Association of Disparities in Family History and Family Cancer History in the Electronic Health Record With Sex, Race, Hispanic or Latino Ethnicity, and Language Preference in 2 Large US Health Care Systems.
Association of Disparities in Family History and Family Cancer History in the Electronic Health Record With Sex, Race, Hispanic or Latino Ethnicity, and Language Preference in 2 Large US Health Care Systems.
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DOI：
10.1001/jamanetworkopen.2022.34574
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发表时间：
2022-10-03
影响因子：
13.8
通讯作者：
Kaphingst, Kimberly A.
中科院分区：
文献类型：
--
作者：
Chavez-Yenter, Daniel;Goodman, Melody S.;Chen, Yuyu;Chu, Xiangying;Bradshaw, Richard L.;Chambers, Rachelle Lorenz;Chan, Priscilla A.;Daly, Brianne M.;Flynn, Michael;Gammon, Amanda;Hess, Rachel;Kessler, Cecelia;Kohlmann, Wendy K.;Mann, Devin M.;Monahan, Rachel;Peel, Sara;Kawamoto, Kensaku;Del Fiol, Guilherme;Sigireddi, Meenakshi;Buys, Saundra S.;Ginsburg, Ophira;Kaphingst, Kimberly A.
电子健康记录（EHR）中家族史信息的可用性和全面性如何？这些信息与临床决策支持算法有何关联？在这项EHR质量改进研究中，包括522 105名初级保健患者，发现基于性别，种族和民族以及语言偏好的家族史可用性和全面性存在显着差异。这些研究结果表明，在历史上医疗服务不足的群体中，患者被排除在依赖于家族史输入的临床决策支持工具的识别之外，这可能进一步加剧或产生新的医疗保健差异。这项质量改进研究检查了美国2个大型医疗保健系统中电子健康记录数据中性别、种族和民族以及语言偏好的癌症家族史信息的可用性和全面性的差异。临床决策支持（CDS）算法越来越多地在医疗保健系统中实施，以识别需要专科护理的患者。然而，系统的差异，在电子健康记录（EHR）数据的缺失可能会导致差异识别的CDS算法。研究2021年2个大型医疗保健系统中按性别、种族、西班牙裔或拉丁裔以及语言偏好分类的患者EHR中癌症家族史信息（FHI）的可用性和全面性。这项回顾性EHR质量改进研究使用了来自2个医疗保健系统的EHR数据：犹他州大学健康（UHealth）和纽约大学Langone健康（NYULH）。参与者包括年龄在25至60岁之间的患者，他们在过去3年中有过初级保健预约。数据收集或提取自2020年12月10日至2021年10月31日的EHR，并于2021年6月15日至10月31日进行分析。在初级保健环境中预先收集癌症FHI。可用性定义为在EHR中具有任何FHI和任何癌症FHI，并在患者水平上进行检查。全面性定义为EHR中的癌症家族史观察是否指定了家庭成员诊断的癌症类型，家庭成员与患者的关系以及家庭成员的发病年龄，并在观察水平上进行检查。在UHealth系统的144484名患者中，53.6%为女性; 74.4%为非西班牙裔或非拉丁裔，67.6%为白色; 83.0%的人偏好英语。在NYULH系统的377 621例患者中，55.3%为女性; 63.2%为非西班牙裔或非拉丁裔，55.3%为白色; 89.9%偏好英语。患者来自历史医学上不合理的人群-特别是黑人vs白色患者（UHealth：17.3% [95% CI，16.1%-18.6%] vs 42.8% [95% CI，42.5%-43.1%]; NYULH：24.4% [95% CI，24.0%-24.8%] vs 33.8% [95% CI，33.6%-34.0%]），西班牙裔或拉丁裔vs非西班牙裔或非拉丁裔患者（UHealth：27.2% [95% CI，26.5%-27.8%] vs 40.2% [95% CI，39.9%-40.5%]; NYULH：24.4% [95% CI，24.1%-24.7%] vs 31.6% [95% CI，31.4%-31.8%]），西班牙语vs英语患者（UHealth：18.4% [95% CI，17.2%-19.1%] vs 40.0% [95% CI，39.7%-40.3%]; NYULH：15.1% [95% CI，14.6%-15.6%] vs 31.1% [95% CI，30.9%-31.2%），男性vs女性（UHealth：30.8% [95% CI，30.4%-31.2%] vs 43.0% [95% CI，42.6%-43.3%]; NYULH：23.1% [95%CI，22.9%-23.3%] vs 34.9% [95%CI，34.7%-35.1%]）-癌症FHI的可用性和全面性显著较低（P < .001）。这些研究结果表明，系统性差异的可用性和全面性的FHI在EHR可能会引入信息存在偏见输入CDS算法。观察到的差异也可能加剧医疗服务不足群体的差距。需要系统、临床医生和患者层面的努力来改善FHI的收集。
What is the availability and comprehensiveness of family history information in electronic health records (EHRs) and how are these associated with clinical decision support algorithms? In this EHR quality improvement study that included 522 105 primary care patients, significant differences were found in family history availability and comprehensiveness based on sex, race and ethnicity, and language preference. These findings suggest inadvertent exclusion of patients in historically medically underserved groups from identification by clinical decision support tools that depend on family history input, potentially further exacerbating or creating new health care disparities. This quality improvement study examines disparities in the availability and comprehensiveness of cancer family history information by sex, race and ethnicity, and language preference in electronic health record data in 2 large US health care systems. Clinical decision support (CDS) algorithms are increasingly being implemented in health care systems to identify patients for specialty care. However, systematic differences in missingness of electronic health record (EHR) data may lead to disparities in identification by CDS algorithms. To examine the availability and comprehensiveness of cancer family history information (FHI) in patients’ EHRs by sex, race, Hispanic or Latino ethnicity, and language preference in 2 large health care systems in 2021. This retrospective EHR quality improvement study used EHR data from 2 health care systems: University of Utah Health (UHealth) and NYU Langone Health (NYULH). Participants included patients aged 25 to 60 years who had a primary care appointment in the previous 3 years. Data were collected or abstracted from the EHR from December 10, 2020, to October 31, 2021, and analyzed from June 15 to October 31, 2021. Prior collection of cancer FHI in primary care settings. Availability was defined as having any FHI and any cancer FHI in the EHR and was examined at the patient level. Comprehensiveness was defined as whether a cancer family history observation in the EHR specified the type of cancer diagnosed in a family member, the relationship of the family member to the patient, and the age at onset for the family member and was examined at the observation level. Among 144 484 patients in the UHealth system, 53.6% were women; 74.4% were non-Hispanic or non-Latino and 67.6% were White; and 83.0% had an English language preference. Among 377 621 patients in the NYULH system, 55.3% were women; 63.2% were non-Hispanic or non-Latino, and 55.3% were White; and 89.9% had an English language preference. Patients from historically medically undeserved groups—specifically, Black vs White patients (UHealth: 17.3% [95% CI, 16.1%-18.6%] vs 42.8% [95% CI, 42.5%-43.1%]; NYULH: 24.4% [95% CI, 24.0%-24.8%] vs 33.8% [95% CI, 33.6%-34.0%]), Hispanic or Latino vs non-Hispanic or non-Latino patients (UHealth: 27.2% [95% CI, 26.5%-27.8%] vs 40.2% [95% CI, 39.9%-40.5%]; NYULH: 24.4% [95% CI, 24.1%-24.7%] vs 31.6% [95% CI, 31.4%-31.8%]), Spanish-speaking vs English-speaking patients (UHealth: 18.4% [95% CI, 17.2%-19.1%] vs 40.0% [95% CI, 39.7%-40.3%]; NYULH: 15.1% [95% CI, 14.6%-15.6%] vs 31.1% [95% CI, 30.9%-31.2%), and men vs women (UHealth: 30.8% [95% CI, 30.4%-31.2%] vs 43.0% [95% CI, 42.6%-43.3%]; NYULH: 23.1% [95% CI, 22.9%-23.3%] vs 34.9% [95% CI, 34.7%-35.1%])—had significantly lower availability and comprehensiveness of cancer FHI (P < .001). These findings suggest that systematic differences in the availability and comprehensiveness of FHI in the EHR may introduce informative presence bias as inputs to CDS algorithms. The observed differences may also exacerbate disparities for medically underserved groups. System-, clinician-, and patient-level efforts are needed to improve the collection of FHI.
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影响因子：
8.8
作者：
Frezzo, TM;Rubinstein, WS;Ormond, KE
通讯作者：
Ormond, KE
影响因子：
2.2
作者：
Edwards, E.;Lucassen, A.
通讯作者：
Lucassen, A.
影响因子：
4.2
作者：
Del Fiol, Guilherme;Kohlmann, Wendy;Kawamoto, Kensaku
通讯作者：
Kawamoto, Kensaku
影响因子：
5.7
作者：
Chapman-Davis, Eloise;Zhou, Zhen Ni;Holcomb, Kevin M.
通讯作者：
Holcomb, Kevin M.
DOI：
10.3390/ijerph16244979
发表时间：
2019-12-02
影响因子：
--
作者：
Diez, Maria Cerda;Cortes, Dharma E.;Wang, Catharine
通讯作者：
Wang, Catharine