Measures

All NYC Macroscope data were extracted from structured fields within the EHR. In NYC Macroscope, obesity was classified based on body mass index (BMI) calculated within the EHR from height and weight data. Height and weight were self-reported in CHS and measured in NYC HANES.

The NYC Macroscope smoking indicator was extracted from a dedicated field in the EHR that documented whether the patient was a current smoker. This field is tied to a prevention-oriented feature of the eClinicalWorks EHR software that reminds providers to assess patient smoking status annually. In NYC HANES and CHS, respondents were classified as smokers if they reported they had smoked at least 100 cigarettes in their lifetime and currently smoke.

Depression was captured in NYC Macroscope either by a Patient Health Questionnaire (PHQ 9)18 screening with a score of 10 or higher (moderate depression) recorded in a dedicated field in the EHR, or by an ICD-9 code diagnosis of depression in the assessment or problem list sections of the EHR. Participants in NYC HANES were classified as depressed if they had a self-reported depression diagnosis (reported ever being told they had depression by a health care professional) or if they scored 10 or higher on the PHQ-9. Since CHS did not include the PHQ 9, the NYC Macroscope depression indicator was also evaluated against NYC HANES and CHS measures of self-reported depression diagnosis alone. We did not formally evaluate a depression measure that included medication for depression because those medications are often prescribed to treat other conditions.19,20

Receipt of influenza vaccination in the past year was captured by NYC Macroscope as the presence of an appropriate ICD-9, CPT, or CVX code. Vaccinations recorded in the unstructured portions of the EHR could not be captured by NYC Macroscope. NYC HANES and CHS used the same self-reported measure of having received an influenza vaccination in the past 12 months.