Arwen Bunce
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View article: Help us document what we already do: pilot study of clinical decision support tools targeting social risk-informed care
Help us document what we already do: pilot study of clinical decision support tools targeting social risk-informed care Open
Objective Little is known about how clinical decision support (CDS) tools can support care teams in changing clinical decisions to account for patients’ social risks. We piloted a suite of electronic health record (EHR)-based CDS tools des…
View article: “The start of something that I hope could be greater”: Health information technology tools for social care
“The start of something that I hope could be greater”: Health information technology tools for social care Open
Federal policies and professional guidelines in the United States increasingly encourage and incentivize health systems to collect and meaningfully respond to patients' social risks. In response, many health systems employ health informati…
View article: Applying Realist Retroduction to EHR-Based Clinical Decision Support Tool Development
Applying Realist Retroduction to EHR-Based Clinical Decision Support Tool Development Open
The application of realist-informed approaches to implementation research can produce answers to why, for whom and under what circumstances social determinants of health interventions work. In the context of a study to develop and test EHR…
View article: Finding meaning: a realist-informed perspective on social risk screening and relationships as mechanisms of change
Finding meaning: a realist-informed perspective on social risk screening and relationships as mechanisms of change Open
Background Social risk screening rates in many US primary care settings remain low. This realist-informed evaluation explored the mechanisms through which a tailored coaching and technical training intervention impacted social risk screeni…
View article: Implementation Support for a Social Risk Screening and Referral Process in Community Health Centers
Implementation Support for a Social Risk Screening and Referral Process in Community Health Centers Open
Evidence is needed about how to effectively support health care providers in implementing screening for social risks (adverse social determinants of health) and providing related referrals meant to address identified social risks. This nee…
View article: Patient-Reported Social Risks and Clinician Decision Making: Results of a Clinician Survey in Primary Care Community Health Centers
Patient-Reported Social Risks and Clinician Decision Making: Results of a Clinician Survey in Primary Care Community Health Centers Open
Electronic health records present an opportunity to support clinicians integrating information about patients' social and economic circumstances into care planning. Study findings suggest that SDOH information from standardized screening d…
View article: Partner-developed electronic health record tools to facilitate social risk-informed care planning
Partner-developed electronic health record tools to facilitate social risk-informed care planning Open
Objective Increased social risk data collection in health care settings presents new opportunities to apply this information to improve patient outcomes. Clinical decision support (CDS) tools can support these applications. We conducted a …
View article: Designing and Implementing an Electronic Health Record–Embedded Card Study in Primary Care: Methods and Considerations
Designing and Implementing an Electronic Health Record–Embedded Card Study in Primary Care: Methods and Considerations Open
Card studies-short surveys about the circumstances within which patients receive care-are traditionally completed on physical cards. We report on the development of an electronic health record (EHR)-embedded card study intended to decrease…
View article: Melding Multiple Sources of Knowledge: Using Theory and Experiential Knowledge to Design a Community Health Intervention Study
Melding Multiple Sources of Knowledge: Using Theory and Experiential Knowledge to Design a Community Health Intervention Study Open
Although Community-Based Participatory Research (CBPR) is grounded in socioecological theories of health, using and addressing theory in CBPR can be challenging. This paper explores how theory was used and melded with community expertise i…
View article: Using Electronic Health Record–Based Clinical Decision Support to Provide Social Risk–Informed Care in Community Health Centers: Protocol for the Design and Assessment of a Clinical Decision Support Tool
Using Electronic Health Record–Based Clinical Decision Support to Provide Social Risk–Informed Care in Community Health Centers: Protocol for the Design and Assessment of a Clinical Decision Support Tool Open
Background Consistent and compelling evidence demonstrates that social and economic adversity has an impact on health outcomes. In response, many health care professional organizations recommend screening patients for experiences of social…
View article: Using Electronic Health Record–Based Clinical Decision Support to Provide Social Risk–Informed Care in Community Health Centers: Protocol for the Design and Assessment of a Clinical Decision Support Tool (Preprint)
Using Electronic Health Record–Based Clinical Decision Support to Provide Social Risk–Informed Care in Community Health Centers: Protocol for the Design and Assessment of a Clinical Decision Support Tool (Preprint) Open
BACKGROUND Consistent and compelling evidence demonstrates that social and economic adversity has an impact on health outcomes. In response, many health care professional organizations recommend screening patients for experiences of socia…
View article: “I didn't know you could do that”: A Pilot Assessment of EHR Optimization Training
“I didn't know you could do that”: A Pilot Assessment of EHR Optimization Training Open
Background Informatics tools within electronic health records (EHRs)—for example, data rosters and clinical reminders—can help disseminate care guidelines into clinical practice. Such tools' adoption varies widely, however, possibly becaus…
View article: Initiating and Implementing Social Determinants of Health Data Collection in Community Health Centers
Initiating and Implementing Social Determinants of Health Data Collection in Community Health Centers Open
Successfully incorporating social determinants of health (SDH) screening into clinic workflows can help care teams provide targeted care, appropriate referrals, and other interventions to address patients' social risk factors. However, int…
View article: Does increased implementation support improve community clinics’ guideline-concordant care? Results of a mixed methods, pragmatic comparative effectiveness trial
Does increased implementation support improve community clinics’ guideline-concordant care? Results of a mixed methods, pragmatic comparative effectiveness trial Open
Background Disseminating care guidelines into clinical practice remains challenging, partly due to inadequate evidence on how best to help clinics incorporate new guidelines into routine care. This is particularly true in safety net commun…
View article: Variation in Electronic Health Record Documentation of Social Determinants of Health Across a National Network of Community Health Centers
Variation in Electronic Health Record Documentation of Social Determinants of Health Across a National Network of Community Health Centers Open
This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Heal…
View article: Study protocol: a pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation
Study protocol: a pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation Open
Background National leaders recommend documenting social determinants of health and actions taken to address social determinants of health in electronic health records, and a growing body of evidence suggests the health benefits of doing s…
View article: Study protocol: a pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation
Study protocol: a pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation Open
clinicaltrials.gov, NCT03607617 , registration date: 7/31/2018-retrospectively registered.
View article: Adoption of Social Determinants of Health EHR Tools by Community Health Centers
Adoption of Social Determinants of Health EHR Tools by Community Health Centers Open
Our results indicate that adoption of systematic EHR-based SDH documentation may be feasible, but substantial barriers to adoption exist. Lessons from this study may inform primary care providers seeking to implement SDH-related efforts, a…
View article: How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care
How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care Open
Little is known about how health care organizations are developing tools for identifying/addressing patients' social determinants of health (SDH). We describe the processes recently used by 6 organizations to develop SDH screening tools fo…
View article: Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health
Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health Open
Standardizing SDH data collection and presentation in EHRs could lead to improved patient and population health outcomes in CHCs and other care settings. We know of no previous reports of processes used to develop similar tools. This artic…
View article: Cardiovascular care guideline implementation in community health centers in Oregon: a mixed-methods analysis of real-world barriers and challenges
Cardiovascular care guideline implementation in community health centers in Oregon: a mixed-methods analysis of real-world barriers and challenges Open
This trial was registered retrospectively. Currently Controlled Trials NCT02299791 . Retrospectively registered 10 November 2014.
View article: “Salt in the Wound”
“Salt in the Wound” Open
Electronic health record (EHR) data can be extracted for calculating performance feedback, but users' perceptions of such feedback impact its effectiveness. Through qualitative analyses, we identified perspectives on barriers and facilitat…