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Using Electronic Health Record Data to Study Latino Immigrant Populations in Health Services Research

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Abstract

The study of healthcare disparities in Latino immigrants is underdeveloped and limited by risk to participants. To validate an electronic health record (EHR)-based algorithm that could serve as a safe proxy for self-reported immigration status for health services researchers. Primary collection/analysis of interview data and secondary analysis of electronic health record data. We developed an EHR algorithm to classify a population of patients as likely undocumented or recent Latino immigrants and validated this algorithm by conducting semi-structured interviews of staff whose main role entails asking about immigration status. We presented them with a list of patients (masked to the interviewer) with whom they had worked, and asked them to indicate patient’s immigration status, if they recalled it. We analyzed the correspondence between staff knowledge and our EHR algorithm. Staff described routine conversations with patients about immigration status. The EHR algorithm had fair agreement (66.2%, 95% CI 57.3–74.2) with staff knowledge. When the staff were more confident of their assessment, agreement increased (77.6%, 95% CI 63.4–88.2). The EHR has potential for studying immigration status in health services research, although more study is needed to determine the accuracy and utility of EHRs for this purpose.

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Funding

This study was funded by Agency for Healthcare Research and Quality (Grant No. K08HS02152201A1) and National Institute on Minority Health and Health Disparities (Grant No. R01MD011404).

Author information

Authors and Affiliations

  1. Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA

    John Heintzman, Miguel Marino, Sonia Sosa, David Ezekiel-Herrera & Deborah Cohen

  2. Veterans Affairs Medical Center, 3710 SW US Veterans Hospital Rd., Portland, OR, 97239, USA

    Khaya Clark

  3. OCHIN Inc., 1881 SW Naito Pkwy, Portland, OR, 97201, USA

    Stuart Cowburn

  4. Benton County Health Department, 530 NW 27th St, Corvallis, OR, 97330, USA

    Lizdaly Cancel

Authors
  1. John Heintzman
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  2. Miguel Marino
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  3. Khaya Clark
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  4. Stuart Cowburn
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  5. Sonia Sosa
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  6. Lizdaly Cancel
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  7. David Ezekiel-Herrera
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  8. Deborah Cohen
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Correspondence to John Heintzman.

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The authors declare that they have no conflict of interest.

Ethical Approval

IRB Statement: All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted. (Oregon Health and Science University Research Integrity Office).

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Appendices

Appendix A: Interview Guide

  1. (1)

    Describe your role here at the clinic.

  2. (2)

    How does that role involve working with Latino immigrants?

  3. (3)

    Tell me how you learn about patients’ immigration status?

  4. (4)

    How do you decide how to handle or discuss patient’s immigration status?

  5. (5)

    If one wanted to know the immigration status of a group of patients, what would be the best way to do that?

    [Explanation of EHR algorithm: Our research study is investigating whether or not we can use electronic health records to study the health care if undocumented or recent Latino immigrants. We think using electronic health records may help avoid having to ask patients sensitive questions about their immigration status, but still enable us to study how recent or undocumented immigrants use healthcare. To study immigrants in this way, we use several pieces of information to identify a population whom we think are likely recent or undocumented Latino immigrants: adults who are Hispanic or Latino or Spanish speaking, whose income is 100% FPL or lower, and who are uninsured]

What did you think about this EHR method for studying Latino immigrants?

Appendix B

See Table 3.

Table 3 Cross-tabulation of overall correspondence between EHR algorithm and Eligibility Specialist Assessment, N(%)
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Heintzman, J., Marino, M., Clark, K. et al. Using Electronic Health Record Data to Study Latino Immigrant Populations in Health Services Research. J Immigrant Minority Health 22, 754–761 (2020). https://doi.org/10.1007/s10903-019-00925-2

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  • DOI: https://doi.org/10.1007/s10903-019-00925-2

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