The Community Health Applied Research Network (CHARN) Data Warehouse: a Resource for Patient-Centered Outcomes Research and Quality Improvement in Underserved, Safety Net Populations

Abstract

Background:The Community Health Applied Research Network, funded by the Health Resources and Services Administration, is a research network comprising 18 Community Health Centers organized into four Research Nodes (each including an academic partner) and a data coordinating center. The network represents more than 500,000 diverse safety net patients across 11 states.Objective:The primary objective of this paper is to describe the development and implementation process of the CHARN data warehouse.Methods:The methods involved regulatory and governance development and approval, development of content and structure of the warehouse and processes for extracting the data locally, performing validation, and finally submitting data to the data coordinating center.Progress to Date:Version 1 of the warehouse has been developed. Tables have been added, the population and the years of electronic health records (EHR) have been expanded for Version 2.Conclusions:It is feasible to create a national, centralized data warehouse with multiple Community Health Center partners using different EHR systems. It is essential to allow sufficient time: (1) to develop collaborative, trusting relationships among new partners with varied technology, backgrounds, expertise, and interests; (2) to complete institutional, business, and regulatory review processes; (3) to identify and address technical challenges associated with diverse data environments, practices, and resources; and (4) to provide continuing data quality assessments to ensure data accuracy.

Implications of American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Guidelines on Statin Underutilization for Prevention of Cardiovascular Disease in Diabetes Mellitus Among Several US Networks of Community Health Centers

“…The Kaiser Permanente Northwest Institutional Review Board and the Northwestern University Institutional Review Board deemed the study exempt from review, and the other participating organizations’ review boards reviewed and approved the study or judged that it qualified to be exempt as well. A full description of CHARN can be found elsewhere …”

Sociodemographic and Health-Related Characteristics of a Safety-Net Patient Population

“…The differences in characteristics between safety-net populations and patients in the general population raise questions about definitions of safety-net institutions based on Medicaid or Medicare distribution. In addition, the transportability of findings from studies in which safety-net populations are unrepresented are questionable [29][30][31][32][33][34][35]. Despite a Federal Act in 1993 to improve representation of vulnerable populations in research [36], little improvement has been reported [37,38].…”

Impact of Social Determinants of Health on Patients with Complex Diabetes Who Are Served by National Safety-Net Health Centers

“…Evaluating the way SDHs affect health outcomes is critical to appropriately allocate primary care resources to patients who are most at risk and to ensure that resources are allocated to services that are most likely to affect outcomes. Standardized documentation of SDHs and services in the EHR, 29 including enabling services, 48,49 is especially important to carry out such evaluations to assess the intermediary role of enabling services in treating complex patients. The data on SDHs can also help in the development of new risk prediction methods that assess the contribution of SDHs to and their impact on health outcomes for all vulnerable populations at CHCs, including both older patients with comorbidities and younger patients with a single disease.…”

“…The research nodes upload the EHR-based CHC limited data sets to the secure website at the data coordinating center from their local data warehouses, which conform to a standardized SQL relational database schema. 29 All CHARN studies, including this one, have received institutional review board approval. …”