ArticleThe western journal of emergency medicine2021
Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study.
Article in The western journal of emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 14 citations in OpenAlex.
- An Evidence Map of the Women Veterans' Health Literature, 2016 to 2023: A Systematic Review.JAMA network open · 2025Pooled it
- Improving Clinical Documentation with Artificial Intelligence: A Systematic Review.Perspectives in health information management · 2024Pooled it
- Firearm Access Screening in Mental Healthcare: An Exploratory Study of the Role of Provider and Client Characteristics.Journal of clinical psychology · 2026Article
- Development of a Patient Decision Aid to Prevent Firearm Suicide Among US Women Reserve and National Guard Veterans.Journal of general internal medicine · 2026Article
- Prevalence and Correlates of Firearm Screening and Safety Counseling in Pediatric Primary Care.Journal of community health · 2025Article
- Identifying Firearm Violence Exposure in Primary Care Clinical Notes: Protocol for Developing a National Language Processing Text Classifier.JMIR research protocols · 2025Article
- Comparison of six natural language processing approaches to assessing firearm access in Veterans Health Administration electronic health records.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Assessing the use of unstructured electronic health record data to identify exposure to firearm violence.JAMIA open · 2024Article
- Measuring interpersonal firearm violence: natural language processing methods to address limitations in criminal charge data.Journal of the American Medical Informatics Association : JAMIA · 2024Article
Corrections and comments
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Authors and funding
12 authors at 6 institutions in 1 country.
Funding
Abstract
introductionPresence of a firearm is associated with increased risk of violence and suicide. United States military veterans are at disproportionate risk of suicide. Routine healthcare provider screening of firearm access may prompt counseling on safe storage and handling of firearms. The objective of this study was to determine the frequency with which Veterans Health Administration (VHA) healthcare providers document firearm access in electronic health record (EHR) clinical notes, and whether this varied by patient characteristics.
methodsThe study sample is a post-9-11 cohort of veterans in their first year of VHA care, with at least one outpatient care visit between 2012-2017 (N = 762,953). Demographic data, veteran military service characteristics, and clinical comorbidities were obtained from VHA EHR. We extracted clinical notes for outpatient visits to primary, urgent, or emergency clinics (total 105,316,004). Natural language processing and machine learning (ML) approaches were used to identify documentation of firearm access. A taxonomy of firearm terms was identified and manually annotated with text anchored by these terms, and then trained the ML algorithm. The random-forest algorithm achieved 81.9% accuracy in identifying documentation of firearm access.
resultsThe proportion of patients with EHR-documented access to one or more firearms during their first year of care in the VHA was relatively low and varied by patient characteristics. Men had significantly higher documentation of firearms than women (9.8% vs 7.1%; P < .001) and veterans >50 years old had the lowest (6.5%). Among veterans with any firearm term present, only 24.4% were classified as positive for access to a firearm (24.7% of men and 20.9% of women).
conclusionNatural language processing can identify documentation of access to firearms in clinical notes with acceptable accuracy, but there is a need for investigation into facilitators and barriers for providers and veterans to improve a systemwide process of firearm access screening. Screening, regardless of race/ethnicity, gender, and age, provides additional opportunities to protect veterans from self-harm and violence.
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Registered trials
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