title: The geographic distribution of cardiovascular health in the stroke prevention in healthcare delivery environments (SPHERE) study.
abstract: BACKGROUND
  Community-level factors have been clearly linked to health outcomes, but are challenging to incorporate into medical practice. Increasing use of electronic health records (EHRs) makes patient-level data available for researchers in a systematic and accessible way, but these data remain siloed from community-level data relevant to health.
  
  
  OBJECTIVE
  This study sought to link community and EHR data from an older female patient cohort participating in an ongoing intervention at the Ohio State University Wexner Medical Center to associate community-level data with patient-level cardiovascular health (CVH) as well as to assess the utility of this EHR integration methodology.
  
  
  METHODS
  CVH was characterized among patients using available EHR data collected May through July of 2013. EHR data for 153 patients were linked to United States census-tract level data to explore feasibility and insights gained from combining these disparate data sources. Analyses were conducted in 2014.
  
  
  RESULTS
  Using the linked data, weekly per capita expenditure on fruits and vegetables was found to be significantly associated with CVH at the p<0.05 level and three other community-level attributes (median income, average household size, and unemployment rate) were associated with CVH at the p<0.10 level.
  
  
  CONCLUSIONS
  This work paves the way for future integration of community and EHR-based data into patient care as a novel methodology to gain insight into multi-level factors that affect CVH and other health outcomes. Further, our findings demonstrate the specific architectural and functional challenges associated with integrating decision support technologies and geographic information to support tailored and patient-centered decision making therein.
authors.affiliation: Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Caryn
authors.initials: C
authors.lastname: Roth
authors.affiliation: Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Philip R O
authors.initials: PR
authors.lastname: Payne
authors.affiliation: Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Rory C
authors.initials: RC
authors.lastname: Weier
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Shoben
authors.affiliation: Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Erica N
authors.initials: EN
authors.lastname: Fletcher
authors.affiliation: Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Albert M
authors.initials: AM
authors.lastname: Lai
authors.affiliation: Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Kelley
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Plascak
authors.affiliation: Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA. Electronic address: rforaker@cph.osu.edu.
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
mesh_terms: D000368:Aged; D002319:Cardiovascular System; D015331:Cohort Studies; D003695:Delivery of Health Care; D057286:Electronic Health Records; D005260:Female; D040362:Geographic Information Systems; D006304:Health Status; D006801:Humans; D016247:Information Storage and Retrieval; D009820:Ohio; D012111:Residence Characteristics; D012959:Socioeconomic Factors
keywords: Applied clinical informatics; Cardiovascular health; Data integration; Electronic health records; Geographic information systems
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