Hadi Kharrazi

Hadi Kharrazi
Johns Hopkins University | JHU · Department of Health Policy

MD PhD FAMIA

About

170
Publications
35,648
Reads
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3,082
Citations
Citations since 2017
129 Research Items
2702 Citations
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Introduction
Dr. Kharrazi is a core faculty of Health Policy and Management at the Johns Hopkins School of Public Health with a joint appointment at the School of Medicine. He is the research director of the Center for Population Health IT (CPHIT) and serves on multiple national advisory boards and steering committees. His research focuses on leveraging informatics to advance population health. He has been the principal investigator of multiple federal and state grants/awards with special focus on population/clinical health IT. Dr. Kharrazi was the Co-PI of an ONC award to develop a national curriculum for population health informatics. He is the director of the DrPH Informatics track and the co-director of the DHSI PhD program. More info can be found at: http://hkharrazi.com

Publications

Publications (170)
Article
There is increased acceptance that social and behavioral determinants of health (SBDH) impact health outcomes, but electronic health records (EHRs) are not always set up to capture the full range of SBDH variables in a systematic manner. The purpose of this study was to explore rates and trends of social history (SH) data collection-1 element of SB...
Chapter
Clinicians, care coordinators, and epidemiologist need timely access to patient data from the healthcare organizations which hold it. However, many barriers exist to requesting and receiving data. Technical standards must be decided and implemented consistently. Privacy protections must be maintained, including audit logs of transactions and method...
Article
Full-text available
Background Measuring and addressing the disparity between access to healthcare resources and underlying health needs of populations is a prominent focus in health policy development. More recently, the fair distribution of healthcare resources among population subgroups have become an important indication of health inequities. Single disease outcom...
Preprint
BACKGROUND Older adults account for the largest percentage of the long-term care (LTC) and total medical spending. Prior studies have identified several data sources and many predictors for nursing home admission among the elderly [5]-[10]; however, such studies have often used data sources with limited availability across large populations and met...
Article
Full-text available
Purpose: Patient vital signs are related to specific health risks and outcomes but are underutilized in the prediction of health-care utilization and cost. To measure the added value of electronic health record (EHR) extracted Body Mass Index (BMI) and blood pressure (BP) values in improving healthcare risk and utilization predictions. Patients a...
Article
Patients enrolled in Medicaid have significantly higher social needs (SNs) than others. Using claims and electronic health records (EHRs) data, managed care organizations (MCOs) could systemically identify high-risk patients with SNs and develop population health management interventions. Impact of SNs on models predicting health care utilization a...
Article
Full-text available
Objective Health care providers increasingly rely upon predictive algorithms when making important treatment decisions, however, evidence indicates that these tools can lead to inequitable outcomes across racial and socio-economic groups. In this study, we introduce a bias evaluation checklist that allows model developers and health care providers...
Article
Background Three claims-based pharmacy markers (complex, costly and risky medications) were developed to help automatically identify patients for comprehensive medication management. Objective To evaluate the association between newly-developed markers and healthcare outcomes. Methods This was a two-year retrospective cohort study using PharMetri...
Preprint
BACKGROUND In the U.S., over 3.6 million deliveries occur each year. Among them, up to 20% (~700k) of women experience postpartum depression (PPD), according to the Center for Disease Control and Prevention. Absence of accurate reporting and diagnosis has made phenotyping patients with PPD difficult. Existing literature has shown that factors such...
Article
Background: In the U.S., over 3.6 million deliveries occur each year. Among them, up to 20% (~700k) of women experience postpartum depression (PPD), according to the Center for Disease Control and Prevention. Absence of accurate reporting and diagnosis has made phenotyping patients with PPD difficult. Existing literature has shown that factors suc...
Article
Full-text available
Background There is a need to evaluate how the choice of time interval contributes to the lack of consistency of SDoH variables that appear as important to COVID-19 disease burden within an analysis for both case counts and death counts. Methods This study identified SDoH variables associated with U.S county-level COVID-19 cumulative case and deat...
Article
Full-text available
Although most health care occurs in the ambulatory setting, limited research examines how providers and patients think about and enact ambulatory patient safety. This multimethod qualitative study seeks to identify perceived challenges and strategies to improve ambulatory safety from the perspectives of clinicians, staff, and patients. Data include...
Article
Full-text available
Objective Early and accurate prediction of patients at risk of readmission is key to reducing costs and improving outcomes. LACE is a widely used score to predict 30-day readmissions. We examine whether adding social determinants of health (SDOH) to LACE can improve its predictive performance. Methods This is a retrospective study that included al...
Article
BACKGROUND: Patient effort to comply with complex medication instructions is known to be related to nonadherence and subsequent medical complications or health care costs. A widely used Medication Regimen Complexity Index (MRCI) has been used with electronic health records (EHRs) to identify patients who could benefit from pharmacist intervention....
Article
Objective: Ineligibility for and refusal to participate in randomized controlled trials (RCTs) can potentially lead to unrepresentative study samples and limited generalizability of findings. We examined the rates of exclusion and refusal in RCTs that have studied impact on suicide-related outcomes in the US. Data Sources: PubMed, the Cochrane Lib...
Article
Background: The care of pediatric trauma patients is delivered by multidisciplinary care teams with high fluidity that may vary in composition and organization depending on the time of day. Objective: This study aims to identify and describe diurnal variations in multidisciplinary care teams taking care of pediatric trauma patients using social...
Article
Objectives: Computable social risk factor phenotypes derived from routinely collected structured electronic health record (EHR) or health information exchange (HIE) data may represent a feasible and robust approach to measuring social factors. This study convened an expert panel to identify and assess the quality of individual EHR and HIE structur...
Article
Full-text available
Objective To evaluate whether a natural language processing (NLP) algorithm could be adapted to extract, with acceptable validity, markers of residential instability (ie, homelessness and housing insecurity) from electronic health records (EHRs) of 3 healthcare systems. Materials and methods We included patients 18 years and older who received car...
Article
Full-text available
Background The opioid epidemic in the United States has precipitated a need for public health agencies to better understand risk factors associated with fatal overdoses. Matching person-level information stored in public health, medical, and human services datasets can enhance the understanding of opioid overdose risk factors and interventions. Ob...
Article
Health care providers are increasingly using clinical measures derived from electronic health records (EHRs) for risk stratification and predictive modeling. EHR-specific data elements such as prescriptions, laboratory results, and vital signs have been shown to improve risk prediction models. In this study, the value of EHR-based blood pressure (B...
Article
Full-text available
We aimed to empirically measure the degree to which there is a “digital divide” in terms of access to the internet at the small-area community level within the State of Maryland and the City of Baltimore and to assess the relationship and association of this divide with community-level SDOH risk factors, community-based social service agency locati...
Article
Full-text available
Objective Clinical Knowledge Authoring Tools (CKATs) are integral to the computerized Clinical Decision Support (CDS) development life cycle. CKATs enable authors to generate accurate, complete, and reliable digital knowledge artifacts in a relatively efficient and affordable manner. This scoping review aims to compare knowledge authoring tools and...
Article
Aim Brief screening and predictive modeling have garnered attention for utility at identifying individuals at risk of suicide. Although previous research has investigated these methods, little is known about how these methods compare against each other or work in combination in the pediatric population. Methods Patients were aged 8–18 years old wh...
Article
Full-text available
Introduction: Despite the growing efforts to standardize coding for social determinants of health (SDOH), they are infrequently captured in electronic health records (EHRs). Most SDOH variables are still captured in the unstructured fields (i.e., free-text) of EHRs. In this study we attempt to evaluate a practical text mining approach (i.e., advanc...
Article
Background: A small proportion of high-need patients persistently use the bulk of healthcare services and incur disproportionate costs. Population health management (PHM) programs often refer to these patients as persistent high users/utilizers (PHUs). Accurate PHU prediction enables PHM programs to better align scarce healthcare resources with hi...
Article
Physiological data, such as heart rate and blood pressure, are critical to clinical decision-making in the intensive care unit (ICU). Vital signs data, which are available from electronic health records, can be used to diagnose and predict important clinical outcomes; While there have been some reports on the data quality of nurse-verified vital si...
Article
BACKGROUND: Pharmacists optimize medication use and ensure the safe and effective delivery of pharmacotherapy to patients using comprehensive medication management (CMM). Identifying and prioritizing individual patients who will most likely benefit from CMM can be challenging. Health systems have far more candidates for CMM than there are clinical...
Article
Background: The COVID-19 pandemic has impacted communities differentially, with poorer and minority populations being more adversely affected. Prior rural health research suggests such disparities may be exacerbated during the pandemic and in remote parts of the U.S. Objectives: To understand the spread and impact of COVID-19 across the U.S., co...
Article
Objective: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality. Surgical interventions, such as uterine artery ligation and utero-ovarian arteries ligation (UAL and UOAL), are considered as effective methods to control PPH. Owing to PPH's severe outcomes, various educational tools have been developed to train surgical residents. A...
Article
Full-text available
Importance The National COVID Cohort Collaborative (N3C) is a centralized, harmonized, high-granularity electronic health record repository that is the largest, most representative COVID-19 cohort to date. This multicenter data set can support robust evidence-based development of predictive and diagnostic tools and inform clinical care and policy....
Article
Background: A high proportion of healthcare services are persistently utilized by a small subpopulation of patients. To improve clinical outcomes while reducing cost and utilization, population health management programs often provide targeted interventions to patients who may become persistent high users/utilizers (PHUs). Enhanced prediction and...
Preprint
BACKGROUND A high proportion of health care services are persistently utilized by a small subpopulation of patients. To improve clinical outcomes while reducing costs and utilization, population health management programs often provide targeted interventions to patients who may become persistent high users/utilizers (PHUs). Enhanced prediction and...
Article
Full-text available
Background The spread of COVID-19 has highlighted the long-standing health inequalities across the U.S. as neighborhoods with fewer resources were associated with higher rates of COVID-19 transmission. Although the stay-at-home order was one of the most effective methods to contain its spread, residents in lower-income neighborhoods faced barriers...
Article
Background: Social ties between health care workers may be an important driver of job satisfaction; however, research on this topic is limited. Purpose: We used social network methods to collect data describing two types of social ties, (a) instrumental ties (i.e., exchange of advice that enables work) and (b) expressive ties (i.e., exchange of...
Article
Full-text available
The relationship between political affiliations and diet-related discussions on social media has not been studied on a population level. This study used a cost- and -time effective framework to leverage, aggregate, and analyze data from social media. This paper enhances our understanding of diet-related discussions with respect to political orienta...
Article
Full-text available
Disclosure of HIV and other sexually transmitted infection (HIV/STI) testing history to sexual partners is low among gay, bisexual, and other U.S. sexual minority men (SMM). Patient portals (PP) could increase HIV/STI testing history disclosure. This study estimated the predictive validity of the Enhancing Dyadic Communication (EDC) latent construc...
Article
Purpose: Social and behavioral determinants of health (SBDH) are important factors that affect the health of individuals but are not routinely captured in a structured and systematic manner in electronic health records (EHRs). The purpose of this study is to generate recommendations for systematic implementation of SBDH data collection in EHRs thr...
Article
Multiple indices are available to measure medication adherence behaviors. Medication adherence measures, however, have rarely been extracted from electronic health records (EHRs) for population-level risk predictions. This study assessed the value of medication adherence indices in improving predictive models of cost and hospitalization. This study...
Article
This study aimed to assess the impact of coronavirus disease (COVID-19) prevalence in the United States in the week leading to the relaxation of the stay-at-home orders (SAH) on future prevalence across states that implemented different SAH policies. We used data on the number of confirmed COVID-19 cases as of August 21, 2020 on county level. We cl...
Article
Background: Prescription Drug Monitoring Programs (PDMPs) collect controlled substance prescriptions dispensed within a state. Many PDMP programs perform targeted outreach (i.e., “unsolicited reporting”) for patients who exceed numerical thresholds, however, the degree to which patients at highest risk of fatal opioid overdose are identified has no...
Preprint
Objective: To compare the accuracy, sensitivity and utility of brief screening to predictive modeling for identifying suicide-related outcomes in a pediatric emergency department. Our hypothesis was that predictive modeling would be more accurate and useful compared to brief screening. Methods: This was a retrospective cohort study at an urban pedi...
Preprint
Full-text available
Background The spread of COVID-19 has highlighted the long-standing health inequalities across the U.S. as neighborhoods with fewer resources were associated with higher rates of COVID-19 transmission. Although the stay-at-home order was one of the most effective methods to contain its spread, residents in lower-income neighborhoods faced barriers...
Article
Full-text available
Background Comorbidities are strong predictors of current and future healthcare needs and costs; however, comorbidities are not evenly distributed geographically. A growing need has emerged for comorbidity surveillance that can inform decision-making. Comorbidity-derived risk scores are increasingly being used as valuable measures of individual hea...
Preprint
Full-text available
Background The spread of COVID-19 has highlighted the long-standing health inequalities across the U.S. as neighborhoods with fewer resources were associated with higher rates of COVID-19 transmission. Although the stay-at-home order was one of the most effective methods to contain its spread, residents in lower-income neighborhoods faced barriers...
Preprint
Full-text available
Background The COVID-19 pandemic has impacted communities differentially, with poorer and minority populations being more adversely affected. Prior rural health research suggests such disparities may be exacerbated during the pandemic and in remote parts of the U.S. Objectives To understand the spread and impact of COVID-19 across the U.S., county...
Article
Background: Nonfilling of prescribed medications is a worldwide problem of serious concern. Studies of health care costs and utilization associated with medication nonadherence frequently rely on claims data and usually focus on patients with specific conditions. Past studies also have little agreement on whether higher medication costs associated...
Article
To monitor public opinions on diet, large survey data is commonly used though costly and time consuming. Social media has become a mainstream channel of communication and has drastically grown in popularity, connecting users to a ready stream of health information. While the literature has provided valuable information on the use of social media fo...
Article
Objective: To provide a methodology for estimating the effect of U.S.-based Certified Electronic Health Records Technology (CEHRT) implemented by primary care physicians (PCPs) on a Healthcare Effectiveness Data and Information Set (HEDIS) measure for childhood immunization delivery. Materials and methods: This study integrates multiple health c...
Article
Traditionally, risk-adjustment models do not address the characteristics of minority populations, such as race or socioeconomic status. This study aimed to evaluate the added value of place-based social determinants on risk-adjustment models in explaining health care costs and utilization. Statewide commercial claims from the Maryland Medical Care...
Article
Introduction: Patient safety in primary care is an emerging priority, and experts have highlighted medications, diagnoses, transitions, referrals, and testing as key safety domains. This study aimed to (1) describe how frontline clinicians, administrators, and staff conceptualize patient safety in primary care; and (2) compare and contrast these c...
Article
Full-text available
Introduction: The spread of Coronavirus Disease 2019 (COVID-19) across the United States has highlighted the long-standing nationwide health inequalities with socioeconomically challenged communities experiencing a higher burden of the disease. We assessed the impact of neighborhood socioeconomic characteristics on the COVID-19 prevalence across se...
Article
Objectives Despite the availability of many frailty measures to identify older adults at risk, frailty instruments are not routinely used for risk assessment in population health management. Here, we assessed the potential value of electronic health records (EHRs) and administrative claims in providing the necessary data for variables used across v...
Article
Research Objective Population health management programs often use administrative claims to measure medication refills (eg, medication possession ratio); however, claims‐based indexes lack measuring medication complexity and adherence together. Medication Regimen Complexity Index (MRCI) is a validated measure of medication complexity and adherence...
Article
Objectives: The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture. Methods: This was a cross-case analysis study in 25 diverse U.S. PCMHs....
Chapter
Decision-making by public health leaders requires data, information, and knowledge. Information systems that support transformation of data into information and knowledge, and that inform decision-making processes, are referred to as decision support systems (DSS). There exist a variety of DSS in clinical and public health contexts. For example, cl...
Chapter
Population health is an evolving concept of healthcare. Population health aims to improve the health outcomes of defined populations by modifying health determinants that range from clinical to social and environmental factors. Both population and public health efforts aim to reach similar outcomes and target comparable determinants of health. With...
Article
Background: Nonadherence to medication regimens can lead to adverse health care outcomes and increasing costs. Objectives: To (a) assess the level of medication complexity at an outpatient setting using population-level electronic health record (EHR) data and (b) evaluate its association with medication adherence measures derived from medication...
Conference Paper
Full-text available
To monitor public opinions on diet, large survey data is commonly used though costly and time consuming. Social media has become a mainstream channel of communication and has drastically grown in popularity, connecting users to a ready stream of health information. While the literature has provided valuable information on the use of social media fo...
Article
Full-text available
As the US health care system moves to expand access to and quality of medical care, the importance of addressing patient-level social needs and community-level social determinants of health (SDOH) is increasingly being recognized. This study evaluates individual- and community-level needs of housing (one of the SDOH domains) across the patient popu...
Article
Background Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight exa...
Preprint
BACKGROUND Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight exa...
Article
Background: Malignant pleural effusion (MPE) poses a considerable healthcare burden, but little is known about trends in directly attributable hospital utilization. Objective: We aimed to study national trends in healthcare utilization and outcomes among hospitalized MPE patients. Methods: We analyzed adult hospitalizations attributable to MPE...
Article
Full-text available
Background: Serious educational games have shown effectiveness in improving various health outcomes. Previous reviews of health education games have focused on specific diseases, certain medical subjects, fixed target groups, or limited outcomes of interest. Given the recent surge in health game studies, a scoping review of health education games...
Preprint
BACKGROUND Digital technologies are now key to a wide range of social interactions, including those related to the receipt of health and social services. But the lack of affordable internet connectivity and the underlying “digital divide” has led to significant disparities across the U.S. in terms of access to such technology. Recently, within the...
Preprint
UNSTRUCTURED In an era of accelerating health information technology capability, healthcare organizations increasingly use digital data to predict outcomes such as emergency department use, hospitalizations, and healthcare costs. This trend occurs alongside a growing recognition that social and behavioral determinants of health (SBDH) influence hea...
Preprint
BACKGROUND The opioid epidemic in the United States has precipitated a need for public health agencies to better understand risk factors associated with fatal overdoses. Matching person-level information stored in public health, medical, and human services datasets can enhance the understanding of opioid overdose risk factors and interventions. A m...
Article
Full-text available
In an era of accelerated health information technology capability, health care organizations increasingly use digital data to predict outcomes such as emergency department use, hospitalizations, and health care costs. This trend occurs alongside a growing recognition that social and behavioral determinants of health (SBDH) influence health and medi...
Preprint
One of the challenges for text analysis in medical domains is analyzing large-scale medical documents. As a consequence, finding relevant documents has become more difficult. One of the popular methods to retrieve information based on discovering the themes in the documents is topic modeling. The themes in the documents help to retrieve documents o...
Article
Objective: This paper promotes rigorous methods and designs currently underutilized in obesity research, informed by a recent systematic review of the methods and risks of bias in studies of policies, programs, and built environment changes for obesity prevention and control. Methods: To determine the current state of the field, relevant databas...
Article
Full-text available
Background: Social determinants of health (SDOH) have an inextricable impact on health. If remained unaddressed, poor SDOH can contribute to increased health care utilization and costs. We aimed to determine if geographically derived neighborhood level SDOH had an impact on hospitalization rates of patients receiving care at the Veterans Health Ad...