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Exploring the potential of preferred language in electronic health record data for monitoring Hepatitis B in Chinese populations


Tuesday, November 3, 2015 : 11:15 a.m. - 11:30 a.m.

Kimberly Sebek, MPH, Primary Care Information Project, NYCDOHMH, Long Island City, NY
Ha Vo, BA, Yale University
Katherine Bornschlegel, MPH, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY
Jennifer Baumgartner, MPH, NYCDOHMH
Remle Newton-Dame, MPH, Primary Care Information Project, NYC Department of Health and Mental Hygiene, Queens, NY
Jason Wang, PhD, Primary Care Information Project, NYC Department of Health and Mental Hygiene, Long Island City, NY
Audio (mp3) recording Recorded Presentation (mp4)
Background: Chronic hepatitis B virus (HBV) infection constitutes a stark racial health disparity in the United States.  While less than 0.5% of the general population suffers from HBV chronic infection, approximately 10% of foreign-born Asians and Pacific Islanders (API) are chronically infected, with the problem concentrated among Chinese populations.  It is thus critical that providers screen for HBV in foreign-born Asians, especially Chinese-born.  It is challenging to monitor provider behavior in this regard, since country of birth is not typically documented in medical records.  However, patients’ preferred language might serve as a proxy for foreign-born status.

 

Objective Purpose: To analyze how HBV screening and diagnosis rates differ among Asians vs. non-Asians, and among Asians with a preferred language of English vs. Chinese. 

 

Methods: We analyzed electronic health record (EHR) data from 422 New York City health care providers (636,008 patients).  The patient population consists of adults with no prior diagnosis of HBV. 

 

Results: In 2013, 8.2% of Asians with preferred language of Chinese (“Chinese-speaking Asians”) were screened for HBV, twice that of Other Asians (4.12%), and Non-Asians (4.11%).  0.56% Chinese-speaking Asians received a new HBV diagnosis , compared to 0.16% among Other Asians and .06% among Non-Asians. ANOVA and post-hoc Tukey test confirmed screening and diagnosis rates were significantly higher (p<.05) for Chinese-speaking Asians compared to Other Asians and non-Asians; rates did not significantly differ between Other Asians and non-Asians. 

 

Discussion: Results suggest providers screen and diagnose HBV more frequently in Asians with preferred language of Chinese compared Other Asians and to non-Asians, a finding consistent with elevated HBV risk observed among Chinese-born Asians.  Preferred language may serve as a proxy for country of birth in monitoring certain health issues.  That said, monitoring country of birth in medical records remains a challenge, suggesting policy implications for future EHR requirements.

Learning Areas:

Clinical medicine applied in public health
Provision of health care to the public
Public health or related research

Learning Objectives:
Explain the importance of identifying foreign-born status and country of origin in primary care medical records, particularly in settings like NYC, a city with a large foreign-born population Describe how patient’s preferred language, increasingly captured in EHR data, might serve as a proxy for foreign-born status Discuss the strengths and limitations of the preferred language variable in EHR data

Keyword(s): Hepatitis B, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I serve as Manager of Health Services Research for the Bureau of the Primary Care Information Project, NYC Department of Health, and have published several papers on topics related to quality improvement in primary care. My current work is focused on the potential of EHR data to reduce disparities in health service delivery.
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.

Back to: 4132.0: Challenges in Public Health Data Analytics in Research and Clinical Practice Part II