Using Electronic Health Records to understand the population of local children captured in a large health system in Durham County, NC, USA, and implications for population health research

Allison Stolte; M Giovanna Merli; Jillian H Hurst; Yaxing Liu; Charles T Wood; Benjamin A Goldstein

doi:10.1016/j.socscimed.2022.114759

Using Electronic Health Records to understand the population of local children captured in a large health system in Durham County, NC, USA, and implications for population health research

Soc Sci Med. 2022 Mar:296:114759. doi: 10.1016/j.socscimed.2022.114759. Epub 2022 Jan 29.

Authors

Allison Stolte¹, M Giovanna Merli², Jillian H Hurst³, Yaxing Liu⁴, Charles T Wood⁵, Benjamin A Goldstein⁶

Affiliations

¹ Department of Sociology, Duke University, Durham, NC, USA; Duke Population Research Institute, Duke University, Durham, NC, USA. Electronic address: allison.stolte@duke.edu.
² Duke Population Research Institute, Duke University, Durham, NC, USA; Sanford School of Public Policy, Duke University, Durham, NC, USA.
³ Duke Children's Health and Discovery Initiative, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA; Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
⁴ Office of Academic Solutions and Information Systems, Duke University School of Medicine, Durham, NC, USA.
⁵ Division of Primary Care Pediatrics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
⁶ Duke Children's Health and Discovery Initiative, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA.

Abstract

Although local policies aimed at reducing childhood health inequities can benefit from local data, sample size constraints in population representative health surveys often prevent rigorous evaluations of child health disparities and health care patterns at local levels. Electronic Health Records (EHRs) offer a possible solution as they contain large amounts of information on pediatric patients within a health system. In this paper, we consider the suitability of using EHRs from a large health system to study local children's health by evaluating the extent to which the EHRs capture the county's child population. First, we compare the demographic characteristics of Duke University Health System pediatric patients who live in Durham County, NC (USA) to the child population estimates in the 2015-2019 American Community Survey. We then examine geographic variation in census tract rates of children captured in the EHR data and estimate negative binomial models to assess how tract characteristics are associated with these rates. We also perform these analyses for the subset of pediatric patients who have a well-child encounter. We find that the demographic characteristics of pediatric patients captured by the EHRs are similar to those of the county's child population. Although the county rate of children captured in the EHRs is high, there is variation across census tracts. On average, census tracts with higher concentrations of non-Hispanic Black residents have lower capture rates and tracts with higher concentrations of poverty have higher capture rates, with the poorest tracts showing the largest racial gap in rates of children captured by EHRs. Our findings suggest that EHRs from a large health system can be used to assess children's population health, but that EHR-based evaluations of children's health disparities and health care patterns should account for differences in who is captured by the EHRs based on census tract characteristics.

Keywords: Children's health; Electronic health records; Health systems; Neighborhoods.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Child
Electronic Health Records*
Humans
Medical Assistance
Population Health*
Poverty
Racial Groups

Grants and funding

P2C HD065563/HD/NICHD NIH HHS/United States