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Sciaska Ulysse

Pronouns

Job Title

Research Assistant

Academic Rank

Department

Authors

Sciaska N. Ulysse, Mia Chandler, Leah Santacroce, Tianrun Cai, Katherine P. Liao, Candace H. Feldman

Principal Investigator

Dr. Candace Feldman

Research Category: Musculoskeletal/Orthopedics/Sports Medicine

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Documentation of Social Determinants of Health Among Individuals with Systemic Rheumatic and Musculoskeletal Diseases

Scientific Abstract

Social determinants of health (SDoH) are structural, environmental, social, and economic factors that contribute to health inequities. We assessed the documentation of SDoH in the electronic medical records (EMRs) among individuals with rheumatic conditions enrolled in the MGB integrated care management program (iCMP). We randomly selected 383 patients (≥18 years) among 20,395 iCMP enrollees and two reviewers extracted terms from the EMR concerning financial insecurity, food insecurity, housing instability, access to transportation, education, childcare, and access to medications. The mean (SD) age was 72.2 (13.4) years, 61% were female, 79% were White, 10% were Black, and 80% were non-Hispanic. Overall, 105 individuals (27%) had financial needs, 77 (20%) transportation needs, 63 (16%) food insecurity, 18 (5%) housing instability, and 21 (5%) medication access challenges. Individuals with osteoarthritis had slightly higher burden of SDoH needs (46%) compared to systemic rheumatic conditions (27%) and crystalline arthritis (27%). In a multivariable regression model, the odds of having ≥1 SDoH need was 2.85 times higher (95% CI 1.28-6.80) for Black vs. White individuals and 3.44 times higher (95% CI 1.17-10.19) for Medicaid vs. Commercial insurance beneficiaries. This study justifies SDoH assessment among individuals with rheumatic conditions.

Lay Abstract

Social determinants of health (SDoH), the conditions in which people are born, grow, work, live, and age, play a role in health inequities. To understand the documentation of SDoH-related needs, we studied patient charts with rheumatic conditions enrolled in an integrated care management program (iCMP). After randomly selecting 401 charts among 20,395 adults (≥18 years), we performed an intensive chart review to extract terms and sentences concerning financial insecurity, food insecurity, housing instability, access to transportation, education, childcare, access to medications, and medication adherence. We found among 383 patients (18 patients were excluded due to insufficient electronic medical record data), the mean (SD) age was 72.2 (13.4) years, 61% were female, 79% were White, 10% were Black, and 80% were non-Hispanic. Overall, 105 individuals (27%) had evidence of financial needs, 77 (20%) transportation needs, 63 (16%) food insecurity, 18 (5%) housing instability, and 21 (5%) medication access challenges, with variation by rheumatic condition. In the multivariable model, the odds of having ≥1 SDoH need was 2.85 times higher (95% CI 1.28-6.80) for Black vs. White individuals and 3.44 times higher (95% CI 1.17-10.19) for Medicaid vs. Commercial insurance beneficiaries. This study provides justification for SDoH documentation in all specialties.

Clinical Implications

Nearly half of this population of complex care patients with rheumatic conditions had SDoH needs documented in EMR notes. Further efforts are needed to incorporate SDoH screening into routine rheumatology care and to develop standardized strategies to extract these data.