| Submitted By: Julia Skapik
/ NACHC
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| Data Element Information |
| Use Case Description(s) |
| Use Case Description |
The evaluation of social determinants of health (SDOH) are primary components in the care of patients with social risk factors that can impact their ability to participate in or successfully access health care. Lack of nutrition is the cause of or a contributor to many chronic medical conditions. All federally qualified health centers (FQHCs) gather data about material security with a specific focus on food insecurity in order to identify barriers to health and wellness and to provide opportunities to improve the patient's well-being through social interventions and enabling services.
Why Is Food Security Important?
Material security encompasses both presence of resource and presence of skills and knowledge to manage resources. It is common in households that have material insecurity that patients must make tradeoffs to meet their needs. For example, they may choose not to fill a prescription in order to put food on the table. Overall, material security has been linked to many disparities and has a validated relationship with forgoing care and with cost outcomes.
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.0645
Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. The literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes.
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| Estimate the breadth of applicability of the use case(s) for this data element
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All federally qualified health centers (FQHCs) gather data about material security with a specific focus on food insecurity. This encompasses in 2019 29 million patients at 1400+ FQHCs with more than 13000 health care delivery sites. The evaluation of social determinants of health, however, should be considered a required component of a patient-centered, value-based approach to care and therefore should be potentially relevant for any patient or care setting. |
| Link to use case project page |
https://www.nachc.org/research-and-data/prapare/about-the-prapare-assessment-tool/ |
| Supporting Attachments |
NACHC_PRAPARE_ALL-Updated-8.24.20.pdf
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| Healthcare Aims |
- Improving patient experience of care (quality and/or satisfaction)
- Improving the health of populations
- Reducing the cost of care
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| Maturity of Use and Technical Specifications for Data Element |
| Applicable Standard(s) |
LOINC 93031-3
In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?
https://www.nachc.org/research-and-data/prapare/about-the-prapare-assessment-tool/
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| Additional Specifications |
See attachment |
| Current Use |
This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders |
| Supporting Artifacts |
The PRAPARE tool is implemented in all 50 states and in all major EHR vendors that support outpatient care at FQHCs. Academic research has been published on the findings in a nationwide survey. It is the most commonly used tool across FQHCs.
https://muse.jhu.edu/article/756691
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| Extent of exchange
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5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders. |
| Supporting Artifacts |
Commercial vendors including Aunt Bertha, UNITEUS and NowPow consume PRAPARE data and use it to link individual patients to social interventions.
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| Potential Challenges |
| Restrictions on Standardization (e.g. proprietary code) |
No restriction on the use of the code. |
| Restrictions on Use (e.g. licensing, user fees) |
The PRAPARE tool itself is freely available for use. The only restrictions on its use are for the purpose of commercialization, which includes a relatively low, one time licensing fee to support the tool's maintenance. |
| Privacy and Security Concerns |
This data should be in the context of a private and secure EHR or other social service record. There are no additional risk factors associated with the element outside of its inclusion with PHI. |
| Estimate of Overall Burden |
Burden is equal to any single data element in a system that does not support it; however, most outpatient vendors do support the concept of food insecurity. |
| Other Implementation Challenges |
As with many common data elements, challenges arise in incorporating these data into the workflow of clinical users and care teams. Teams have reported that the capture of this data is sometimes challenging to link to the needed services. |
Official Website of The Office of the National Coordinator for Health Information Technology (ONC)
Submitted by RUy on
Health Care Access Insecurity as SDOH data element in USCDI/ISA
NACHC would like to resupport this data element for consideration / inclusion to USCDIv3.
All federally qualified health centers (FQHCs) gather SDOH data, which includes a focus on this data element through the PRAPARE screening tool. This data is relevant to and encompasses in 2019 29 million patients at 1400+ FQHCs with more than 13000 health care delivery sites.
If this data element is not considered for addition to USCDI, we would like to comment on it's addition to ISA as a coded data element under SDOH, with applicable standards and representation accross ICD-10-CM, SNOMED-CT and LOINC.
Please see attached document supporting this.