142nd APHA Annual Meeting and Exposition

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Leveraging EHR data to explore associations between patient place of residence and depression diagnosis and screening in New York City

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Kimberly Sebek, MPH , Primary Care Information Project, NYCDOHMH, Long Island City, NY
Mark Alexander, MS , Primary Care Information Project, NYCDOHMH, Long Island City, NY
Jason Wang, PhD , Primary Care Information Project, NYC Department of Health and Mental Hygiene, Long Island City, NY
Background: Previous research supports an association between low neighborhood-level socioeconomic status (SES) and increased likelihood of depression, but this relationship has not been well explored in primary care.  We used EHR quality measure (QM) data to analyze associations between patients’ neighborhood-level SES and depression screening and diagnosis. 

Objective Purpose: To explore the relationship between neighborhood-level SES and depression diagnosis and screening in primary care.


Methods: The New York City Department of Health has developed a set of QMs aligned with national standards to help providers understand data from their EHR systems and to guide quality improvement activities.  We analyzed 227 primary care practices’ 2012 QM data on depression diagnosis and screening and data related to patients’ neighborhood-level SES, based on patient ZIP codes.  In accordance with Community Health Survey standards, we defined extremely poor areas as ZIP codes where >=30% of residents were living below the poverty line.  


Results: After controlling for patient panel characteristics including age, sex, race and ethnicity; and for practice type (CHC vs. small practice), an increased proportion of patients from extremely poor areas was associated with an increase in the proportion of depression diagnosis (.074, SE=.022, p-value = .0007).  Apart from neighborhood-level SES, being a community health center was the only other factor significantly associated with higher rates of depression diagnosis (.065, SE=.020, p-value=.0011).  By contrast, in multivariate models, no predictor variables were associated with increased rates of depression screening.


Discussion: This study lends support that neighborhood-level low SES is associated with increased likelihood of depression diagnosis among New York City primary care seekers; however, we did not observe increased rates of screening in practices serving a high proportion of patients with low neighborhood-level SES, suggesting providers may not be screening more for depression among higher risk groups.

Learning Areas:

Provision of health care to the public

Learning Objectives:
Describe the relationship between depression diagnosis and depression screening among a group of New York City primary care practices, and neighborhood characteristics of practice patient panels Explain associations between neighborhood-level socioeconomic status and depression in urban contexts Differentiate between neighborhood-level and individual-level socioeconomic status

Keyword(s): Primary Care, Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a city research scientist with the New York City Department of Health and Mental Hygiene. In my current role I evaluate data and programs related to HIT-driven quality improvement initiatives. I have published on trends in electronically derived health data and have previously presented at APHA.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.