulty to collecting and acting on SDH data; (eg, due to lack of…”
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“25 Successful screening implementation in select settings may suggest that patients do not object to screening, 26–37 though some clinicians have expressed concerns about time constraints 38 and the potential for increasing patient stigma.”
Self-citation
Metadata
- Authors
- Gold, R., Bunce, A., Cowburn, S., Dambrun, K., Dearing, M., Middendorf, M., Mossman, N., Hollombe, C., Mahr, P., Melgar, G., Davis, J., Gottlieb, L., & Cottrell, E.
- Affiliations
- Kaiser Permanente Center for Health Research (US)
- Ochin (US)
- Multnomah County Health Department (US)
- University of California, San Francisco (US)
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2018-09
- Volume
- 16
- Issue
- 5
- Pages
- 399-407
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC6131002
- OpenAlex
- W2891941547
- Semantic Scholar
- ec90bbff459f6d579a5de4a0ee6586f1aebfa662
- Cited by
- 252
- References
- 55
- Citations by year
- 2026: 21 · 2025: 32 · 2024: 25 · 2023: 38 · 2022: 38 · 2021: 42 · 2020: 31 · 2019: 23 · 2018: 2
- FWCI
- 31.11
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- 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
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Keywords
- social determinants of health, electronic health records, community health centers, social needs screening, referral documentation, implementation barriers, primary care, health policy
- MeSH terms
- Community Health Centers, Documentation, Feasibility Studies, Health Plan Implementation, Humans, Pilot Projects, Referral and Consultation, Electronic Health Records, Social Determinants of Health
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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