scholarly journals Mining 100 million notes to find homelessness and adverse childhood experiences: 2 case studies of rare and severe social determinants of health in electronic health records

2017 ◽  
Vol 25 (1) ◽  
pp. 61-71 ◽  
Author(s):  
Cosmin A Bejan ◽  
John Angiolillo ◽  
Douglas Conway ◽  
Robertson Nash ◽  
Jana K Shirey-Rice ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Determinants Of Health ◽  
Homeless Population ◽  
Health Records ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Electronic Health

Abstract Objective Understanding how to identify the social determinants of health from electronic health records (EHRs) could provide important insights to understand health or disease outcomes. We developed a methodology to capture 2 rare and severe social determinants of health, homelessness and adverse childhood experiences (ACEs), from a large EHR repository. Materials and Methods We first constructed lexicons to capture homelessness and ACE phenotypic profiles. We employed word2vec and lexical associations to mine homelessness-related words. Next, using relevance feedback, we refined the 2 profiles with iterative searches over 100 million notes from the Vanderbilt EHR. Seven assessors manually reviewed the top-ranked results of 2544 patient visits relevant for homelessness and 1000 patients relevant for ACE. Results word2vec yielded better performance (area under the precision-recall curve [AUPRC] of 0.94) than lexical associations (AUPRC = 0.83) for extracting homelessness-related words. A comparative study of searches for the 2 phenotypes revealed a higher performance achieved for homelessness (AUPRC = 0.95) than ACE (AUPRC = 0.79). A temporal analysis of the homeless population showed that the majority experienced chronic homelessness. Most ACE patients suffered sexual (70%) and/or physical (50.6%) abuse, with the top-ranked abuser keywords being “father” (21.8%) and “mother” (15.4%). Top prevalent associated conditions for homeless patients were lack of housing (62.8%) and tobacco use disorder (61.5%), while for ACE patients it was mental disorders (36.6%–47.6%). Conclusion We provide an efficient solution for mining homelessness and ACE information from EHRs, which can facilitate large clinical and genetic studies of these social determinants of health.

Advocacy and Ac­tion in Appalachia Aimed at Adverse Childhood Experiences

2020 ◽  
pp. 125-148
Author(s):  
Adam Hege ◽  
Denise Presnell ◽  
Kellie B. Reed-Ashcraft ◽  
Karen Caldwell ◽  
Damiana Gibbons Pyles ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Academic Research ◽  
Social Determinant ◽  
Determinants Of Health ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Community Initiative ◽  
Rural Appalachia

Rural Appalachia faces extreme poverty-linked hardships, often referred to as ‘social determinants of health'. One social determinant of health often linked with rural poverty is adverse childhood experiences (ACEs). ACEs refer to numerous experiences (e.g., forms of abuse and maltreatment, a dysfunctional household, mental illness in the household, etc.) that one encounters before the age of 18. Local leaders of a county in the heart of Appalachia in northwestern North Carolina (Watauga) embarked on a community level initiative (Watauga Compassionate Community Initiative) aimed at preventing and treating the effects of ACEs and building resiliency. This chapter delves into the academic research related to ACEs and poverty and details the background and ongoing story of the Watauga Compassionate Community Initiative, concluding with lessons learned and insights into what other rural communities can focus on when addressing ACEs, poverty, and other social determinants of health.

scholarly journals Assessing the Social Determinants of Health and Adverse Childhood Experiences in Patients Attending a Children's Hospital Cleft Palate-Craniofacial Program

2021 ◽  
pp. 105566562110487
Author(s):  
Ethan Ponton ◽  
Rebecca Courtemanche ◽  
Tanjot K. Singh ◽  
Damian Duffy ◽  
Douglas J. Courtemanche ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Determinants Of Health ◽  
Childhood Experiences ◽  
Children's Hospital ◽  
Adverse Childhood ◽  
The Social ◽  
Children’S Hospital

This study aimed to describe the social determinants of health (SDoH) for patients receiving multidisciplinary team care in a Cleft Palate-Craniofacial program, develop responsive and consistent processes to include trauma-informed psychosocial histories, promote discussions about additional “non-medical” factors influencing health and surgical outcomes, and demonstrate that these activities are feasible in the context of multidisciplinary patient-provider interactions. Single-site, cross-sectional study using a questionnaire. Participants were recruited from a provincial quaternary care Cleft Palate-Craniofacial program at British Columbia Children's Hospital in Vancouver, BC, Canada. 290 families completed the questionnaire. 34% of families experience significant barriers to accessing primary health care, 51% struggle financially, and 11% scored four or more on the Adverse Childhood Experiences scale. Furthermore, 47% reported not having adequate social support in their lives, and 5% reported not feeling resilient at the time of the survey. Patients with cleft and craniofacial anomalies have complex needs that extend beyond the surgical and medical care they receive. It is critical that all Cleft and Craniofacial teams incorporate social histories into their clinic workflow and be responsive to these additional needs. Discussions surrounding SDoH and adversity are welcomed by families; being involved in the care and decision-making plans is highly valued. Healthcare providers can and should ask about SDoH and advocate for universal access to responsive, site-based, social work support for their patients.

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