The ADVANCE network: accelerating data value across a national community health center network

DeVoe, Jennifer E.; Gold, Rachel; Cottrell, Erika; Bauer, Vance; Brickman, Andrew L.; Puro, Jon; Nelson, Christine A.; Mayer, Kenneth H.; Sears, Abigail; Burdick, Tim; Merrell, Jonathan; Matthews, P.; Fields, Scott

doi:10.1136/amiajnl-2014-002744

Cited by 90 publications

(77 citation statements)

References 25 publications

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“…Using funding from the Patient-Centered Outcomes Research Institute, these partners are testing integration of community VS data into the EHR data warehouse of the ADVANCE (Accelerating Data Value Across a National Community Health Center Network) Clinical Data Research Network of PCORnet, a national Patient-Centered Outcomes Research Institute-funded network for conducting patientcentered outcomes research. 17 The linkage of these data at the population level will enhance PCORnet's comparative effectiveness research efforts. In the future this data system could also support practicelevel access to the linked clinical and community VS data through EHRs, allowing providers and administrators a greater ability to target chronic disease interventions for both individual patients and the communities in which they live.…”

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confidence: 99%

Community Vital Signs: Taking the Pulse of the Community While Caring for Patients

Hughes

Phillips

DeVoe

et al. 2016

The Journal of the American Board of Family Medicine

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In 2014 both the Institute of Medicine and the National Quality Forum recommended the inclusion of social determinants of health data in electronic health records (EHRs). Both entities primarily focus on collecting socioeconomic and health behavior data directly from individual patients. The burden of reliably, accurately, and consistently collecting such information is substantial, and it may take several years before a primary care team has actionable data available in its EHR. A more reliable and less burdensome approach to integrating clinical and social determinant data exists and is technologically feasible now. Community vital signs-aggregated community-level information about the neighborhoods in which our patients live, learn, work, and play-convey contextual social deprivation and associated chronic disease risks based on where patients live. Given widespread access to "big data" and geospatial technologies, community vital signs can be created by linking aggregated population health data with patient addresses in EHRs. These linked data, once imported into EHRs, are a readily available resource to help primary care practices understand the context in which their patients reside and achieve important health goals at the patient, population, and policy levels.

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confidence: 99%

Community Vital Signs: Taking the Pulse of the Community While Caring for Patients

Hughes

Phillips

DeVoe

et al. 2016

The Journal of the American Board of Family Medicine

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“…The ADVANCE data warehouse has been described previously (DeVoe et al, 2014). Briefly, these systems have outpatient clinical data from >100 Federally-Qualified Health Center (FQHC) health systems with 974 clinics serving >2 million safety net patients in 22 states (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…Yet the handful of existing EHR-based perinatal and pediatric research datasets (Hillier et al, 2008; Koebnick et al, 2012; Vesco et al, 2011) are comprised predominately of insured health system members, and thus underrepresent socioeconomically disadvantaged populations. The growth of EHR data from community health centers serving safety net (publicly insured and uninsured) patients (DeVoe et al, 2014) thus has great potential for enhancing early life obesity research in socially vulnerable children.…”

Section: Introductionmentioning

confidence: 99%

Characterizing a “Big Data” Cohort of Over 200,000 Low-Income U.S. Infants and Children for Obesity Research: The ADVANCE Early Life Cohort

Boone‐Heinonen

Tillotson

O’Malley

et al. 2017

Matern Child Health J

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Introduction Low-income populations have elevated exposure to early life risk factors for obesity, but are understudied in longitudinal research. Our objective was to assess the utility of a cohort derived from electronic health record data from safety net clinics for investigation of obesity emerging in early life. Methods We examined data from the PCORNet ADVANCE Clinical Data Research Network, a national network of Federally-Qualified Health Centers serving >1.7 million safety net patients across the US. This cohort includes patients who, in 2012–2014, had ≥1 valid Body Mass Index measure when they were 0–5 years of age. We characterized the cohort with respect to factors required for early life obesity research in vulnerable subgroups: sociodemographic diversity, weight status based on World Health Organization (<2 years) or Centers for Disease Control (≥2 years) growth curves, and data longitudinality. Results The cohort includes 216,473 children and is racially/ethnically diverse (e.g., 17.9% Black, 45.4% Hispanic). A majority (56.9%) had family incomes below the Federal Poverty Level (FPL); 32% were <50% of FPL. Among children <2 years, 7.6% and 5.3% had high and low weight-for-length, respectively. Among children 2–5 years, 15.0%, 12.7%, and 2.4% were overweight, obese, and severely obese, respectively; 5.3% were underweight. In the study period, 79.1% of children had ≥2 BMI measures. Among 4–5 year olds, 21.9% had >1 BMI measure when they were <2 years. Discussion The ADVANCE Early Life cohort offers unique opportunities to investigate early life determinants of obesity in the understudied population of low income and minority children.

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“…The study CHCs were members of OCHIN, Inc., a non-profit organization that provides health information technology, including an EpicCare© electronic health record (EHR), to CHCs [20, 21]. All OCHIN member clinics share one instance of the EpicCare EHR with a single master patient index, managed by OCHIN.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular care guideline implementation in community health centers in Oregon: a mixed-methods analysis of real-world barriers and challenges

Gold

Bunce

Cowburn

et al. 2017

BMC Health Serv Res

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BackgroundSpreading effective, guideline-based cardioprotective care quality improvement strategies between healthcare settings could yield great benefits, particularly in under-resourced contexts. Understanding the diverse factors facilitating or impeding such guideline implementation could improve cardiovascular care quality and outcomes for vulnerable patients.MethodsWe sought to identify multi-level factors affecting uptake of cardioprotective care guidelines in community health centers (CHCs), within a successful trial of cross-setting implementation of an effective intervention. Quantitative analyses used multivariable logistic regression to examine in-person patient encounters at 10 CHCs from June 2011-May 2014. At these encounters, a point-of-care alert flagged adults with diabetes who were clinically indicated for, but not currently prescribed, cardioprotective medications. The main outcome measure was the rate of relevant prescriptions issued within two days of encounters. Qualitative analyses focused on CHC providers and staff, and, guided by the constant comparative method, were used to enhance understanding of the factors that influenced this prescribing.ResultsRecommended prescribing occurred at 13–16% of encounters with patients who were indicated for such prescribing. The odds of this prescribing were higher when the patient was male, had HbA1c ≥7, was previously prescribed a similar medication, gave diabetes as the chief complaint, saw a mid-level practitioner, or saw their primary care provider. The odds were lower when the patient was insured, had ≥1 clinic visits in the past year, had kidney disease, or was prescribed certain other medications. Additional factors were associated with prescribing of each medication class. Qualitative results both supported and challenged the quantitative findings, illustrating important tensions involved in guideline-based prescribing. Clinic staff stressed the importance of the provider-patient relationship in guiding prescribing decisions in the face of competing priorities and care needs, and the impact of rapidly changing guidelines.ConclusionsDiverse factors associated with guideline-concordant prescribing illuminate the complexity of delivering evidence-based care in CHCs. We present possible strategies for addressing barriers to guideline-based prescribing.Clinical trials registrationThis trial was registered retrospectively.Currently Controlled Trials NCT02299791. Retrospectively registered 10 November 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2194-3) contains supplementary material, which is available to authorized users.

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The ADVANCE network: accelerating data value across a national community health center network

Cited by 90 publications

References 25 publications

Community Vital Signs: Taking the Pulse of the Community While Caring for Patients

Community Vital Signs: Taking the Pulse of the Community While Caring for Patients

Characterizing a “Big Data” Cohort of Over 200,000 Low-Income U.S. Infants and Children for Obesity Research: The ADVANCE Early Life Cohort

Cardiovascular care guideline implementation in community health centers in Oregon: a mixed-methods analysis of real-world barriers and challenges

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