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Potter TBH, Pratap S, Nicolas JC, Khan OS, Pan AP, Bako AT, Hsu E, Johnson C, Jefferson IN, Adegbindin SK, Baig E, Kelly HR, Jones SL, Britz GW, Tannous J, Vahidy FS. A Neuro-Informatics Pipeline for Cerebrovascular Disease: Research Registry Development. JMIR Form Res 2023; 7:e40639. [PMID: 37477961 PMCID: PMC10403790 DOI: 10.2196/40639] [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: 06/30/2022] [Revised: 02/28/2023] [Accepted: 04/07/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Although stroke is well recognized as a critical disease, treatment options are often limited. Inpatient stroke encounters carry critical information regarding the mechanisms of stroke and patient outcomes; however, these data are typically formatted to support administrative functions instead of research. To support improvements in the care of patients with stroke, a substantive research data platform is needed. OBJECTIVE To advance a stroke-oriented learning health care system, we sought to establish a comprehensive research repository of stroke data using the Houston Methodist electronic health record (EHR) system. METHODS Dedicated processes were developed to import EHR data of patients with primary acute ischemic stroke, intracerebral hemorrhage (ICH), transient ischemic attack, and subarachnoid hemorrhage under a review board-approved protocol. Relevant patients were identified from discharge diagnosis codes and assigned registry patient identification numbers. For identified patients, extract, transform, and load processes imported EHR data of primary cerebrovascular disease admissions and available data from any previous or subsequent admissions. Data were loaded into patient-focused SQL objects to enable cross-sectional and longitudinal analyses. Primary data domains (admission details, comorbidities, laboratory data, medications, imaging data, and discharge characteristics) were loaded into separate relational tables unified by patient and encounter identification numbers. Computed tomography, magnetic resonance, and angiography images were retrieved. Imaging data from patients with ICH were assessed for hemorrhage characteristics and cerebral small vessel disease markers. Patient information needed to interface with other local and national databases was retained. Prospective patient outreach was established, with patients contacted via telephone to assess functional outcomes 30, 90, 180, and 365 days after discharge. Dashboards were constructed to provide investigators with data summaries to support access. RESULTS The Registry of Neurological Endpoint Assessments among Patients with Ischemic and Hemorrhagic Stroke (REINAH) database was constructed as a series of relational category-specific SQL objects. Encounter summaries and dashboards were constructed to draw from these objects, providing visual data summaries for investigators seeking to build studies based on REINAH data. As of June 2022, the database contains 18,061 total patients, including 1809 (10.02%) with ICH, 13,444 (74.43%) with acute ischemic stroke, 1221 (6.76%) with subarachnoid hemorrhage, and 3165 (17.52%) with transient ischemic attack. Depending on the cohort, imaging data from computed tomography are available for 85.83% (1048/1221) to 98.4% (1780/1809) of patients, with magnetic resonance imaging available for 27.85% (340/1221) to 85.54% (11,500/13,444) of patients. Outcome assessment has successfully contacted 56.1% (240/428) of patients after ICH, with 71.3% (171/240) of responders providing consent for assessment. Responders reported a median modified Rankin Scale score of 3 at 90 days after discharge. CONCLUSIONS A highly curated and clinically focused research platform for stroke data will establish a foundation for future research that may fundamentally improve poststroke patient care and outcomes.
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Affiliation(s)
- Thomas B H Potter
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Sharmila Pratap
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Juan Carlos Nicolas
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Osman S Khan
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Alan P Pan
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Abdulaziz T Bako
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Enshuo Hsu
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Carnayla Johnson
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Imory N Jefferson
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | | | - Eman Baig
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Hannah R Kelly
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Stephen L Jones
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Gavin W Britz
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
- Weill Cornell Medicine, New York, NY, United States
- Neurological Institute, Houston Methodist, Houston, TX, United States
| | - Jonika Tannous
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Farhaan S Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
- Weill Cornell Medicine, New York, NY, United States
- Neurological Institute, Houston Methodist, Houston, TX, United States
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Keller MS, Chen X, Godwin J, Needleman J, Pourat N. Evaluating inpatient adverse outcomes under California's Delivery System Reform Incentive Payment Program. Health Serv Res 2020; 56:36-48. [PMID: 32844435 DOI: 10.1111/1475-6773.13550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The California Delivery System Reform Incentive Payment Program (DSRIP) provided incentive payments to Designated Public Hospitals (DPHs) to improve quality of care. We assessed the program's impact on reductions in sepsis mortality, central line-associated bloodstream infections (CLABSIs), venous thromboembolisms (VTEs), and hospital-acquired pressure ulcers (HAPUs). DATA SOURCES We used 2009-2014 discharge data from California hospitals. STUDY DESIGN We used a pre-post study design with a comparison group. We constructed propensity scores and used them to assign inverse probability weights according to their similarity to DPH discharges. Interaction term coefficients of time trends and treatment group provided significance testing. DATA EXTRACTION We used Patient Safety Indicators for CLABSI, HAPU, and VTE, and constructed a sepsis mortality measure. PRINCIPAL FINDINGS Discharges from DPHs and non-DPHs both saw decreases in the four outcomes over the DSRIP period (2010-2014). The difference-in-difference estimator (DD) for sepsis was only significant during two time periods, comparing 2010 with 2012 (DD: -2.90 percent, 95% CI: -5.08, -0.72 percent) and 2010 with 2014 (DD: -5.74, 95% CI: -8.76 percent, -2.72 percent); the DD estimator was not significant comparing 2010 with 2012 (DD: -1.30, 95% CI: -3.18 percent, 0.58 percent) or comparing 2010 with 2013 (DD: -3.05 percent, 95% CI: -6.50 percent, 0.40 percent). For CLABSI, we did not find any meaningful differences between DPHs and non-DPHs across the four time periods. For HAPU and VTE, the only significant DD estimator compared 2014 with 2010. CONCLUSIONS We did not find that DPHs participating in DSRIP outperformed non-DPHs during the DSRIP program. Our results were robust to multiple sensitivity analyses. Given multiple concurrent inpatient safety initiatives, it was challenging to assign improvements over time periods to DSRIP.
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Affiliation(s)
- Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health,, Los Angeles, California, USA
| | - Xiao Chen
- UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Jamie Godwin
- Department of Health Policy and Management, UCLA Fielding School of Public Health,, Los Angeles, California, USA.,UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health,, Los Angeles, California, USA.,UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Nadereh Pourat
- Department of Health Policy and Management, UCLA Fielding School of Public Health,, Los Angeles, California, USA.,UCLA Center for Health Policy Research, Los Angeles, California, USA
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Gotur DB, Masud FN, Ezeana CF, Nisar T, Paranilam J, Chen S, Puppala M, Wong STC, Zimmerman JL. Sepsis outcomes in solid organ transplant recipients. Transpl Infect Dis 2019; 22:e13214. [PMID: 31755202 DOI: 10.1111/tid.13214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/27/2019] [Accepted: 11/10/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND We present data on a cohort of patients diagnosed with sepsis over a 10-year period comparing outcomes in solid organ transplant (SOT) and non-solid organ transplant (non-SOT) recipients. METHODS This is a retrospective single-center study of patients with diagnosis of sepsis from 1/1/06 to 6/30/16. Cases and controls were matched by year of sepsis diagnosis with propensity score matching. Conditional logistic regression and repeated measurement models were performed for binary outcomes. Trends over time for in-hospital mortality were determined using the Cochran-Armitage test. A gamma-distributed model was performed on the continuous variables. RESULTS Overall, there were 18 632 admission encounters with a discharge diagnosis of sepsis in 14 780 unique patients. Of those admissions, 1689 were SOT recipients. After 1:1 matching by year, there were three thousand three hundred and forty patients (1670 cases; 1670 controls) diagnosed with sepsis. There was a decreasing trend for in-hospital mortality for sepsis over time in SOT patients and non-SOT patients (P < .05) due to early sepsis recognition and improved standard of care. Despite higher comorbidities in the SOT group, conditional logistic regression showed that in-hospital mortality for sepsis in SOT patients was similar compared with non-SOT patients (odds ratio [OR] =1.14 [95% confidence interval {CI}, 0.95-1.37], P = .161). However, heart and lung SOT subgroups had higher odds of dying compared with the non-SOT group (OR = 1.83 [95% CI, 1.30-2.57], P < .001 and OR = 1.77 [95% CI, 1.34-2.34], P < .001). On average, SOT patients had 2 days longer hospital length of stay compared with non-SOT admissions (17.00 ± 19.54 vs 15.23 ± 17.07, P < .05). Additionally, SOT patients had higher odds of hospital readmission within 30 days (OR = 1.25 [95% CI, 1.06-1.51], P = .020), and higher odds for DIC compared with non-SOT patients (OR = 1.76 [95% CI, 1.10-2.86], P = .021). CONCLUSION Sepsis in solid organ transplants and non-solid organ transplant patients have similar mortality; however, the subset of heart and lung transplant recipients with sepsis has a higher rate of mortality compared with the non-solid organ transplant recipients. SOT with sepsis as a group has a higher hospital readmission rate compared with non-transplant sepsis patients.
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Affiliation(s)
- Deepa B Gotur
- Weill Cornell Medicine, Houston Methodist Hospital, Houstan, TX, USA
| | | | - Chika F Ezeana
- Informatics Development, Houston Methodist Hospital, Houstan, TX, USA
| | - Tariq Nisar
- Center for Outcomes Research, Houston Methodist Research Institute, Houstan, TX, USA
| | | | - Shenyi Chen
- Informatics Development, Houston Methodist Hospital, Houstan, TX, USA
| | - Mamta Puppala
- Informatics Development, Houston Methodist Hospital, Houstan, TX, USA
| | - Stephen T C Wong
- Institute for Academic Medicine, Houston Methodist Research Institute, Houstan, TX, USA.,Bioinformatics and Biostatistics Cores, Houston Methodist Cancer Center, Houstan, TX, USA.,Weill Cornell Medicine, Houstan, TX, USA
| | - Janice L Zimmerman
- Department of Medicine, Weill Cornell Medicine, Interim Head of Pulmonary, Critical care and Sleep Medicine, Houston Methodist Hospital, Houstan, TX, USA
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Malik AT, Kim J, Yu E, Khan SN. Discharge to Inpatient Care Facility After Anterior Lumbar Interbody Fusion: Incidence, Predictors, and Postdischarge Outcomes. World Neurosurg 2018; 122:e584-e590. [PMID: 31108074 DOI: 10.1016/j.wneu.2018.10.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite a significant number of patients being discharged to inpatient care facilities after anterior lumbar interbody fusion (ALIF), the current literature remains limited regarding the predictors associated with a nonhome discharge and the impact of continued inpatient care in a facility on postdischarge outcomes. METHODS The 2013-2016 American College of Surgeons National Surgical Quality Improvement Program was queried using Current Procedural Terminology (CPT) codes for ALIF (CPT-22558) and additional level fusions (CPT-22585). Discharge to inpatient care facilities included discharge to skilled care facilities and/or inpatient rehabilitation units. RESULTS Independent predictors of an inpatient care facility discharge were age older than 45 years (P < 0.001), female sex (P < 0.001), more than 10% body weight loss in the last 6 months prior to surgery (P=0.012), American Society of Anesthesiologists grade greater than II (P=0.005), undergoing a 2-level (P < 0.001) or more than 2-level fusion (P=0.017), a length of stay greater than 3 days (P < 0.001), and the occurrence of any predischarge complication (P < 0.001). After adjustment for differences in clinical and baseline characteristics between the 2 groups, discharge to an inpatient care facility after ALIF was independently associated with higher odds of any postdischarge complication (P=0.010), postdischarge wound complication (P=0.005), and postdischarge septic complications (P=0.011). No significant impact was seen on 30-day readmissions (P=0.943), 30-day reoperations (P=0.228), and 30-day mortality (P=0.913). CONCLUSIONS With an increasing focus toward minimizing costs associated with postacute care, providers should understand the need of appropriate preoperative risk stratification and construction of care pathways aimed at a home discharge to reduce the occurrence and/or risk of experiencing postdischarge complications.
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Affiliation(s)
- Azeem Tariq Malik
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffery Kim
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elizabeth Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Safdar N Khan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
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Long D, Capan M, Mascioli S, Weldon D, Arnold R, Miller K. Evaluation of User-Interface Alert Displays for Clinical Decision Support Systems for Sepsis. Crit Care Nurse 2018; 38:46-54. [PMID: 30068720 PMCID: PMC6080211 DOI: 10.4037/ccn2018352] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hospitals are increasingly turning to clinical decision support systems for sepsis, a life-threatening illness, to provide patient-specific assessments and recommendations to aid in evidence-based clinical decision-making. Lack of guidelines on how to present alerts has impeded optimization of alerts, specifically, effective ways to differentiate alerts while highlighting important pieces of information to create a universal standard for health care providers. OBJECTIVE To gain insight into clinical decision support systems-based alerts, specifically targeting nursing interventions for sepsis, with a focus on behaviors associated with and perceptions of alerts, as well as visual preferences. METHODS An interactive survey to display a novel user interface for clinical decision support systems for sepsis was developed and then administered to members of the nursing staff. RESULTS A total of 43 nurses participated in 2 interactive survey sessions. Participants preferred alerts that were based on an established treatment protocol, were presented in a pop-up format, and addressed the patient's clinical condition rather than regulatory guidelines. CONCLUSIONS The results can be used in future research to optimize electronic medical record alerting and clinical practice workflow to support the efficient, effective, and timely delivery of high-quality care to patients with sepsis. The research also may advance the knowledge base of what information health care providers want and need to improve the health and safety of their patients.
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Affiliation(s)
- Devida Long
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Muge Capan
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Susan Mascioli
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Danielle Weldon
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Ryan Arnold
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Kristen Miller
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania.
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania.
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety.
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC.
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare.
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Early Identification and Management of Sepsis in Nursing Facilities: Challenges and Opportunities. J Am Med Dir Assoc 2018; 19:465-471. [DOI: 10.1016/j.jamda.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/01/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022]
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