{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T01:54:03Z","timestamp":1790560443371,"version":"4.1.0"},"reference-count":39,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Population Health Management"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>\n                    As the US health care system moves to expand access to and quality of medical care, the importance of addressing patient-level social needs and community-level social determinants of health (SDOH) is increasingly being recognized. This study evaluates individual- and community-level needs of housing (one of the SDOH domains) across the patient population of an academic medical center and explores how the level of housing needs impacts health care utilization. The authors performed a descriptive analysis of housing issues identified in both structured and unstructured (eg, clinical notes) data extracted from the electronic health record (EHR) and compared this to community-level characteristics of patients' neighborhood as measured by the Area Deprivation Index. Multivariate analyses were performed to assess the association between these and other factors on the frequency of service encounters. Among the 1,034,683 study participants, 59,703 (5.8%) had at least 1 housing issue identified in their EHR from structured or unstructured data combined. After adjusting for other factors, patients with housing instability and homelessness had 49% and 34% more encounters with the health care system compared to patients without housing issues (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u20090.00001). Patients living in the most disadvantaged neighborhoods had 55% more encounters with the health care system compared to those living in the most advantaged neighborhoods (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u20090.00001). This data collection approach and findings can inform health care systems aiming to make use of their EHRs and community-level SDOH information to provide a full assessment of patients' social needs and challenges.\n                  <\/jats:p>","DOI":"10.1089\/pop.2020.0043","type":"journal-article","created":{"date-parts":[[2020,6,29]],"date-time":"2020-06-29T12:23:55Z","timestamp":1593433435000},"page":"222-230","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":83,"title":["Assessing the Impact of Social Needs and Social Determinants of Health on Health Care Utilization: Using Patient- and Community-Level Data"],"prefix":"10.1177","volume":"24","author":[{"given":"Elham","family":"Hatef","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA."},{"name":"Department of Health Policy and Management at Bloomberg School of Public Health, Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomeng","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoud","family":"Rouhizadeh","sequence":"additional","affiliation":[{"name":"Center for Clinical Data Analysis, Institute for Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurmehar","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan P.","family":"Weiner","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadi","family":"Kharrazi","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA."},{"name":"Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,4,9]]},"reference":[{"key":"e_1_3_5_2_2","unstructured":"Castrucci B Auerbach J. Meeting individual social needs falls short of addressing social determinants of health. 2019. https:\/\/www.healthaffairs.org\/do\/10.1377\/hblog20190115.234942\/full\/ Accessed January21 2020."},{"key":"e_1_3_5_3_2","first-page":"262","article-title":"Budget impact of a comprehensive nutrition-focused quality improvement program for malnourished hospitalized patients","volume":"10","author":"Sulo S","year":"2017","unstructured":"Sulo S, , Feldstein J, , Partridge J, , Schwander B, , Sriram K, , Summerfelt WT. Budget impact of a comprehensive nutrition-focused quality improvement program for malnourished hospitalized patients. Am Health Drug Benefits, 2017; 10:262\u2013270.","journal-title":"Am Health Drug Benefits"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2017.0199"},{"key":"e_1_3_5_5_2","unstructured":"Centers for Disease Control and Prevention; Office of the Associate Director for Policy and Strategy. The HI-5 Interventions. 2016. https:\/\/www.cdc.gov\/policy\/hst\/hi5\/interventions\/index.html Accessed January21 2020."},{"key":"e_1_3_5_6_2","unstructured":"de Beaumont Foundation and Kaiser Permanente. cityhealth website. https:\/\/www.cityhealth.org Accessed January21 2020."},{"key":"e_1_3_5_7_2","unstructured":"Azar AM . The Root of the Problem: America's Social Determinants of Health Hatch Foundation for Civility and Solutions. 2018. https:\/\/www.hhs.gov\/about\/leadership\/secretary\/speeches\/2018-speeches\/the-root-of-the-problem-americas-social-determinants-of-health.html Accessed January21 2020."},{"key":"e_1_3_5_8_2","unstructured":"Institute of Medicine. Capturing social and behavioral domains and measures in electronic health records: phase 2. Washington DC: National Academies Press 2014."},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4226"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13244"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000436"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.0393"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.561"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2012.01449.x"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2016.09.029"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-5-29"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1080\/21551197.2016.1200334"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-012-2176-4"},{"key":"e_1_3_5_19_2","unstructured":"The United States Census Bureau. American Community Survey (ACS). https:\/\/www.census.gov\/programs-surveys\/acs\/ Accessed January21 2020."},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.2196\/13802"},{"key":"e_1_3_5_21_2","unstructured":"Arons A DeSilvey S Fichtenberg C Gottlieb L. Compendium of medical terminology codes for social risk factors. 2018. https:\/\/sirenetwork.ucsf.edu\/tools-resources\/mmi\/compendium-medical-terminology-codes-social-risk-factors Accessed January21 2020."},{"key":"e_1_3_5_22_2","first-page":"221","article-title":"Enrich classifications in psychiatry with textual data: an ontology for psychiatry including social concepts","volume":"210","author":"Richard M","year":"2015","unstructured":"Richard M, , Aim\u00e9 X, , Krebs MO, , Charlet J. Enrich classifications in psychiatry with textual data: an ontology for psychiatry including social concepts. Stud Health Technol Inform, 2015; 210:221\u2013223.","journal-title":"Stud Health Technol Inform"},{"key":"e_1_3_5_23_2","unstructured":"National Association of Community Health Centers . The Protocol for Responding to and Assessing Patients' Assets Risks and Experiences (PRAPARE). www.nachc.org\/research-and-data\/prapare\/ Accessed January21 2020."},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15411"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.93.7.1137"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_3_5_27_2","unstructured":"The R Foundation for Statistical Computing. The R project for statistical computing. www.r-project.org Accessed January21 2020."},{"key":"e_1_3_5_28_2","first-page":"2","article-title":"Integrating social determinants of health into primary care clinical and informational workflow during care transitions","volume":"5","author":"Hewner S","year":"2019","unstructured":"Hewner S, , Casucci S, , Sullivan S, et al. Integrating social determinants of health into primary care clinical and informational workflow during care transitions. EGEMS (Wash DC), 2019; 5:2.","journal-title":"EGEMS (Wash DC)"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2018.12.012"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2017.09.008"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2014.07.009"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-1849"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2017.04.170046"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2275"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-0549"},{"key":"e_1_3_5_36_2","unstructured":"National Academies of Sciences Engineering and Medicine. Integrating social care into the delivery of health care: moving upstream to improve the nation's health. Washington DC: National Academies Press 2019."},{"key":"e_1_3_5_37_2","first-page":"236","article-title":"Evaluation of flowsheet documentation in the electronic health record for residence, living situation, and living conditions","volume":"2018","author":"Winden TJ","year":"2018","unstructured":"Winden TJ, , Chen ES, , Monsen KA, , Wang Y, , Melton GB. Evaluation of flowsheet documentation in the electronic health record for residence, living situation, and living conditions. AMIA Jt Summits Transl Sci Proc, 2018; 2018:236\u2013245.","journal-title":"AMIA Jt Summits Transl Sci Proc"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12670"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6617e1"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.2716"}],"container-title":["Population Health Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/pop.2020.0043","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/pop.2020.0043","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/pop.2020.0043","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T01:24:38Z","timestamp":1777685078000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/pop.2020.0043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1089\/pop.2020.0043"],"URL":"https:\/\/doi.org\/10.1089\/pop.2020.0043","relation":{},"ISSN":["1942-7891","1942-7905"],"issn-type":[{"value":"1942-7891","type":"print"},{"value":"1942-7905","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}