Identifying individual social risk factors using unstructured data in electronic health records and their relationship with adverse clinical outcomes

OBJECTIVE: To determine the prevalence of individual-level social risk factors documented in unstructured data from electronic health records (EHRs) and the relationship between social risk factors and adverse clinical outcomes. STUDY SETTING: Inpatient encounters for adults (≥18 years) at the University of Virginia Medical Center during a 12-month study period between July 2018 and June 2019. Inpatient encounters for labor and delivery patients were excluded, as well as encounters where the patient was discharged to hospice, left against medical advice, or expired in the hospital. The study population included 21,402 inpatient admissions, representing 15,116 unique patients who had at least one inpatient admission during the study period. STUDY DESIGN: We identified measures related to individual social risk factors in EHRs through existing workflows, flowsheets, and clinical notes. Multivariate binomial logistic regression was performed to determine the association of individual social risk factors with unplanned inpatient readmissions, post-discharge emergency department (ED) visits, and extended length of stay (LOS). Other predictors included were age, sex, severity of illness, location of residence, and discharge destination. RESULTS: Predictors of 30-day unplanned readmissions included severity of illness (OR = 3.96), location of residence (OR = 1.31), social and community context (OR = 1.26), and economic stability (OR = 1.37). For 30-day post-discharge ED visits, significant predictors included location of residence (OR = 2.56), age (OR = 0.60), economic stability (OR = 1.39), education (OR = 1.38), social and community context (OR = 1.39), and neighborhood and built environment (OR = 1.61). For extended LOS, significant predictors were age (OR = 0.51), sex (OR = 1.18), severity of illness (OR = 2.14), discharge destination (OR = 2.42), location of residence (OR = 0.82), economic stability (OR = 1.14), neighborhood and built environment (OR = 1.31), and education (OR = 0.79). CONCLUSIONS: Individual-level social risk factors are associated with increased risk for unplanned hospital readmissions, post-discharge ED visits, and extended LOS. While individual-level social risk factors are currently documented on an ad-hoc basis in EHRs, standardized SDoH screening tools using validated metrics could help eliminate bias in the collection of SDoH data and facilitate social risk screening.