Vol.:(0123456789) 1 3 Maternal and Child Health Journal (2020) 24:829–836 https://doi.org/10.1007/s10995-020-02930-6 Exploring Opportunities for Household‑Level Chronic Care Management Using Linked Electronic Health Records of Adults and Children: A Retrospective Cohort Study Keri J. S. Brady 1  · Aaron Legler 2  · William G. Adams 2 Published online: 9 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Objective Linking electronic health records (EHR) of pediatric and adult patients living in the same household has the potential to improve chronic care management efciencies by facilitating the delivery of services to multiple household members at once. However, little is known about relationship between the chronic medical (CM) and behavioral health (CBH) of adults and children living in common households. Methods EHR data for children were linked to the EHR data of adults living at the same address during the same time in a retrospective cohort study from 2006 to 2014 to evaluate associations between adult and child CM and CBH conditions within a Boston safety-net primary care patient sample. Results Of the 13,845 included children, 61.6% lived with at least one adult with ≥ 1 CM or CBH condition. Compared to children living with an adult(s) without a chronic condition, children living with an adult with a CM or CBH condition had a respective 16.2% and 18.1% increased likelihood of having a chronic condition themselves, with multiple adult chronic conditions in adults increasing children’s likelihood. Conclusions for Practice We found a positive association between the chronic diseases of adult and child household members. Given the clustering of child and adult chronic disease within households, using EHR data to support the care management needs of multiple members of households may be a promising approach to improving child and adult health in safety-net settings. Keywords Chronic disease · Chronic disease management · Household health · Electronic health records Signifcance Current chronic care management approaches typically focus on risk identifcation and intervention for individuals with a single health condition and do not address the health needs of multiple members of a household. Using linked electronic health records (EHR) from a safety-net primary care population, we found that the majority of children lived with an adult with a CM or CBH condition and adults’ bur- den of chronic disease predicted children’s chronic disease outcomes. In safety-net settings, linking members of house- holds within EHRs may improve care management efcien- cies by informing the delivery of services to multiple mem- bers at the same time. Introduction Managing the care of patients with chronic health condi- tions is a critical tool for achieving the triple aim (improved patient experience, improved health of populations, and reduced per capita costs) in primary care safety-net patient populations (Farrell et al. 2015). With a respective 27% and Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10995-020-02930-6) contains supplementary material, which is available to authorized users. * William G. Adams badams@bu.edu 1 Health Law, Policy & Management Department, School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118, USA 2 Division of General Pediatrics, Boston Medical Center/Boston University School of Medicine, 801 Albany St., Boston, MA 02118, USA