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Gupta AK, Xu H, Li X, Vest JR, Grannis SJ. Manual Evaluation of Record Linkage Algorithm Performance in Four Real-World Datasets. Appl Clin Inform 2024; 15:620-628. [PMID: 38508580 PMCID: PMC11290950 DOI: 10.1055/a-2291-1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/18/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES Patient data are fragmented across multiple repositories, yielding suboptimal and costly care. Record linkage algorithms are widely accepted solutions for improving completeness of patient records. However, studies often fail to fully describe their linkage techniques. Further, while many frameworks evaluate record linkage methods, few focus on producing gold standard datasets. This highlights a need to assess these frameworks and their real-world performance. We use real-world datasets and expand upon previous frameworks to evaluate a consistent approach to the manual review of gold standard datasets and measure its impact on algorithm performance. METHODS We applied the framework, which includes elements for data description, reviewer training and adjudication, and software and reviewer descriptions, to four datasets. Record pairs were formed and between 15,000 and 16,500 records were randomly sampled from these pairs. After training, two reviewers determined match status for each record pair. If reviewers disagreed, a third reviewer was used for final adjudication. RESULTS Between the four datasets, the percent discordant rate ranged from 1.8 to 13.6%. While reviewers' discordance rate typically ranged between 1 and 5%, one exhibited a 59% discordance rate, showing the importance of the third reviewer. The original analysis was compared with three sensitivity analyses. The original analysis most often exhibited the highest predictive values compared with the sensitivity analyses. CONCLUSION Reviewers vary in their assessment of a gold standard, which can lead to variances in estimates for matching performance. Our analysis demonstrates how a multireviewer process can be applied to create gold standards, identify reviewer discrepancies, and evaluate algorithm performance.
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Affiliation(s)
- Agrayan K. Gupta
- Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Xiaochun Li
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Joshua R. Vest
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States
| | - Shaun J. Grannis
- Indiana University School of Medicine, Indianapolis, Indiana, United States
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States
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2
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Gupta AK, Kasthurirathne SN, Xu H, Li X, Ruppert MM, Harle CA, Grannis SJ. A framework for a consistent and reproducible evaluation of manual review for patient matching algorithms. J Am Med Inform Assoc 2022; 29:2105-2109. [DOI: 10.1093/jamia/ocac175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/05/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Healthcare systems are hampered by incomplete and fragmented patient health records. Record linkage is widely accepted as a solution to improve the quality and completeness of patient records. However, there does not exist a systematic approach for manually reviewing patient records to create gold standard record linkage data sets. We propose a robust framework for creating and evaluating manually reviewed gold standard data sets for measuring the performance of patient matching algorithms. Our 8-point approach covers data preprocessing, blocking, record adjudication, linkage evaluation, and reviewer characteristics. This framework can help record linkage method developers provide necessary transparency when creating and validating gold standard reference matching data sets. In turn, this transparency will support both the internal and external validity of recording linkage studies and improve the robustness of new record linkage strategies.
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Affiliation(s)
| | - Suranga N Kasthurirathne
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana, USA
- Department of Family Medicine, Indiana University School of Medicine , Indianapolis, Indiana, USA
- Black Dog Institute, University of New South Wales , Sydney, New South Wales, Australia
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine , Indianapolis, Indiana, USA
| | - Xiaochun Li
- Department of Biostatistics, Indiana University School of Medicine , Indianapolis, Indiana, USA
| | - Matthew M Ruppert
- Department of Medicine, University of Florida Health , Gainesville, Florida, USA
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida , Gainesville, Florida, USA
| | - Christopher A Harle
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida , Gainesville, Florida, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana, USA
- Department of Family Medicine, Indiana University School of Medicine , Indianapolis, Indiana, USA
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3
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Hatch B, Tillotson C, Hoopes M, Huguet N, Marino M, DeVoe J. Patient-level factors associated with receipt of preventive care in the safety net. Prev Med 2022; 158:107024. [PMID: 35331782 PMCID: PMC9231228 DOI: 10.1016/j.ypmed.2022.107024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Prevention is critical to optimizing health, yet most people do not receive all recommended preventive services. As the complexity of preventive recommendations increases, there is a need for new measurements to capture the degree to which a person is up to date, and identify individual-level barriers and facilitators to receiving needed preventive care. We used electronic health record data from a national network of community health centers (CHCs) in the United States (US) during 2014-2017 to measure patient-level up-to-date status with preventive ratios (measuring up-to-date person-time denoted as a percent) for 12 preventive services and an aggregate preventive index. We use negative binomial regression to identify factors associated with up-to-date preventive care. We assessed 267,767 patients across 165 primary care clinics. Mean preventive ratios ranged from 8.7% for Hepatitis C screening to 83.3% for blood pressure screening. The mean aggregate preventive index was 43%. Lack of health insurance, smoking, and homelessness were associated with lower preventive ratios for most cancer and cardiovascular screenings (p < 0.05). Having more ambulatory visits, better continuity of care, and enrollment in the patient portal were positively associated with the aggregate preventive index (p < 0.05) and higher preventive ratios for all services (p < 0.05) except chlamydia and HIV screening. Overall, receipt of preventive services was low. CHC patients experience many barriers to receiving needed preventive care, but certain healthcare behaviors - regular visits, usual provider continuity, and patient portal enrollment - were consistently associated with more up-to-date preventive care. These associations should inform future efforts to improve preventive care delivery.
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Affiliation(s)
- Brigit Hatch
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America; OCHIN, 1881 SW Naito Pkwy, Portland, OR 97291, United States of America.
| | - Carrie Tillotson
- OCHIN, 1881 SW Naito Pkwy, Portland, OR 97291, United States of America
| | - Megan Hoopes
- OCHIN, 1881 SW Naito Pkwy, Portland, OR 97291, United States of America
| | - Nathalie Huguet
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Miguel Marino
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America; Oregon Health & Science University-Portland State University, School of Public Health, Biostatistics Group, United States of America
| | - Jennifer DeVoe
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
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4
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Voss RW, Schmidt TD, Weiskopf N, Marino M, Dorr DA, Huguet N, Warren N, Valenzuela S, O’Malley J, Quiñones AR. Comparing ascertainment of chronic condition status with problem lists versus encounter diagnoses from electronic health records. J Am Med Inform Assoc 2022; 29:770-778. [PMID: 35165743 PMCID: PMC9006679 DOI: 10.1093/jamia/ocac016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess and compare electronic health record (EHR) documentation of chronic disease in problem lists and encounter diagnosis records among Community Health Center (CHC) patients. MATERIALS AND METHODS We assessed patient EHR data in a large clinical research network during 2012-2019. We included CHCs who provided outpatient, older adult primary care to patients age ≥45 years, with ≥2 office visits during the study. Our study sample included 1 180 290 patients from 545 CHCs across 22 states. We used diagnosis codes from 39 Chronic Condition Warehouse algorithms to identify chronic conditions from encounter diagnoses only and compared against problem list records. We measured correspondence including agreement, kappa, prevalence index, bias index, and prevalence-adjusted bias-adjusted kappa. RESULTS Overlap of encounter diagnosis and problem list ascertainment was 59.4% among chronic conditions identified, with 12.2% of conditions identified only in encounters and 28.4% identified only in problem lists. Rates of coidentification varied by condition from 7.1% to 84.4%. Greatest agreement was found in diabetes (84.4%), HIV (78.1%), and hypertension (74.7%). Sixteen conditions had <50% agreement, including cancers and substance use disorders. Overlap for mental health conditions ranged from 47.4% for anxiety to 59.8% for depression. DISCUSSION Agreement between the 2 sources varied substantially. Conditions requiring regular management in primary care settings may have a higher agreement than those diagnosed and treated in specialty care. CONCLUSION Relying on EHR encounter data to identify chronic conditions without reference to patient problem lists may under-capture conditions among CHC patients in the United States.
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Affiliation(s)
| | | | - Nicole Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Steele Valenzuela
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Ana R Quiñones
- Corresponding Author: Ana R. Quiñones, Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., FM, Portland, OR 97239, USA;
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5
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Hoopes M, Voss R, Angier H, Marino M, Schmidt T, DeVoe JE, Soule J, Huguet N. Assessing Cancer History Accuracy in Primary Care Electronic Health Records Through Cancer Registry Linkage. J Natl Cancer Inst 2021; 113:924-932. [PMID: 33377908 PMCID: PMC8246795 DOI: 10.1093/jnci/djaa210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/23/2020] [Accepted: 12/14/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many cancer survivors receive primary care in community health centers (CHCs). Cancer history is an important factor to consider in the provision of primary care, yet little is known about the completeness or accuracy of cancer history data contained in CHC electronic health records (EHRs). METHODS We probabilistically linked EHR data from more than1.5 million adult CHC patients to state cancer registries in California, Oregon, and Washington and estimated measures of agreement (eg, kappa, sensitivity, specificity). We compared demographic and clinical characteristics of cancer patients as estimated by each data source, evaluating distributional differences with absolute standardized mean differences. RESULTS A total 74 707 cancer patients were identified between the 2 sources (EHR only, n = 22 730; registry only, n = 23 616; both, n = 28 361). Nearly one-half of cancer patients identified in registries were missing cancer documentation in the EHR. Overall agreement of cancer ascertainment in the EHR vs cancer registries (gold standard) was moderate (kappa = 0.535). Cancer site-specific agreement ranged from substantial (eg, prostate and female breast; kappa > 0.60) to fair (melanoma and cervix; kappa < 0.40). Comparing population characteristics of cancer patients as ascertained from each data source, groups were similar for sex, age, and federal poverty level, but EHR-recorded cases showed greater medical complexity than those ascertained from cancer registries. CONCLUSIONS Agreement between EHR and cancer registry data was moderate and varied by cancer site. These findings suggest the need for strategies to improve capture of cancer history information in CHC EHRs to ensure adequate delivery of care and optimal health outcomes for cancer survivors.
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Affiliation(s)
| | | | - Heather Angier
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jeffrey Soule
- Oregon State Cancer Registry, Oregon Health Authority, Portland, OR, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
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6
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Grape A, Wicks M, Tumiel-Berhalter L, Sloand E, Rhee H. Enhanced access to healthcare utilization data through medical record review: Lessons learned from a community-based, multi-site project. Res Nurs Health 2021; 44:724-731. [PMID: 34114246 DOI: 10.1002/nur.22160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/08/2021] [Accepted: 05/31/2021] [Indexed: 11/07/2022]
Abstract
Collecting accurate healthcare utilization (HCU) data on community-based interventions is essential to establishing their clinical effectiveness and cost-related impact. Strategies used to enhance receiving medical records for HCU data extraction in a multi-site longitudinal randomized control trial with urban adolescents are presented. Successful strategies included timely assessment of procedures and practice preferences for access to electronic health records and hardcopy medical charts. Repeated outreach to clinical practice sites to identify and accommodate their preferred procedure for medical record release and flexibility in obtaining chart information helped achieve a 75% success rate in this study. Maintaining participant contact, updating provider information, and continuously evaluating site-specific personnel needs are recommended.
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Affiliation(s)
- Annette Grape
- Department of Social Work, SUNY Brockport, Brockport, New York, USA
| | - Mona Wicks
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Elizabeth Sloand
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hyekyun Rhee
- School of Nursing, University of Rochester, Rochester, New York, USA
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7
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Boniface ER, Rodriguez MI, Heintzman J, Knipper S, Jacobs R, Darney BG. Contraceptive provision in Oregon school-based health centers: Method type trends and the role of Title X. Contraception 2021; 104:206-210. [PMID: 33781759 DOI: 10.1016/j.contraception.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We describe provision of contraception to adolescents at Oregon school-based health centers (SBHCs). We examine trends over time, by race/ethnicity, and by Title X clinic status and test whether these factors are associated with provision of long-acting reversible contraception (LARC; intrauterine devices/IUDs and implants). STUDY DESIGN We conducted a retrospective cohort study of 33 SBHCs participating in a shared electronic health record 2012-2016. We identified 20,339 contraception provision visits to 5,934 adolescent females ages 14-19 using diagnosis and procedure codes. We used logistic regression to evaluate the association of clinic Title X status, race/ethnicity, and year with receipt of LARC, controlling for individual-, clinic-, and residence-level factors. We calculated adjusted probabilities. RESULTS Provision of IUDs and implants increased at Oregon SBHCs between 2012 and 2016. IUD provision increased almost 5-fold, (from 0.9% to 4.4% of contraception provision visits), and implants increased approximately 6.5-fold (from 1.1% to 7.2%). More adolescent contraception provision visits occurred at Title X SBHCs, which had greater than twice the adjusted probability of providing LARCs than non-Title X SBHCs (4.4% versus 1.7%). After adjusting for adolescent-, clinic-, and residence-level covariates, non-white adolescents had lower probabilities of receiving LARC methods than white adolescents. CONCLUSIONS SBHCs play an important role in providing access to contraceptive services to adolescents in Oregon. Access to IUDs and implants is increasing over time in SBHCs, particularly those that participate in the Title X program. IMPLICATIONS Adolescents have expanding access to IUDs and implants in SBHCs over time in Oregon. Participation in the Title X program can help further increase access to effective contraception in SBHCs.
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Affiliation(s)
- Emily R Boniface
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, United States.
| | - Maria I Rodriguez
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, United States
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Sarah Knipper
- Public Health Division, Oregon Health Authority, Portland, OR, United States
| | - Rebecca Jacobs
- Public Health Division, Oregon Health Authority, Portland, OR, United States
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, United States; OHSU-Portland State University School of Public Health, Portland, OR, United States; Center for Population Health Research, National Institute of Public Health, Morelos, Mexico
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8
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Ukhanova MA, Tillotson CJ, Marino M, Huguet N, Quiñones AR, Hatch BA, Schmidt T, DeVoe JE. Uptake of Preventive Services Among Patients With and Without Multimorbidity. Am J Prev Med 2020; 59:621-629. [PMID: 32978012 PMCID: PMC7577968 DOI: 10.1016/j.amepre.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/12/2020] [Accepted: 04/27/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with multiple chronic conditions (multimorbidity) are seen commonly in primary care practices and often have suboptimal uptake of preventive care owing to competing treatment demands. The complexity of multimorbidity patterns and their impact on receiving preventive services is not fully understood. This study identifies multimorbidity combinations associated with low receipt of preventive services. METHODS This was a retrospective cohort study of U.S. community health center patients aged ≥19 years. Electronic health record data from 209 community health centers for the January 1, 2014-December 31, 2017 study period were analyzed in 2018-2019. Multimorbidity patterns included physical only, mental health only, and physical and mental health multimorbidity patterns, with no multimorbidity as a reference category. Electronic health record-based preventive ratios (number of months services were up-to-date/total months the patient was eligible for services) were calculated for the 14 preventive services. Negative binomial regression models assessed the relationship between multimorbidity physical and/or mental health patterns and the preventive ratio for each service. RESULTS There was a variation in receipt of preventive care between multimorbidity groups: individuals with mental health only multimorbidity were less likely to be up-to-date with cardiometabolic and cancer screenings than the no multimorbidity group or groups with physical health conditions, and the physical only multimorbidity group had low rates of depression screening. CONCLUSIONS This study provided critical insights into receipt of preventive service among adults with multimorbidity using a more precise method for measuring up-to-date preventive care delivery. Findings would be useful to identify target populations for future intervention programs to improve preventive care.
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Affiliation(s)
- Maria A Ukhanova
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; Division of Biostatistics, School of Public Health, Oregon Health & Science University - Portland State University, Portland, Oregon
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brigit A Hatch
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; Research Department, OCHIN Inc., Portland, Oregon
| | | | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
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9
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Barlow WE, Beaber EF, Geller BM, Kamineni A, Zheng Y, Haas JS, Chao CR, Rutter CM, Zauber AG, Sprague BL, Halm EA, Weaver DL, Chubak J, Doria-Rose VP, Kobrin S, Onega T, Quinn VP, Schapira MM, Tosteson ANA, Corley DA, Skinner CS, Schnall MD, Armstrong K, Wheeler CM, Silverberg MJ, Balasubramanian BA, Doubeni CA, McLerran D, Tiro JA. Evaluating Screening Participation, Follow-up, and Outcomes for Breast, Cervical, and Colorectal Cancer in the PROSPR Consortium. J Natl Cancer Inst 2020; 112:238-246. [PMID: 31292633 DOI: 10.1093/jnci/djz137] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/11/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer screening is a complex process encompassing risk assessment, the initial screening examination, diagnostic evaluation, and treatment of cancer precursors or early cancers. Metrics that enable comparisons across different screening targets are needed. We present population-based screening metrics for breast, cervical, and colorectal cancers for nine sites participating in the Population-based Research Optimizing Screening through Personalized Regimens consortium. METHODS We describe how selected metrics map to a trans-organ conceptual model of the screening process. For each cancer type, we calculated calendar year 2013 metrics for the screen-eligible target population (breast: ages 40-74 years; cervical: ages 21-64 years; colorectal: ages 50-75 years). Metrics for screening participation, timely diagnostic evaluation, and diagnosed cancers in the screened and total populations are presented for the total eligible population and stratified by age group and cancer type. RESULTS The overall screening-eligible populations in 2013 were 305 568 participants for breast, 3 160 128 for cervical, and 2 363 922 for colorectal cancer screening. Being up-to-date for testing was common for all three cancer types: breast (63.5%), cervical (84.6%), and colorectal (77.5%). The percentage of abnormal screens ranged from 10.7% for breast, 4.4% for cervical, and 4.5% for colorectal cancer screening. Abnormal breast screens were followed up diagnostically in almost all (96.8%) cases, and cervical and colorectal were similar (76.2% and 76.3%, respectively). Cancer rates per 1000 screens were 5.66, 0.17, and 1.46 for breast, cervical, and colorectal cancer, respectively. CONCLUSIONS Comprehensive assessment of metrics by the Population-based Research Optimizing Screening through Personalized Regimens consortium enabled systematic identification of screening process steps in need of improvement. We encourage widespread use of common metrics to allow interventions to be tested across cancer types and health-care settings.
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Affiliation(s)
| | - Elisabeth F Beaber
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Berta M Geller
- Departments of Family Medicine, and the University of Vermont Cancer Center, University of Vermont, Burlington, VT
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Dana Farber, Harvard Cancer Institute, Harvard School of Public Health, Boston, MA
| | - Chun R Chao
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Ann G Zauber
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont, Burlington, VT
| | - Ethan A Halm
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.,Simmons Comprehensive Cancer Center, Dallas, TX
| | - Donald L Weaver
- Department of Pathology and the UVM Cancer Center, University of Vermont, Burlington, VT
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - V Paul Doria-Rose
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Sarah Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Tracy Onega
- Departments of Biomedical Data Science, Epidemiology, and the Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | | | - Marilyn M Schapira
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, and CMC VA Medical Center, Philadelphia, PA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Celette Sugg Skinner
- Simmons Comprehensive Cancer Center, Dallas, TX.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mitchell D Schnall
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Katrina Armstrong
- General Medicine Division, MA General Hospital, Harvard Medical School, Boston, MA
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Science Center, Albuquerque, NM.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | - Bijal A Balasubramanian
- Simmons Comprehensive Cancer Center, Dallas, TX.,UTHealth School of Public Health, Dallas, TX
| | - Chyke A Doubeni
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Dale McLerran
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jasmin A Tiro
- Simmons Comprehensive Cancer Center, Dallas, TX.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
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10
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Macinski SE, Gunn JKL, Goyal M, Neighbors C, Yerneni R, Anderson BJ. Validation of an Optimized Algorithm for Identifying Persons Living With Diagnosed HIV From New York State Medicaid Data, 2006-2014. Am J Epidemiol 2020; 189:470-480. [PMID: 31612200 PMCID: PMC7306686 DOI: 10.1093/aje/kwz225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 11/14/2022] Open
Abstract
Algorithms are regularly used to identify persons living with diagnosed human immunodeficiency virus (HIV) (PLWDH) in Medicaid data. To our knowledge, there are no published reports of an HIV algorithm from Medicaid claims codes that have been compared with an HIV surveillance system to assess its sensitivity, specificity, positive predictive value, and negative predictive value in identifying PLWDH. Therefore, our aims in this study were to 1) develop an algorithm that could identify PLWDH in New York State Medicaid data from 2006-2014 and 2) validate this algorithm using the New York State HIV surveillance system. Classification and regression tree analysis identified 16 nodes that we combined to create a case-finding algorithm with 5 criteria. This algorithm identified 86,930 presumed PLWDH, 88.0% of which were verified by matching to the surveillance system. The algorithm yielded a sensitivity of 94.5%, a specificity of 94.4%, a positive predictive value of 88.0%, and a negative predictive value of 97.6%. This validated algorithm has the potential to improve the utility of Medicaid data for assessing health outcomes and programmatic interventions.
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Affiliation(s)
- Sarah E Macinski
- Correspondence to Sarah E. Macinski, Bureau of HIV/AIDS Epidemiology, AIDS Institute, New York State Department of Health, Empire State Plaza, Corning Tower, Room 717, Albany, NY 12237-0627 (e-mail: )
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11
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Darney BG, Biel FM, Rodriguez MI, Jacob RL, Cottrell EK, DeVoe JE. Payment for Contraceptive Services in Safety Net Clinics: Roles of Affordable Care Act, Title X, and State Programs. Med Care 2020; 58:453-460. [PMID: 32049877 PMCID: PMC7148195 DOI: 10.1097/mlr.0000000000001309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We describe payor for contraceptive visits 2013-2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs. METHODS Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10-49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities. RESULTS We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference: -1.29 percentage points; confidence interval: -1.39 to -1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states. CONCLUSIONS Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy.
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Affiliation(s)
- Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
- National Institute of Public Health, Population Research Center (INSP/CISP), Cuernavaca, Morelos, Mexico
- OHSU-PSU School of Public Health
| | - Frances M Biel
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | | | | | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
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Martin MA, Bisarini R, Roy A, Mosnaim G, Rosales G, Weinstein S, Walton SM. Implementation Lessons From a Randomized Trial Integrating Community Asthma Education for Children. J Ambul Care Manage 2020; 43:125-135. [PMID: 32073501 PMCID: PMC8329939 DOI: 10.1097/jac.0000000000000326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study characterized and compared the implementation of clinically integrated community health workers (CHWs) to a certified asthma educator (AE-C) for low-income children with asthma. In the AE-C arm (N = 115), 51.3% completed at least one in-clinic education session. In the CHW arm (N = 108), 722 home visits were completed. The median number of visits was 7 (range, 0-17). Scheduled in-clinic asthma education may not be the optimal intervention for this patient population. CHW visit completion rates suggest that the schedule, location, and content of CHW asthma services better met patients' needs. Seven to 10 visits seemed to be the preferred CHW dose.
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Affiliation(s)
- Molly A Martin
- University of Illinois at Chicago (Drs Martin, Bisarini, Weinstein, and Walton and Ms Rosales); Erie Family Health Center, Chicago, Illinois (Dr Roy); and Northshore University Health System, Evanston, Illinois (Dr Mosnaim)
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13
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Prevalence of Cervical Cancer Overscreening: Review of a Wellness Registry. Comput Inform Nurs 2020; 38:459-465. [PMID: 32168022 DOI: 10.1097/cin.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Appropriately matching preventive health services and screenings with patient risk is an important quality indicator. Adherence by both providers and patients to cervical cancer screening guidelines has been inconsistent, resulting in overscreening and increased costs. This study examined the prevalence of cervical cancer overscreening following changes in screening guidelines in a wellness registry database. Cervical cancer overscreening after guideline implementation decreased for 18- to 20-year-old patients from 26.8% to 24.8% (P < .001) and increased for those aged 65 years and older from 11.1% to 12.5% (P = .0005). Black race, Hispanic ethnicity, Medicaid insurance, and the presence of a personal health record were associated with overscreening. Reliability and accuracy of data are a concern when data intended for one purpose, such as clinical care, are used for research. Correctly identifying screening tests in the electronic health record is important so that appropriate screening can be reliably assessed. In this study on the prevalence of cervical cancer overscreening, we used a focused chart review to identify whether screening Pap tests were accurately identified in the electronic medical record. Pap tests were correctly identified as screening in 85% of those aged 18 to 20, and in 74% of those aged 65 and older.
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Bonafede MM, Miller JD, Pohlman SK, Troeger KA, Sprague BL, Herschorn SD, Winer IH. Breast, Cervical, and Colorectal Cancer Screening: Patterns Among Women With Medicaid and Commercial Insurance. Am J Prev Med 2019; 57:394-402. [PMID: 31377088 PMCID: PMC7433028 DOI: 10.1016/j.amepre.2019.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Despite healthcare reforms mandating expanded insurance coverage and reduced out-of-pocket costs for preventive care, cancer screening rates remain relatively static. No study has measured cancer screening rates for multiple tests among non-Medicare patients. METHODS This retrospective, population-based claims analysis, conducted in 2016-2017, of commercially insured and Medicaid-insured women aged 30-59 years enrolled in IBM MarketScan Commercial and Medicaid Databases (containing approximately 90 and 17 million enrollees, respectively) during 2010-2015 describes screening rates for breast, cervical, and colorectal cancer. Key outcomes were (1) proportion screened for breast, cervical, and colorectal cancer among the age-eligible population compared with accepted age-based recommendations and (2) proportion with longer-than-recommended intervals between tests. RESULTS One half (54.7%) of commercially insured women aged 40-59 years (n=1,538,444) were screened three or more times during the 6-year study period for breast cancer; for Medicaid-insured women (n=78,897), the rates were lower (23.7%). One third (43.4%) of commercially insured and two thirds (68.9%) of Medicaid-insured women had a >2.5-year gap between mammograms. Among women aged 30-59 years, 59.3% of commercially insured women and 31.4% of Medicaid-insured women received two or more Pap tests. The proportion of patients with a >3.5-year gap between Pap tests was 33.9% (commercially insured) and 57.1% (Medicaid-insured). Among women aged 50-59 years, 63.3% of commercially insured women and 47.2% of Medicaid-insured women were screened at least one time for colorectal cancer. Almost all women aged 30-59 years (commercially insured, 99.1%; Medicaid-insured, 98.9%) had at least one healthcare encounter. CONCLUSIONS Breast and cervical cancer screenings remain underutilized among both commercially insured and Medicaid-insured populations, with lower rates among the Medicaid-insured population. However, almost all women had at least one healthcare encounter, suggesting opportunities for better coordinated care.
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Affiliation(s)
| | | | - Scott K Pohlman
- Outcomes Research, Hologic, Inc., Marlborough, Massachusetts
| | | | - Brian L Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont; Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
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Hatch BA, Tillotson CJ, Huguet N, Hoopes MJ, Marino M, DeVoe JE. Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care. Am J Prev Med 2019; 57:241-249. [PMID: 31326008 PMCID: PMC6684138 DOI: 10.1016/j.amepre.2019.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applies a new measurement approach and assesses clinic-level factors associated with preventive care delivery. METHODS This retrospective longitudinal cohort study of 94 community health centers used electronic health record data from the OCHIN community health information network, 2014-2015. Clinic-level preventive ratios (time covered by a preventive service/time eligible for a preventive service) were calculated in 2017 for 12 preventive services with A or B recommendations from the U.S. Preventive Services Task Force along with an aggregate preventive index for all services combined. For each service, multivariable negative binomial regression modeling and calculated rate ratios assessed the association between clinic-level variables and delivery of care. RESULTS Of ambulatory community health center visits, 59.8% were Medicaid-insured and 10.4% were uninsured. Ambulatory community health centers served 16.9% patients who were Hispanic, 13.1% who were nonwhite, and 68.7% who had household incomes <138% of the federal poverty line. Clinic-level preventive ratios ranged from 3% (hepatitis C screening) to 93% (blood pressure screening). The aggregate preventive index including all screening measures was 47% (IQR, 42%-50%). At the clinic level, having a higher percentage of uninsured visits was associated with lower preventive ratios for most (7 of 12) preventive services. CONCLUSIONS Approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time. Health insurance remains strongly associated with access to needed preventive care, even for safety net clinic populations.
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Affiliation(s)
- Brigit A Hatch
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon.
| | | | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; Biostatistics Group, Portland State University School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon
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Marino M, Angier H, Valenzuela S, Hoopes M, Killerby M, Blackburn B, Huguet N, Heintzman J, Hatch B, O'Malley JP, DeVoe JE. Medicaid coverage accuracy in electronic health records. Prev Med Rep 2018; 11:297-304. [PMID: 30116701 PMCID: PMC6082971 DOI: 10.1016/j.pmedr.2018.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 01/21/2023] Open
Abstract
Health insurance coverage facilitates access to preventive screenings and other essential health care services, and is linked to improved health outcomes; therefore, it is critical to understand how well coverage information is documented in the electronic health record (EHR) and which characteristics are associated with accurate documentation. Our objective was to evaluate the validity of EHR data for monitoring longitudinal Medicaid coverage and assess variation by patient demographics, visit types, and clinic characteristics. We conducted a retrospective, observational study comparing Medicaid status agreement between Oregon community health center EHR data linked at the patient-level to Medicaid enrollment data (gold standard). We included adult patients with a Medicaid identification number and ≥1 clinic visit between 1/1/2013-12/31/2014 [>1 million visits (n = 135,514 patients)]. We estimated statistical correspondence between EHR and Medicaid data at each visit (visit-level) and for different insurance cohorts over time (patient-level). Data were collected in 2016 and analyzed 2017-2018. We observed excellent agreement between EHR and Medicaid data for health insurance information: kappa (>0.80), sensitivity (>0.80), and specificity (>0.85). Several characteristics were associated with agreement; at the visit-level, agreement was lower for patients who preferred a non-English language and for visits missing income information. At the patient-level, agreement was lower for black patients and higher for older patients seen in primary care community health centers. Community health center EHR data are a valid source of Medicaid coverage information. Agreement varied with several characteristics, something researchers and clinic staff should consider when using health insurance information from EHR data.
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Affiliation(s)
- Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.,School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Steele Valenzuela
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Marie Killerby
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brenna Blackburn
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brigit Hatch
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.,OCHIN, Portland, OR, USA
| | - Jean P O'Malley
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.,OCHIN, Portland, OR, USA
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.,OCHIN, Portland, OR, USA
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Ter-Minassian M, Lanzkron S, Derus A, Brown E, Horberg MA. Quality Metrics and Health Care Utilization for Adult Patients with Sickle Cell Disease. J Natl Med Assoc 2018; 111:54-61. [PMID: 30129484 DOI: 10.1016/j.jnma.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/09/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND To date, there are no standardized, well-accepted, quality metrics that guide care for adults with sickle cell disease (SCD). The primary objective of this study was to evaluate the quality metrics that are in use at the Adult Sickle Cell Disease Program at Johns Hopkins Hospital (JHH) and the applicability of the metrics to Kaiser Permanente Mid-Atlantic States (KPMAS), an integrated healthcare system with a developing adult sickle cell disease program. METHODS We performed a retrospective cross-sectional study of 146 KPMAS and 308 JHH patients from January 1, 2014-December 31, 2015. Demographics, genotype and data on several key quality metrics (yearly screening labs, documented vaccinations and appropriate hydroxyurea prescriptions) were collected from electronic health records (EPIC Systems). We defined hydroxyurea adherence as having had at least 6 months of refills prescribed during the two years of study by either EHR or patient report. RESULTS Patients at KPMAS were older than those at JHH (median age 44 and 33 respectively) and less likely to have hemoglobin SS disease (29% and 66% respectively). Among KPMAS patients, 85% had documentation of any pneumococcal vaccination compared to 87% at JHH. 21 of 54 eligible patients at KPMAS and 95 of 165 eligible patients at JHH were prescribed hydroxyurea. At both institutions, 62% of patients were adherent to hydroxyurea. There were limitations to diagnosis coding and availability of vaccination and refill documentation. CONCLUSIONS Interventions to improve preventative care adherence are needed to improve outcomes in both academic medical centers and integrated health systems.
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Affiliation(s)
- Monica Ter-Minassian
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
| | - Sophie Lanzkron
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alphonse Derus
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Elizabeth Brown
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
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Use of a prescription opioid registry to examine opioid misuse and overdose in an integrated health system. Prev Med 2018; 110:31-37. [PMID: 29410132 PMCID: PMC6034705 DOI: 10.1016/j.ypmed.2018.01.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/22/2018] [Accepted: 01/31/2018] [Indexed: 01/03/2023]
Abstract
Strategies are needed to identify at-risk patients for adverse events associated with prescription opioids. This study identified prescription opioid misuse in an integrated health system using electronic health record (EHR) data, and examined predictors of misuse and overdose. The sample included patients from an EHR-based registry of adults who used prescription opioids in 2011 in Kaiser Permanente Northern California, a large integrated health care system. We characterized time-at-risk for opioid misuse and overdose, and used Cox proportional hazard models to model predictors of these events from 2011 to 2014. Among 396,452 patients, 2.7% were identified with opioid misuse and 1044 had an overdose event. Older patients were less likely to meet misuse criteria or have an overdose. Whites were more likely to be identified with misuse, but not to have an overdose. Alcohol and drug disorders were related to higher risk of misuse and overdose, with the exception that marijuana disorder was not related to opioid misuse. Higher daily opioid dosages and benzodiazepine use increased the risk of both opioid misuse and overdose. We characterized several risk factors associated with misuse and overdose using EHR-based data, which can be leveraged relatively quickly to inform preventive strategies to address the opioid crisis.
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Generalizability of Indicators from the New York City Macroscope Electronic Health Record Surveillance System to Systems Based on Other EHR Platforms. EGEMS 2017; 5:25. [PMID: 29881742 PMCID: PMC5982844 DOI: 10.5334/egems.247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction: The New York City (NYC) Macroscope is an electronic health record (EHR) surveillance system based on a distributed network of primary care records from the Hub Population Health System. In a previous 3-part series published in eGEMS, we reported the validity of health indicators from the NYC Macroscope; however, questions remained regarding their generalizability to other EHR surveillance systems. Methods: We abstracted primary care chart data from more than 20 EHR software systems for 142 participants of the 2013–14 NYC Health and Nutrition Examination Survey who did not contribute data to the NYC Macroscope. We then computed the sensitivity and specificity for indicators, comparing data abstracted from EHRs with survey data. Results: Obesity and diabetes indicators had moderate to high sensitivity (0.81–0.96) and high specificity (0.94–0.98). Smoking status and hypertension indicators had moderate sensitivity (0.78–0.90) and moderate to high specificity (0.88–0.98); sensitivity improved when the sample was restricted to records from providers who attested to Stage 1 Meaningful Use. Hyperlipidemia indicators had moderate sensitivity (≥0.72) and low specificity (≤0.59), with minimal changes when restricting to Stage 1 Meaningful Use. Discussion: Indicators for obesity and diabetes used in the NYC Macroscope can be adapted to other EHR surveillance systems with minimal validation. However, additional validation of smoking status and hypertension indicators is recommended and further development of hyperlipidemia indicators is needed. Conclusion: Our findings suggest that many of the EHR-based surveillance indicators developed and validated for the NYC Macroscope are generalizable for use in other EHR surveillance systems.
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Assessing Community Cancer care after insurance ExpanSionS (ACCESS) study protocol. Contemp Clin Trials Commun 2017; 7:136-140. [PMID: 29473059 PMCID: PMC5819346 DOI: 10.1016/j.conctc.2017.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Cancer is the second most common cause of mortality in the United States. Cancer screening and prevention services have contributed to improved overall cancer survival rates in the past 40 years. Vulnerable populations (i.e., uninsured, low-income, and racial/ethnic minorities) are disproportionately affected by cancer, receive significantly fewer cancer prevention services, poorer healthcare, and subsequently lower survival rates than insured, white, non-Hispanic populations. The Affordable Care Act (ACA) aims to provide health insurance to all low-income citizens and legal residents, including an expansion of Medicaid eligibility for those earning ≤138% of federal poverty level. As of 2012, Medicaid was expanded in 32 states and the District of Columbia, while 18 states did not expand, creating a ‘natural experiment’ to assess the impact of Medicaid expansion on cancer prevention and care. Methods We will use electronic health record data from up to 990 community health centers available up to 24-months before and at least one year after Medicaid expansion. Primary outcomes include health insurance and coverage status, and type of insurance. Additional outcomes include healthcare delivery, number and types of encounters, and receipt of cancer prevention and screening for all patients and preventive care and screening services for cancer survivors. Discussion Cancer morbidity and mortality is greatly reduced through screening and prevention, but uninsured patients are much less likely than insured patients to receive these services as recommended. This natural policy experiment will provide valuable information about cancer-related healthcare services as the US tackles the distribution of healthcare resources and future health reform. Trial Registration Clinicaltrails.gov identifier NCT02936609.
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