Data Element
Refugee Status
Description

Data element capturing the refugee status of a patient
Submitted By: Raymonde Uy / National Association of Community Health Centers (NACHC)
Data Element Information
Use Case Description(s)
Use Case Description Veteran Status:
Veterans face unique health challenges arising from their military service. While in service, they face deadly occupational hazards, and upon return, face issues with mental health and reintegration, among other issues. As such, veterans are at heightened risk for certain health outcomes, including Post-Traumatic Stress Disorder and joint replacement surgery.

Farmworker Status:
Migrant, Seasonal, and Agricultural Workers’ health is impacted by the convergence of multiple factors, including mobility and temporality of work, occupational hazards and harsh working conditions, cultural and linguistic barriers, and immigration status, among others. Access to affordable and appropriate health care is often rare. As a result, migrant, seasonal, and agricultural workers are at high risk for many clinical, non-clinical, and communal health needs.

Refugee Status:
Refugees are at serious risks for being underserved medically. They additionally survey from an amalgamation of other SDOH such as language barriers, housing instability, occupational risk
Health care providers need to be aware of, and sensitive to, cultural diversity, life situations, and other various factors that shape a person’s identity to provide safe and quality care to all patients. These factors include refugee status, among other factors. (CDC, Cultural Diversity and Considerations)
Estimate the breadth of applicability of the use case(s) for this data element All federally qualified health centers (FQHCs) gather data about Veteran, Farmworker and Refugee Status. This encompasses, in 2019, 29 million patients at 1400+ FQHCs with more than 13000 health care delivery sites. The evaluation of social determinants of health, however, should be considered a required component of a patient-centered, value-based approach to care and therefore should be potentially relevant for any patient or care setting.
Link to use case project page https://www.nachc.org/research-and-data/prapare/toolkit/
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) Veteran Status:
Z56.82 Military deployment status

Farmworker Status:
ICD:
Z57.2 Occupational exposure to dust
Z57.3 Occupational exposure to other air contaminants
Z57.4 Occupational exposure to toxic agents in agriculture
Z57.6 Occupational exposure to extreme temperature
Z57.8 Occupational exposure to other risk factors

Agricultural/animal husbandry worker (occupation) - SNOMED: 106390009

Refugee Status:
Refugee family (social concept) - SNOMED: 413323004
Refugee (person) - SNOMED: 446654005
Are you a refugee? - LOINC: 93027-1
Refugee - LOINC: LA29153-6
Additional Specifications http://build.fhir.org/ig/HL7/sdoh-cc/
http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/
https://confluence.hl7.org/display/GRAV/The+Gravity+Project
Current Use Extensively used in production environments
Supporting Artifacts Community Health Centers, Health Center Controlled Networks and Primary Care Associations routinely capture these data elements in different electronic health record systems
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts Commercial vendors including Aunt Bertha, UNITEUS and NowPow consume PRAPARE data and use it to link individual patients to social interventions.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) The PRAPARE tool has very minimal licensing and user fees.
Privacy and Security Concerns None
Estimate of Overall Burden Low burden, especially for healthcare institutions that routinely cater to the target demographic and geographic catchment area.
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 0 - Data element is not represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 1 - Data element is captured, stored, or accessed in at least one production EHR or HIT module.
Criterion #3
Maturity - Current Exchange		 Level 1 - Data element is electronically exchanged between two production EHRs or other HIT modules using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment This data element represents a component of a specific domain of Social Determinants of Health.

Comment

Submitted by RUy on

Refugee Status as SDOH data element under USCDI or ISA

NACHC would like to resupport this data element for consideration / inclusion to USCDIv3.

All federally qualified health centers (FQHCs) gather SDOH data, which includes a focus on this data element through the PRAPARE screening tool. This data is relevant to and encompasses in 2019 29 million patients at 1400+ FQHCs with more than 13000 health care delivery sites. 

If this data element is not considered for addition to USCDI, we would like to comment on it's addition to ISA as a coded data element under SDOH, with applicable standards and representation accross ICD-10-CM, SNOMED-CT and LOINC.

Please see attached document supporting this. 

2022-09-30 NACHC USCDIv3 Letter of Support_16.pdf

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