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Makkad H, Saini A, Manning ER, Duan Q, Colegate S, Brokamp C. Racial Fairness of Individual- and Community-Level Proxies of Socioeconomic Status Among Birthing Parent-Child Dyads. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02050-9. [PMID: 38918321 DOI: 10.1007/s40615-024-02050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/17/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND While precision medicine algorithms can be used to improve health outcomes, concerns have been raised about racial equity and unintentional harm from encoded biases. In this study, we evaluated the fairness of using common individual- and community-level proxies of pediatric socioeconomic status (SES) such as insurance status and community deprivation index often utilized in precision medicine algorithms. METHODS Using 2012-2021 vital records obtained from the Ohio Department of Health, we geocoded and matched each residential birth address to a census tract to obtain community deprivation index. We then conducted sensitivity and specificity analyses to determine the degree of match between deprivation index, insurance status, and birthing parent education level for all, Black, and White children to assess if there were differences based on race. RESULTS We found that community deprivation index and insurance status fail to accurately represent individual SES, either alone or in combination. We found that deprivation index had a sensitivity of 61.2% and specificity of 74.1%, while insurance status had a higher sensitivity of 91.6% but lower specificity of 60.1%. Furthermore, these inconsistencies were race-based across all proxies evaluated, with greater sensitivities for Black children but greater specificities for White children. CONCLUSION This may explain some of the racial disparities present in precision medicine algorithms that utilize SES proxies. Future studies should examine how to mitigate the biases introduced by using SES proxies, potentially by incorporating additional data on housing conditions.
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Affiliation(s)
| | - Amisha Saini
- University of Cincinnati College of Medicine, Cincinnati, USA
| | - Erika Rasnick Manning
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45219, USA
| | - Qing Duan
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45219, USA
| | - Stephen Colegate
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45219, USA
| | - Cole Brokamp
- University of Cincinnati College of Medicine, Cincinnati, USA.
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45219, USA.
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2
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Campion TR, Craven CK, Dorr DA, Bernstam EV, Knosp BM. Understanding enterprise data warehouses to support clinical and translational research: impact, sustainability, demand management, and accessibility. J Am Med Inform Assoc 2024; 31:1522-1528. [PMID: 38777803 PMCID: PMC11187432 DOI: 10.1093/jamia/ocae111] [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: 02/16/2024] [Revised: 04/10/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Healthcare organizations, including Clinical and Translational Science Awards (CTSA) hubs funded by the National Institutes of Health, seek to enable secondary use of electronic health record (EHR) data through an enterprise data warehouse for research (EDW4R), but optimal approaches are unknown. In this qualitative study, our goal was to understand EDW4R impact, sustainability, demand management, and accessibility. MATERIALS AND METHODS We engaged a convenience sample of informatics leaders from CTSA hubs (n = 21) for semi-structured interviews and completed a directed content analysis of interview transcripts. RESULTS EDW4R have created institutional capacity for single- and multi-center studies, democratized access to EHR data for investigators from multiple disciplines, and enabled the learning health system. Bibliometrics have been challenging due to investigator non-compliance, but one hub's requirement to link all study protocols with funding records enabled quantifying an EDW4R's multi-million dollar impact. Sustainability of EDW4R has relied on multiple funding sources with a general shift away from the CTSA grant toward institutional and industry support. To address EDW4R demand, institutions have expanded staff, used different governance approaches, and provided investigator self-service tools. EDW4R accessibility can benefit from improved tools incorporating user-centered design, increased data literacy among scientists, expansion of informaticians in the workforce, and growth of team science. DISCUSSION As investigator demand for EDW4R has increased, approaches to tracking impact, ensuring sustainability, and improving accessibility of EDW4R resources have varied. CONCLUSION This study adds to understanding of how informatics leaders seek to support investigators using EDW4R across the CTSA consortium and potentially elsewhere.
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Affiliation(s)
- Thomas R Campion
- Clinical & Translational Science Center, Weill Cornell Medicine, New York, NY 10022, United States
| | - Catherine K Craven
- Division of Clinical Research Informatics, Department of Population Health Sciences, The University of Texas Health San Antonio, San Antonio, TX 78229, United States
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, United States
- Department of Medicine, Oregon Health & Science University, Portland, OR 97239, United States
| | - Elmer V Bernstam
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center, Houston, TX 77030, United States
- Division of General Internal Medicine, McGovern Medical School and Center for Clinical and Translational Sciences, The University of Texas Health Science Center, Houston, TX 77030, United States
| | - Boyd M Knosp
- Roy J. and Lucille A. Carver College of Medicine and the Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA 52242, United States
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3
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Suchy‐Dicey AM, Domoto‐Reilly K, Nelson L, Jayadev S, Buchwald DS, Grabowski TJ, Rhoads K. Epidemiology and prevalence of dementia and Alzheimer's disease in American Indians: Data from the Strong Heart Study. Alzheimers Dement 2024; 20:4174-4184. [PMID: 38747387 PMCID: PMC11180871 DOI: 10.1002/alz.13849] [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: 01/19/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Accurate epidemiologic estimates for dementia are lacking for American Indians, despite substantive social and health disparities. METHODS The Strong Heart Study, a population-based cohort of 11 American Indian tribes, conducted detailed cognitive testing and examinations over two visits approximately 7 years apart. An expert panel reviewed case materials for consensus adjudication of cognitive status (intact; mild cognitive impairment [MCI]; dementia; other impaired/not MCI) and probable etiology (Alzheimer's disease [AD], vascular bain injury [VBI], traumatic brain injury [TBI], other). RESULTS American Indians aged 70-95 years had 54% cognitive impairment including 10% dementia. VBI and AD were primary etiology approximately equal proportions (>40%). Apolipoprotein (APO) Eε4 carriers were more common among those with dementia (p = 0.040). Plasma pTau, glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) were higher among those with cognitive impairment, but not amyloid beta (Aβ). Cognitive intact had mean 3MSE 92.2 (SD 6.4) and mean Montreal Cognitive Assessment (MoCA) score of 21.3 (SD 3.2). DISCUSSION This is the first population-based study to estimate the prevalence of vascular and Alzheimer's dementias in a population-based study of American Indians. HIGHLIGHTS The Strong Heart Study is a population-based cohort of American Indian tribes, conducted over 30+ years and three US geographic regions (Northern Plains, Southern Plains, Southwest). Our teams conducted detailed cognitive testing, neurological examination, and brain imaging over two visits approximately 7 years apart. An expert panel reviewed collected materials for consensus-based adjudication of cognitive status (intact; MCI; dementia; other impaired/not MCI) and probable underlying etiology (AD; VBI; TBI; other). In this cohort of American Indians aged 70-95, 54% were adjudicated with cognitive impairment, including approximately 35% MCI and 10% dementia. These data expand on prior reports from studies using electronic health records, which had suggested prevalence, and incidence of dementia in American Indians to be more comparable to the majority population or non-Hispanic White individuals, perhaps due to latent case undercounts in clinical settings. Vascular and neurodegenerative injuries were approximately equally responsible for cognitive impairment, suggesting that reduction of cardiovascular disease is needed for primary prevention. Traumatic injury was more prevalent than in other populations, and common among those in the "other/not MCI" cognitive impairment category. Mean scores for common dementia screening instruments-even among those adjudicated as unimpaired-were relatively low compared to other populations (mean unimpaired 3MSE 92.2, SD 6.4; mean unimpaired MoCA 21.3, SD 3.2), suggesting the need for cultural and environmental adaptation of common screening and evaluation instruments.
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Affiliation(s)
- Astrid M. Suchy‐Dicey
- Huntington Medical Research InstitutesPasadenaCaliforniaUSA
- Washington State University Elson S Floyd College of MedicineSeattleWashingtonUSA
| | | | - Lonnie Nelson
- Washington State University College of NursingSpokaneWashingtonUSA
| | - Suman Jayadev
- University of Washington School of MedicineSeattleWashingtonUSA
| | - Dedra S. Buchwald
- Washington State University Elson S Floyd College of MedicineSeattleWashingtonUSA
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4
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Owosela BO, Steinberg RS, Leslie SL, Celi LA, Purkayastha S, Shiradkar R, Newsome JM, Gichoya JW. Identifying and improving the "ground truth" of race in disparities research through improved EMR data reporting. A systematic review. Int J Med Inform 2024; 182:105303. [PMID: 38088002 DOI: 10.1016/j.ijmedinf.2023.105303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Studies about racial disparities in healthcare are increasing in quantity; however, they are subject to vast differences in definition, classification, and utilization of race/ethnicity data. Improved standardization of this information can strengthen conclusions drawn from studies using such data. The objective of this study is to examine how data related to race/ethnicity are recorded in research through examining articles on race/ethnicity health disparities and examine problems and solutions in data reporting that may impact overall data quality. METHODS In this systematic review, Business Source Complete, Embase.com, IEEE Xplore, PubMed, Scopus and Web of Science Core Collection were searched for relevant articles published from 2000 to 2020. Search terms related to the concepts of electronic medical records, race/ethnicity, and data entry related to race/ethnicity were used. Exclusion criteria included articles not in the English language and those describing pediatric populations. Data were extracted from published articles. This review was organized and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement for systematic reviews. FINDINGS In this systematic review, 109 full text articles were reviewed. Weaknesses and possible solutions have been discussed in current literature, with the predominant problem and solution as follows: the electronic medical record (EMR) is vulnerable to inaccuracies and incompleteness in the methods that research staff collect this data; however, improved standardization of the collection and use of race data in patient care may help alleviate these inaccuracies. INTERPRETATION Conclusions drawn from large datasets concerning peoples of certain race/ethnic groups should be made cautiously, and a careful review of the methodology of each publication should be considered prior to implementation in patient care.
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Affiliation(s)
- Babajide O Owosela
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Rebecca S Steinberg
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Sharon L Leslie
- Emory University, Woodruff Health Sciences Center Library, Atlanta, GA, USA
| | - Leo A Celi
- Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Saptarshi Purkayastha
- Indiana University-Purdue University Indianapolis, Department of BioHealth Informatics, Indianapolis, IN, USA
| | - Rakesh Shiradkar
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Janice M Newsome
- Emory University School of Medicine, Department of Radiology, Atlanta, GA, USA
| | - Judy W Gichoya
- Emory University School of Medicine, Department of Radiology, Atlanta, GA, USA.
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5
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Johnson JA, Moore B, Hwang EK, Hickner A, Yeo H. The accuracy of race & ethnicity data in US based healthcare databases: A systematic review. Am J Surg 2023; 226:463-470. [PMID: 37230870 DOI: 10.1016/j.amjsurg.2023.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/14/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The availability and accuracy of data on a patient's race/ethnicity varies across databases. Discrepancies in data quality can negatively impact attempts to study health disparities. METHODS We conducted a systematic review to organize information on the accuracy of race/ethnicity data stratified by database type and by specific race/ethnicity categories. RESULTS The review included 43 studies. Disease registries showed consistently high levels of data completeness and accuracy. EHRs frequently showed incomplete and/or inaccurate data on the race/ethnicity of patients. Databases had high levels of accurate data for White and Black patients but relatively high levels of misclassification and incomplete data for Hispanic/Latinx patients. Asians, Pacific Islanders, and AI/ANs are the most misclassified. Systems-based interventions to increase self-reported data showed improvement in data quality. CONCLUSION Data on race/ethnicity that is collected with the purpose of research and quality improvement appears most reliable. Data accuracy can vary by race/ethnicity status and better collection standards are needed.
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Affiliation(s)
- Josh A Johnson
- Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | | | - Eun Kyeong Hwang
- State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Andy Hickner
- Samuel J. Wood Library, Weill Cornell Medicine, New York, NY, USA
| | - Heather Yeo
- Department of Surgery, Department of Population Health Sciences, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
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6
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Lewis AE, Weiskopf N, Abrams ZB, Foraker R, Lai AM, Payne PRO, Gupta A. Electronic health record data quality assessment and tools: a systematic review. J Am Med Inform Assoc 2023; 30:1730-1740. [PMID: 37390812 PMCID: PMC10531113 DOI: 10.1093/jamia/ocad120] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE We extended a 2013 literature review on electronic health record (EHR) data quality assessment approaches and tools to determine recent improvements or changes in EHR data quality assessment methodologies. MATERIALS AND METHODS We completed a systematic review of PubMed articles from 2013 to April 2023 that discussed the quality assessment of EHR data. We screened and reviewed papers for the dimensions and methods defined in the original 2013 manuscript. We categorized papers as data quality outcomes of interest, tools, or opinion pieces. We abstracted and defined additional themes and methods though an iterative review process. RESULTS We included 103 papers in the review, of which 73 were data quality outcomes of interest papers, 22 were tools, and 8 were opinion pieces. The most common dimension of data quality assessed was completeness, followed by correctness, concordance, plausibility, and currency. We abstracted conformance and bias as 2 additional dimensions of data quality and structural agreement as an additional methodology. DISCUSSION There has been an increase in EHR data quality assessment publications since the original 2013 review. Consistent dimensions of EHR data quality continue to be assessed across applications. Despite consistent patterns of assessment, there still does not exist a standard approach for assessing EHR data quality. CONCLUSION Guidelines are needed for EHR data quality assessment to improve the efficiency, transparency, comparability, and interoperability of data quality assessment. These guidelines must be both scalable and flexible. Automation could be helpful in generalizing this process.
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Affiliation(s)
- Abigail E Lewis
- Division of Computational and Data Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nicole Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Zachary B Abrams
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Randi Foraker
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Albert M Lai
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Aditi Gupta
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
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Herrera CN, Oblath R, Duncan A. Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2321798. [PMID: 37410466 PMCID: PMC10326644 DOI: 10.1001/jamanetworkopen.2023.21798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023] Open
Abstract
Importance Psychiatric boarding occurs when patients needing intensive psychiatric services who are already under clinical supervision experience delays in their admission to psychiatric facilities. Initial reports have suggested that the US had a psychiatric boarding crisis during the COVID-19 pandemic; however, little is known about the consequences of this crisis for publicly insured youths. Objective To estimate pandemic-associated changes in psychiatric boarding rates and discharge modalities for people aged 4 to 20 years who accessed psychiatric emergency services (PES) through a mobile crisis team (MCT) evaluation and were covered by Medicaid or health safety net programs. Design, Setting, and Participants This retrospective cross-sectional study used data from the MCT encounters of a multichannel PES program in Massachusetts. A total of 7625 MCT-initiated PES encounters with publicly insured youths who lived in Massachusetts between January 1, 2018, and August 31, 2021, were assessed. Main Outcomes and Measures Encounter-level outcomes (psychiatric boarding status, repeat visits, and discharge disposition) during a prepandemic period (January 1, 2018, to March 9, 2020) were compared with outcomes during a pandemic period (March 10, 2020, to August 31, 2021). Descriptive statistics and multivariate regression analysis were used. Results Among 7625 MCT-initiated PES encounters, the mean (SD) age of publicly insured youths was 13.6 (3.7) years; most youths identified as male (3656 [47.9%]), were of Black race (2725 [35.7%]) or Hispanic ethnicity (2708 [35.5%]), and spoke English (6941 [91.0%]). During the pandemic period, the mean monthly boarding encounter rate was 25.3 percentage points higher than the prepandemic period. After adjustment for covariates, the odds of an encounter resulting in boarding doubled during the pandemic (adjusted odds ratio [AOR], 2.03; 95% CI, 1.82-2.26; P < .001), and boarding youths were 64% less likely to be discharged to inpatient psychiatric care (AOR, 0.36; 95% CI, 0.31-0.43; P < .001). Publicly insured youths who boarded during the pandemic had significantly higher rates of 30-day readmissions (incidence rate ratio, 2.17; 95% CI, 1.88-2.50; P < .001). Boarding encounters during the pandemic were significantly less likely to end in discharge to inpatient psychiatric units (AOR, 0.36; 95% CI, 0.31-0.43; P < .001) or community-based acute treatment facilities (AOR, 0.70; 95% CI, 0.55-0.90; P = .005). Conclusions and Relevance In this cross-sectional study, publicly insured youths were more likely to experience psychiatric boarding during the COVID-19 pandemic and, if boarding, were less likely to transfer to a 24-hour level of care. These findings suggest that psychiatric service programs for youths were not prepared to support the levels of acuity and demand that emerged from the pandemic.
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Affiliation(s)
- Carolina-Nicole Herrera
- Department of Health, Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
- Boston Emergency Services Team Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, Massachusetts
| | - Rachel Oblath
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
- Boston Emergency Services Team Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, Massachusetts
| | - Alison Duncan
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
- Boston Emergency Services Team Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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8
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Jolly D, Boskey ER, Ganor O. Racial Disparities in the 30-Day Outcomes of Gender-affirming Chest Surgeries. Ann Surg 2023; 278:e196-e202. [PMID: 35762604 DOI: 10.1097/sla.0000000000005512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if and how race impacts the 30-day outcomes of gender-affirming chest surgeries. BACKGROUND Little is currently known about how race may affect the outcomes of gender-affirming surgeries. METHODS We analyzed data from the National Surgical Quality Improvement Program (NSQIP) database of 30-day complications of gender-affirming chest surgeries from 2005 to 2019. All participants had a postoperative diagnosis code for gender dysphoria and at least one procedure code for bilateral mastectomy, bilateral breast reduction, or bilateral augmentation mammoplasty. Differences by racial group were analyzed through Pearson χ 2 and multivariate logistic regression. RESULTS There were no racial differences in the all-complication rates for both transmasculine and transfeminine individuals undergoing gender-affirming chest surgeries. Black patients undergoing masculinizing procedures were significantly more likely to experience mild systemic [adjusted odds ratio (aOR): 2.17, 95% confidence interval (CI): 1.02-4.65] and severe complications (aOR: 5.63, 95% CI: 1.99-15.98) when compared with White patients. Patients of unknown race had increased odds of experiencing severe complications for masculinizing procedures compared with White patients (aOR: 3.77, 95% CI: 1.39-10.24). Transmasculine individuals whose race was unknown were 1.98 times more likely (95% CI: 1.03-3.81) to experience an unplanned reoperation compared with White individuals. Black transfeminine individuals were 10.50 times more likely to experience an unplanned reoperation (95% CI: 1.15-95.51) than their White peers. CONCLUSIONS Although overall complications are uncommon, there is evidence to suggest that there are racial disparities in certain 30-day outcomes of gender-affirming chest surgeries.
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Affiliation(s)
- Divya Jolly
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, MA
| | - Elizabeth R Boskey
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Oren Ganor
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
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Armstrong M, Benda NC, Seier K, Rogers C, Ancker JS, Stetson PD, Peng Y, Diamond LC. Improving Cancer Care Communication: Identifying Sociodemographic Differences in Patient Portal Secure Messages Not Authored by the Patient. Appl Clin Inform 2023; 14:296-299. [PMID: 36657471 PMCID: PMC10115514 DOI: 10.1055/a-2015-8679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Affiliation(s)
- Misha Armstrong
- Department of Surgery, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Natalie C. Benda
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
| | - Kenneth Seier
- Department of Epidemiology- Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher Rogers
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter D. Stetson
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yifan Peng
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
| | - Lisa C. Diamond
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York
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10
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Oblath R, Herrera CN, Were LPO, Syeda HS, Duncan A, Ferguson T, Kalesan B, Perez DC, Taglieri J, Borba CPC, Henderson DC. Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team. Community Ment Health J 2023; 59:370-380. [PMID: 36001197 PMCID: PMC9399566 DOI: 10.1007/s10597-022-01015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005-2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.
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Affiliation(s)
- Rachel Oblath
- Department of Psychiatry, Boston Medical Center, Boston, USA. .,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.
| | - Carolina N Herrera
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
| | - Lawrence P O Were
- Department of Health Sciences, Boston University's College of Health and Rehabilitation Sciences: Sargent College, Boston, USA.,Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Haniya Saleem Syeda
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Alison Duncan
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Tasha Ferguson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Bindu Kalesan
- Department of Medicine, Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, USA
| | - Daisy C Perez
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Joan Taglieri
- Department of Psychiatry, Boston Medical Center, Boston, USA.,Department of Psychiatry, Cambridge Health Alliance, Cambridge, USA.,Boston University School of Medicine, Boston, USA
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
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11
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Fraiman YS, Barrero-Castillero A, Litt JS. Implications of racial/ethnic perinatal health inequities on long-term neurodevelopmental outcomes and health services utilization. Semin Perinatol 2022; 46:151660. [PMID: 36175260 DOI: 10.1016/j.semperi.2022.151660] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Infants born preterm and with low birth weight have increased risk for neurodevelopmental challenges later in life compared to term-born peers. These include functional motor impairment, cognitive and speech delays, neurobehavioral disorders, and atypical social development. There are well-documented inequities in the population distributions of preterm birth and associated short-term morbidities by race, ethnicity, language, and nativity. Far less is known about how these inequities affect long-term outcomes, though the impact of unequal access to post-discharge support services for preterm infants raises concerns about widening gaps in health, development, and functioning. In this review, we describe what is currently known about the impact of race, ethnicity, nativity, and language on long-term outcomes. We provide a framework for understanding inequities in social, political, and historical context. And we offer guidance for next steps to delineate mechanistic pathways and to identify interventions to eliminate inequities in long-term neurodevelopmental outcomes through research, intervention, and advocacy.
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Affiliation(s)
- Yarden S Fraiman
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Alejandra Barrero-Castillero
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Huser V, Williams ND, Mayer CS. Linking Provider Specialty and Outpatient Diagnoses in Medicare Claims Data: Data Quality Implications. Appl Clin Inform 2021; 12:729-736. [PMID: 34348410 DOI: 10.1055/s-0041-1732404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND With increasing use of real world data in observational health care research, data quality assessment of these data is equally gaining in importance. Electronic health record (EHR) or claims datasets can differ significantly in the spectrum of care covered by the data. OBJECTIVE In our study, we link provider specialty with diagnoses (encoded in International Classification of Diseases) with a motivation to characterize data completeness. METHODS We develop a set of measures that determine diagnostic span of a specialty (how many distinct diagnosis codes are generated by a specialty) and specialty span of a diagnosis (how many specialties diagnose a given condition). We also analyze ranked lists for both measures. As use case, we apply these measures to outpatient Medicare claims data from 2016 (3.5 billion diagnosis-specialty pairs). We analyze 82 distinct specialties present in Medicare claims (using Medicare list of specialties derived from level III Healthcare Provider Taxonomy Codes). RESULTS A typical specialty diagnoses on average 4,046 distinct diagnosis codes. It can range from 33 codes for medical toxicology to 25,475 codes for internal medicine. Specialties with large visit volume tend to have large diagnostic span. Median specialty span of a diagnosis code is 8 specialties with a range from 1 to 82 specialties. In total, 13.5% of all observed diagnoses are generated exclusively by a single specialty. Quantitative cumulative rankings reveal that some diagnosis codes can be dominated by few specialties. Using such diagnoses in cohort or outcome definitions may thus be vulnerable to incomplete specialty coverage of a given dataset. CONCLUSION We propose specialty fingerprinting as a method to assess data completeness component of data quality. Datasets covering a full spectrum of care can be used to generate reference benchmark data that can quantify relative importance of a specialty in constructing diagnostic history elements of computable phenotype definitions.
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Affiliation(s)
- Vojtech Huser
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, United States
| | - Nick D Williams
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, United States
| | - Craig S Mayer
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, United States
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Connolly M, Selling MK, Cook S, Williams JS, Chin MH, Umscheid CA. Development, implementation, and use of an "equity lens" integrated into an institutional quality scorecard. J Am Med Inform Assoc 2021; 28:1785-1790. [PMID: 34010425 PMCID: PMC8324221 DOI: 10.1093/jamia/ocab082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/14/2021] [Indexed: 11/12/2022] Open
Abstract
Few healthcare provider organizations systematically track their healthcare equity, and fewer enable direct interaction with such data by their employees. From May to August 2019, we enhanced the data architecture and reporting functionality of our existing institutional quality scorecard to allow direct comparisons of quality measure performance by gender, age, race, ethnicity, language, zip code, and payor. The Equity Lens was made available to over 4000 staff in September 2019 for 82 institutional quality measures. During the first 11 months, 235 unique individuals used the tool; users were most commonly from the quality and equity departments. Two early use cases evaluated hypertension control and readmissions by race, identifying potential inequities. This is the first description of an interactive equity lens integrated into an institutional quality scorecard made available to healthcare system employees. Early evidence suggests the tool is used and can inform quality improvement initiatives.
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Affiliation(s)
- Mark Connolly
- Data and Analytics, University of Chicago Medicine, Chicago, Illinois, USA
| | - Mary Kate Selling
- Data and Analytics, University of Chicago Medicine, Chicago, Illinois, USA
| | - Scott Cook
- Diversity, Inclusion, and Equity and Urban Health Initiative, University of Chicago Medicine, Chicago, Illinois, USA
- Section of General Internal Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, Illinois, USA
| | - James S Williams
- Diversity, Inclusion, and Equity and Urban Health Initiative, University of Chicago Medicine, Chicago, Illinois, USA
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Marshall H Chin
- Section of General Internal Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Craig A Umscheid
- Section of General Internal Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, Illinois, USA
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