Ochin

Gunshot wounds are typically treated in acute care settings, but longer-term sequelae are likely treated by ambulatory care providers. To understand whether gunshot wounds treated in acute care settings are later documented in ambulatory care electronic health records, acute care claims and ambulatory care electronic health records data were linked. The primary objective was to determine the percentage of patients with a gunshot wound diagnosis in their ambulatory care electronic health records from all patients with both an acute care gunshot wound diagnosis and an observed follow-up ambulatory care visit. The second objective was to identify demographic and clinical factors associated with a patient having a gunshot wound diagnosis in their ambulatory care electronic health records. This observational study linked Oregon Medicaid claims for acute gunshot wound with ambulatory care electronic health records in OCHIN's ADVANCE Data Warehouse from 2012 to 2022 for case identification. Patients with and without an International Classification of Diseases code for gunshot wound in their ambulatory care electronic health records were characterized using descriptive statistics. Multivariable logistic regression conducted between 2024 and 2025 modeled predictors of gunshot wound diagnosis in follow-up ambulatory care electronic health records controlling for patient characteristics. Only 34.3% of patients with a gunshot wound event treated in an acute setting and with an observed ambulatory care visit had a gunshot wound diagnosis in their ambulatory care electronic health records. Time between acute gunshot wound and follow-up ambulatory care and the severity of the acute gunshot wound injury were associated with having a gunshot wound ambulatory care electronic health records diagnosis. Patients identified as Black, non-Hispanic or Hispanic had higher odds of having a gunshot wound ambulatory care electronic health records diagnosis than those identified as White, non-Hispanic. Most people who had a gunshot wound treated in an acute care setting with a later ambulatory care visit did not have a gunshot wound diagnosis in their ambulatory care electronic health records, even though a gunshot wound event can be relevant history for ambulatory care providers and patient care. Strategies to document prior gunshot wound in ambulatory electronic health records should be developed to support whole-person care in ambulatory settings.

Health care systems increasingly incorporate social risk data into electronic health records (EHRs) to address needs like food, housing, and transportation insecurity. This study evaluated whether EHR-integrated social clinical decision support (SCDS) tools improved control of blood pressure (BP) and hemoglobin A1c (HbA1c) and increased social risk-informed care and documentation in community-based clinics. We conducted a cluster randomized trial in a large primary care network. This pragmatic trial was designed to assess tool impact in real-world clinic conditions. Six clinics received SCDS tools embedded in the EHR; 44 clinics served as controls. The tools supported clinic-wide workflows and targeted decision support. A screening alert was triggered for adult patients lacking up-to-date social risk screening. Additional components were activated for patients with uncontrolled hypertension or diabetes, or with a diagnosis of either condition combined with a visit no-show rate of at least 50%. Primary outcomes were BP and HbA1c control. Secondary outcomes included social risk screening and documentation. Generalized linear mixed models accounted for patient clustering. We also examined use patterns of individual tool components. Blood pressure control improved over 12 months in both arms, with significantly greater improvement in intervention clinics. Control of HbA1c showed no significant differences. Intervention clinics had significantly greater odds of social risk screening and documentation. Use of individual SCDS tool components varied widely across clinics. Access to EHR-integrated SCDS tools was associated with increased documentation of social risks and greater improvements in BP control. These findings support embedding social risk data into clinical workflows to enhance chronic disease management in primary care.

Importance:Sleep-disordered breathing (SDB) is preventable but underdiagnosed, with disparities among sociodemographic groups with limited material and social resources, partly driven by community-level environmental and social conditions along with healthcare-related factors.Objectives:We sought to investigate associations between multifactorial community-level environmental, social, and health burdens and SDB prevalence. We also determined effect modification by age, sex, race, and ethnicity.Design, Setting, and Participants:Cross-sectional analysis of electronic health records (EHR) data collected in 2022 from 1,957,775 adult patients in the OCHIN network (>2,000 community health centers across 40 U.S. states).Exposures:Patients’ 2022 residential addresses were linked to a census tract-level environmental, social, and health burden (ESHB) index created by the Centers for Disease Control and Prevention and the Agency for Toxic Substances Disease Registry. The ESHB comprises 36 indicators that capture and rank community-level social (e.g., socioeconomic status), environmental (e.g., air pollution), and health (e.g., hypertension) vulnerability. Higher percentile ranks of ESHB (range: 0–1) indicated higher vulnerability.Main Outcomes and Measures:SDB was identified via diagnostic and procedural codes, and subtypes were categorized as obstructive (OSA), central (CSA), other/unspecified (OUSA), multiple apneas, and procedure-based cases. Log-binomial regression estimated prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusting for age, sex, race, and ethnicity. We assessed effect modification by testing cross-product terms.Results:Among 1,957,775 patients (median age was 43.0 years [IQR: 30.0–58.0]; 40.6% men), SDB prevalence was 5.5%, with CSA at 0.03%, OSA at 3.8%, OUSA at 1.4%, multiple sleep apneas at 0.03%, and procedure-based cases at 0.21%. Each 0.1-unit increase in ESHB percentile rank was associated with higher prevalence of SDB (PR=1.01 [1.01–1.01]), OUSA (PR=1.01 [1.01–1.02]), and procedure-based cases (PR=1.05 [1.03–1.06]). The ESHB-SDB association was elevated among adults aged 18–49 years, women, American Indian/Alaska Native and White, and non-Hispanic. ESHB was not associated with CSA.Conclusions and Relevance:Higher community-level environmental, social, and health vulnerabilities were associated with higher SDB prevalence (although future prospective studies are warranted). Our findings underscore the need to address community-level factors with potential tailoring of interventions across sociodemographic groups.

Introduction: Insufficient cervical cancer screening contributes to increased cervical cancer rates, particularly among disadvantaged groups, yet research on screening practices by race and ethnicity is underreported. Our objectives were to find the rates of up-to-date (UTD) cervical cancer screening within a nationwide network. Methods: A cross-sectional study was conducted using data from OCHIN, a diverse, national database consisting of over 6 million publicly or underinsured patients in rural and medically underserved communities that provides electronic health records to over 34,500 U.S. providers. We included all females between the ages of 21 and 65 with a cervix and at least one encounter at an OCHIN clinic from January 2015 to December 2023. UTD cervical cancer screening was the primary outcome. Results: Of the 2,464,565 patients with OCHIN, 2,279,808 met the inclusion criteria. The 2015-2023 rates of UTD cervical cancer screening for all races and ethnic groups were below the Healthy People 2030 goal of 84.3% and below the 2021 national screening average of 75.2%. Screening varied by race/ethnicity, with Hispanic individuals having the highest rates of UTD screening. Geographic location (urban, large rural, or isolated rural) did not show statistically significant differences in screening rates. Conclusions: In our analysis, we noted lower rates of participation in cervical cancer screening than national goals and the national average among all ages and racial/ethnic groups. Efforts to increase access and participation in cervical cancer screening programs are critical to eliminating preventable cervical cancer health inequities.

Latino pediatric patients have a higher prevalence of obesity, but less is known about how factors related to nativity are associated with obesity in youth. We examined the prevalence of childhood and adolescent obesity in primary care over time by nativity status for Latino and non-Hispanic White children. In this serial cross-sectional analysis, we used electronic health records from a multi-state network of community health centers which included data from clinics in 21 US states for patients aged 9 to 17 years from 2012 through 2020 in at least 1 of 4 nonmutually exclusive cross sections. We estimated the adjusted odds and prevalence of having obesity (ie, body mass index [BMI] at the 95th percentile or greater for age and sex) at all encounters during each cross section by ethnicity and nativity status. The sample included a total of 147,376 patients. In the 2012-2013 cross section, 38,697 children and adolescents had at least 1 BMI measurement recorded compared with 72,747 in the 2018-2020 cross section. US-born Latino children had higher odds of having obesity than non-Hispanic White children. Foreign-born Latino and non-Hispanic White children had lower prevalence of obesity in each cross section compared with US-born Latino children (with a range from 20.4% [95% CI, 16.9%-23.8%] to 32.7% [95% CI, 31.6%-33.9%]). Differences in the prevalence of documented childhood and adolescent obesity by nativity status exist in this sample of community health center patients. This demonstrates opportunity for primary care practice to further consider patients' background and culture when providing obesity care and cardiovascular and metabolic disease prevention.

Framing the public health burden of firearm violence should include people with secondary exposure to firearm violence beyond acute bodily injury, yet such data are limited. Electronic health record clinical notes, when leveraged through natural language processing (NLP), are a potential source of data on firearm exposure. As part of NLP lexicon development, diverse stakeholders were engaged to identify keywords, and our findings demonstrated that engaging diverse stakeholders adds valuable input to NLP development.

The risk of cardiovascular outcomes following SARS-CoV-2 infection has been reported in adults, but evidence in children and adolescents is limited. This paper assessed the risk of a multitude of cardiac signs, symptoms, and conditions 28-179 days after infection, with outcomes stratified by the presence of congenital heart defects (CHDs), using electronic health records (EHR) data from 19 children’s hospitals and health institutions from the United States within the RECOVER consortium between March 2020 and September 2023. The cohort included 297,920 SARS-CoV-2-positive individuals and 915,402 SARS-CoV-2-negative controls. Every individual had at least a six-month follow-up after cohort entry. Here we show that children and adolescents with prior SARS-CoV-2 infection are at a statistically significant increased risk of various cardiovascular outcomes, including hypertension, ventricular arrhythmias, myocarditis, heart failure, cardiomyopathy, cardiac arrest, thromboembolism, chest pain, and palpitations, compared to uninfected controls. These findings were consistent among patients with and without CHDs. Awareness of the heightened risk of cardiovascular disorders after SARS-CoV-2 infection can lead to timely referrals, diagnostic evaluations, and management to mitigate long-term cardiovascular complications in children and adolescents.

Background: In October 2018, we implemented electronic health record (EHR) tools for discrete capture of social drivers of health (SDOH).In January 2021 EHR integration of NCCARE360, 1,2 an electronic social care referral platform, encouraged development of systematic workflows for screening and connection of patients with health-related social needs (HRSN) to resources.We have screened 458,434 patients with 80,973 (17.5%) reporting at least one HRSN.However, successfully connecting our patients to resources is much harder.Recognizing multiple barriers to connection including patient, clinic, and community factors, we deployed a centralized social support (CSS) team in December 2022 to play the role of a key connector and focus solely on social needs.Objective: To improve recognition of HRSN and referral of those who want help, we developed clinical decision support at the time of the visit to alert clinicians of the need and facilitate referral to CSS or for higher medical acuity, to care management (CM).Methods: We designed an electronic health record (EHR) practice advisory (PA) to alert clinicians of patients with HRSN who ask for help and refer them to CSS or CM.We analyzed referral numbers before and after implementation in May 2024.We analyzed referral patterns between May 2024 and Dec 2024 in clinical areas that did and did not have PA implemented.We also investigated difference in referral patterns by gender and race/ ethnicity.Results: Since December 2022 until deployment of the BPA, 2420 referrals were made to CSS (average 32/week).Since May 2024, using the Epic advisory dashboard, we can see that the practice advisories have signaled the clinical team on 4340 patients with 1911 (44%) orders to the CSS Team on patients and 623 patients with 286 (13.2%) orders to Duke WELL care management.Referrals to CSS have quadrupled to an average of 120 per week.Using a data retrieval application called slicer dicer in our EHR (Epic of Verona, WI), we filtered on completed visits and certain encounter types excluding telephone and telemedicine, filtered on patients with HRSN in 4 domains who requested help and then sorted by whether PA was shown or not.In this way we can review orders to CSS and CM based on whether PA was shown or not.Referrals increases approximately 3 fold.Conclusion: Clinical decision support can help alert clinicians of patients' social needs and guide them to a support team.Addressing HRSN, the burden of which disproportionately affects Black, Latinx, and Indigenous people is one step to improve health equity.

Background/Objectives: Information is lacking about how trimester-specific gestational weight gain (GWG) is associated with childhood body mass index (BMI) across maternal BMI categories. Subjects/Methods: We examined the association between GWG and child BMI in patients served by a national network of community health care organizations. We stratified by pre-pregnancy BMI (n=5721 normal weight; 5667 overweight; 3213 obesity class I; 1344 class II; 692 class III). Child BMI z-score and overweight and obesity status at age 5 were modeled as a function of total GWG and GWG rate in each trimester, controlling for GWG rate in previous trimester(s) and maternal characteristics, using modified Poisson regression. Results: Higher total GWG during pregnancy was positively associated with child BMI at 5 years of age in a linear, dose-dependent manner. When examined by trimester of pregnancy, a 1 kg/week in the first trimester was associated with a 0.24 to 0.42 increase in child BMI z-score. The same increase in the second trimester was associated with a 0.30 to 0.53 increase in child BMI z-score, although the associations were not significant in class II and III obesity classes. Associations between GWG in the third trimester and child BMI z-score were weak (0.12 to 0.21 increase in BMI z-score per kg/week increase in maternal weight) and not significant. Conclusion: Among a diverse and underserved pregnant population, GWG in the 1 st and 2 nd trimesters are most strongly associated with child BMI at age 5. Early pregnancy and mid-pregnancy may be key times to intervene to prevent overweight and obesity in offspring.