Environmental Health
Title: Linking Electronic Health Records and In-depth Interviews to Uncover Barriers to Social Mobility and Health in a Declining Coal Mining Community
Site PI: Annemarie G. Hirsch, PhD, MPH (PI: Jennifer Silva, Indiana University)
Funder: Russell Sage Foundation
Dates: 01/01/20 – 03/31/2023
The Russell Sage Foundation is funding a collaboration among Geisinger, Indiana University, and Bucknell University to identify discrepancies between medical record and patient narrative data in terms of sources of poor health, diagnoses, and treatment among women living in rural, socioeconomically deprived communities in central Pennsylvania. Health systems are attempting to capture social determinants of health (SDoH) in electronic health records (EHR) and use these data to adjust care plans. To date, however, methods for identifying social needs, which are the SDoH prioritized by patients, have been underexplored, and there is little guidance as to how clinicians should act on SDoH data when caring for patients. Moreover, the unintended consequences of collecting and responding to SDoH are poorly understood. The objective of this study is to use two data sources, EHR data and patient interviews, to describe divergences between the EHR and patient experiences that could help identify gaps in the documentation of SDoH in the EHR; highlight potential missed opportunities for addressing social needs, and identify unintended consequences of efforts to integrate SDoH into clinical care.
Publications:
doi: 10.2196/36201.
Title: Diabetes LEAD (Location, Environmental Attributes, and Disparities) Network
Co-PIs: Annemarie G. Hirsch, PhD, MPH and Brian S. Schwartz, MD, MS
Funding Source: CDC
Project Number: 1U01DP006296
Dates: 09/2017 – 09/2022
The Geisinger-Johns Hopkins Bloomberg School of Public Health Environmental Health Institute (EHI) is a site in the CDC-funded Network, a collaboration dedicated to identifying the contributions of community features and geography on type 2 diabetes risk and control. Diabetes prevalence and incidence in the US vary substantially by geography. The LEAD Network aims to guide policy decision-making to reduce the burden of type 2 diabetes across the US. LEAD sites conduct studies at their respective institutions as well as network-wide analyses. Using longitudinal electronic health record data and community data, the EHI is studying the role that community types and community features have in onset of type 2 diabetes and type 2 diabetes control (e.g., blood pressure and kidney function) in central and northeastern Pennsylvania. We are evaluating a range of community features, including greenness, blue space, community socioeconomic deprivation, the food environment, urbanicity, and leisure-time physical activity resources. Using questionnaire and salivary cortisol measures we are exploring the various pathways through which community features and community perceptions may impact type 2 diabetes control, including stress, food insecurity, diet, and physical activity. In collaboration with the other LEAD sites, the EHI has developed harmonized approaches to measurement and analysis, allowing for multi-site investigations of modifiable community features, including the food and physical activity environment, that may mediate the association between community socioeconomic deprivation and type 2 diabetes onset.
Publications:
Title: Understanding the role of community determinants in opioid use disorder and program implementation factors influencing patient adherence to opioid agonist therapy
PI: Melissa N. Poulsen, PhD, MPH
Funder: National Institute on Drug Abuse
Grant number: K01 DA 049903-01A1
Dates: 07/01/2020 – 06/30/2025
To inform an effective response to the opioid epidemic, understanding the multilevel factors that influence risk of opioid use disorder (OUD) is critical. In addition, although the efficacy of medications for treating OUD is proven, long-term retention in treatment remains a challenge. Thus, efforts are needed to identify program implementation factors that can be strengthened to improve OUD treatment outcomes. This research seeks to generate evidence to understand novel, understudied risk factors for OUD, with implications for investment in community-level prevention interventions, and how health systems can improve treatment retention among individuals with OUD. The aims of this grant are twofold. The first aim centers on the social determinants that engender vulnerability to OUD, evaluating associations of community contextual factors related to socioeconomic, social, and physical conditions with OUD, and the role individual-level genetic risk factors, healthcare factors, and comorbid medical conditions play in these relations. We are utilizing electronic health record and genetic data from Geisinger patients coupled with secondary data characterizing community factors to conduct a nested case-control study. The second aim seeks to understand factors at the individual, interpersonal, and organizational levels that influence patient engagement in and retention to medication treatment for OUD. We are conducting a mixed methods study that includes interviews with patients and key informants to identify multilevel barriers and facilitators influencing treatment success followed by a survey of adult patients in Geisinger’s addiction medicine treatment clinics to quantify factors influencing treatment engagement and retention from a patient perspective.
Publications: