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Thomas KC, Annis IE, deJong NA, Christian RB, Davis SA, Hughes PM, Prichard BA, Prichard JR, Allen PS, Gettinger JS, Morris DAN, Eaker KB. Association Between Neighborhood Context and Psychotropic Polypharmacy Use Among High-Need Children. Psychiatr Serv 2024:appips20230639. [PMID: 39257315 DOI: 10.1176/appi.ps.20230639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE The authors explored whether neighborhood context is associated with psychotropic polypharmacy and psychotherapy among a cohort of children with high needs for psychiatric and general medical care. METHODS Electronic health record data from a large health care system were used in a cross-sectional design to examine psychotropic polypharmacy and psychotherapy in 2015-2019 among children ages 2-17 years (N=4,017) with geocoded addresses. Inclusion criteria were a diagnosis of a mental health condition, an intellectual and developmental disability, or a complex medical condition and one or more clinical encounters annually over the study period. Polypharmacy was defined as two or more psychotropic drug class prescriptions concurrently for ≥60 days. Psychotherapy was defined as receipt of any psychotherapy or adaptive behavior treatment. Neighborhood context (health, environment, education, and wealth) was measured with the Child Opportunity Index. Multilevel generalized linear mixed models with random intercept for census tracts were used to assess the associations between individual and neighborhood characteristics and psychotropic polypharmacy and psychotherapy. RESULTS Moderate (vs. low) child opportunity was associated with higher odds of polypharmacy (adjusted OR [AOR]=1.79, 95% CI=1.19-2.67). High (vs. low) child opportunity was associated with higher odds of psychotherapy (AOR=2.15, 95% CI=1.43-3.21). Black (vs. White) race (AOR=0.51, 95% CI=0.37-0.71) and Hispanic ethnicity (AOR=0.44, 95% CI=0.26-0.73) were associated with lower odds of polypharmacy. CONCLUSIONS Among high-need children, neighborhood Child Opportunity Index, race, and ethnicity were significantly associated with treatment outcomes in analyses adjusted for clinical factors. The findings underscore concerns about structural disparities and systemic racism and raise questions about access.
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Affiliation(s)
- Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Neal A deJong
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Robert B Christian
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Phillip M Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Beth A Prichard
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Jason R Prichard
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Pamela S Allen
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Joshua S Gettinger
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - D'Jenne-Amal N Morris
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
| | - Kerri B Eaker
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker)
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Sagy I, Schwarzfuchs O, Zeller L, Ling E, Babiev AS, Abu-Shakra M. Short- and Long-Term Mortality of Hospitalized Patients With Autoimmune Rheumatic Diseases and Serious Infections: A National Cohort Study. J Rheumatol 2024; 51:517-522. [PMID: 38302166 DOI: 10.3899/jrheum.2023-1063] [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] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Infectious conditions are a significant cause of mortality in autoimmune rheumatic diseases (ARD). Among patients hospitalized with an infection, we compared in-hospital and long-term (3-year) mortality between those with and without ARD. METHODS This retrospective analysis included members of the largest health maintenance organization in Israel, aged > 18 years at the first episode of infection, who required hospitalization during 2003-2019. We compared in-hospital mortality and the results of a 3-year landmark analysis of those who survived the index hospitalization between patients with ARD, according to disease subgroups, and patients without ARD. Additionally, we compared mortality outcomes among patients with ARD, according to subgroup diagnosis, matched in a 1:3 ratio by age, sex, and ethnicity to patients without ARD. RESULTS Included were 365,247 patients who were admitted for the first time with the diagnosis of a serious infection. Of these, we identified 9755 with rheumatoid arthritis (RA), 1351 with systemic lupus erythematosus, 2120 with spondyloarthritis (SpA), 584 with systemic sclerosis, and 3214 with vasculitis. In a matched multivariate analysis, the risk for in-hospital mortality was lower among patients with RA (odds ratio [OR] 0.89, 95% CI 0.81-0.97) and SpA (OR 0.77, 95% CI 0.63-0.94). In a similar analysis, the risk of 3-year mortality was lower among patients with RA (hazard ratio [HR] 0.82, 95% CI 0.78-0.86) and vasculitis (HR 0.86, 95% CI 0.80-0.93). CONCLUSION Among patients hospitalized for an infection, the risk of in-hospital and 3-year mortality was not increased among those with ARD compared to those without ARD.
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Affiliation(s)
- Iftach Sagy
- I. Sagy, MD, PhD, Rheumatology Disease Unit, and Clinical Research Center, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev;
| | - Omer Schwarzfuchs
- O. Schwarzfuchs, BSc, Faculty of Health Sciences, Ben Gurion University of the Negev
| | - Lior Zeller
- L. Zeller, MD, E. Ling, MD, PhD, M. Abu-Shakra, MD, Rheumatology Disease Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev
| | - Eduard Ling
- L. Zeller, MD, E. Ling, MD, PhD, M. Abu-Shakra, MD, Rheumatology Disease Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev
| | - Amit Shira Babiev
- A.S. Babiev, BSc, Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Mahmoud Abu-Shakra
- L. Zeller, MD, E. Ling, MD, PhD, M. Abu-Shakra, MD, Rheumatology Disease Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev
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3
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Haque MA, Gedara MLB, Nickel N, Turgeon M, Lix LM. The validity of electronic health data for measuring smoking status: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2024; 24:33. [PMID: 38308231 PMCID: PMC10836023 DOI: 10.1186/s12911-024-02416-3] [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: 06/19/2023] [Accepted: 01/03/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Smoking is a risk factor for many chronic diseases. Multiple smoking status ascertainment algorithms have been developed for population-based electronic health databases such as administrative databases and electronic medical records (EMRs). Evidence syntheses of algorithm validation studies have often focused on chronic diseases rather than risk factors. We conducted a systematic review and meta-analysis of smoking status ascertainment algorithms to describe the characteristics and validity of these algorithms. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. We searched articles published from 1990 to 2022 in EMBASE, MEDLINE, Scopus, and Web of Science with key terms such as validity, administrative data, electronic health records, smoking, and tobacco use. The extracted information, including article characteristics, algorithm characteristics, and validity measures, was descriptively analyzed. Sources of heterogeneity in validity measures were estimated using a meta-regression model. Risk of bias (ROB) in the reviewed articles was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS The initial search yielded 2086 articles; 57 were selected for review and 116 algorithms were identified. Almost three-quarters (71.6%) of algorithms were based on EMR data. The algorithms were primarily constructed using diagnosis codes for smoking-related conditions, although prescription medication codes for smoking treatments were also adopted. About half of the algorithms were developed using machine-learning models. The pooled estimates of positive predictive value, sensitivity, and specificity were 0.843, 0.672, and 0.918 respectively. Algorithm sensitivity and specificity were highly variable and ranged from 3 to 100% and 36 to 100%, respectively. Model-based algorithms had significantly greater sensitivity (p = 0.006) than rule-based algorithms. Algorithms for EMR data had higher sensitivity than algorithms for administrative data (p = 0.001). The ROB was low in most of the articles (76.3%) that underwent the assessment. CONCLUSIONS Multiple algorithms using different data sources and methods have been proposed to ascertain smoking status in electronic health data. Many algorithms had low sensitivity and positive predictive value, but the data source influenced their validity. Algorithms based on machine-learning models for multiple linked data sources have improved validity.
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Affiliation(s)
- Md Ashiqul Haque
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Nathan Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maxime Turgeon
- Department of Statistics, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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4
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Shieh D, Sevilla M, Palmeri A, Ly AH, Shi JM, Berringer C, Resurreccion J. The Shieh Score as a Risk Assessment Instrument for Reducing Hospital-Acquired Pressure Injuries: A Prospective Cohort Study. J Wound Ostomy Continence Nurs 2023; 50:375-380. [PMID: 37467392 DOI: 10.1097/won.0000000000000997] [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: 07/21/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the Shieh Score's effectiveness in decreasing the rate of hospital-acquired pressure injuries when combined with an early warning notification system and standard order set of preventative measures. DESIGN This was a prospective cohort study. SUBJECTS AND SETTING This target population was nonpregnant, adult, hospitalized patients on inpatient and observation status at a tertiary hospital (Kaiser Permanente, Baldwin Park, California) during the 2020 year of the COVID-19 pandemic. METHODS A new, risk assessment instrument, the Shieh Score, was developed in 2019 to predict hospitalized patients at high risk for pressure injuries. Data collection occurred between January 21, 2020, and December 31, 2020. When a hospital patient met the high-risk criteria for the Shieh Score, a provider-ordered pink-colored sheet of paper titled "Skin at Risk" was hung at the head of the bed and a standard order set of pressure injury preventative measures was implemented by nursing staff. RESULTS Implementation of the program (Shieh Score, early warning system, and standard order set for preventive interventions) resulted in a 38% reduction in the annual hospital-acquired pressure injury rate from a mean incidence rate of 1.03 to 0.64 hospital-acquired pressure injuries per 1000 patient-days measured for the year 2020. CONCLUSION The Shieh Score is a pressure injury risk assessment instrument, which effectively identifies patients at high risk for hospital-acquired pressure injuries and decreases the hospital-acquired pressure injury rate when combined with an early warning notification system and standard order set.
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Affiliation(s)
- David Shieh
- David Shieh, MD, Kaiser Permanente, Anaheim, California
- Mia Sevilla, BSN, Kaiser Permanente, Baldwin Park, California
- Anthony Palmeri, BS, Kaiser Permanente, Anaheim, California
- An H. Ly, BA, Kaiser Permanente, Pasadena, California
- Jiaxiao M. Shi, PhD, Kaiser Permanente, Pasadena, California
- Christine Berringer, MSN, Kaiser Permanente, Anaheim, California
- Juji Resurreccion, MSN, Kaiser Permanente, Irvine, California
| | - Mia Sevilla
- David Shieh, MD, Kaiser Permanente, Anaheim, California
- Mia Sevilla, BSN, Kaiser Permanente, Baldwin Park, California
- Anthony Palmeri, BS, Kaiser Permanente, Anaheim, California
- An H. Ly, BA, Kaiser Permanente, Pasadena, California
- Jiaxiao M. Shi, PhD, Kaiser Permanente, Pasadena, California
- Christine Berringer, MSN, Kaiser Permanente, Anaheim, California
- Juji Resurreccion, MSN, Kaiser Permanente, Irvine, California
| | - Anthony Palmeri
- David Shieh, MD, Kaiser Permanente, Anaheim, California
- Mia Sevilla, BSN, Kaiser Permanente, Baldwin Park, California
- Anthony Palmeri, BS, Kaiser Permanente, Anaheim, California
- An H. Ly, BA, Kaiser Permanente, Pasadena, California
- Jiaxiao M. Shi, PhD, Kaiser Permanente, Pasadena, California
- Christine Berringer, MSN, Kaiser Permanente, Anaheim, California
- Juji Resurreccion, MSN, Kaiser Permanente, Irvine, California
| | - An H Ly
- David Shieh, MD, Kaiser Permanente, Anaheim, California
- Mia Sevilla, BSN, Kaiser Permanente, Baldwin Park, California
- Anthony Palmeri, BS, Kaiser Permanente, Anaheim, California
- An H. Ly, BA, Kaiser Permanente, Pasadena, California
- Jiaxiao M. Shi, PhD, Kaiser Permanente, Pasadena, California
- Christine Berringer, MSN, Kaiser Permanente, Anaheim, California
- Juji Resurreccion, MSN, Kaiser Permanente, Irvine, California
| | - Jiaxiao M Shi
- David Shieh, MD, Kaiser Permanente, Anaheim, California
- Mia Sevilla, BSN, Kaiser Permanente, Baldwin Park, California
- Anthony Palmeri, BS, Kaiser Permanente, Anaheim, California
- An H. Ly, BA, Kaiser Permanente, Pasadena, California
- Jiaxiao M. Shi, PhD, Kaiser Permanente, Pasadena, California
- Christine Berringer, MSN, Kaiser Permanente, Anaheim, California
- Juji Resurreccion, MSN, Kaiser Permanente, Irvine, California
| | - Christine Berringer
- David Shieh, MD, Kaiser Permanente, Anaheim, California
- Mia Sevilla, BSN, Kaiser Permanente, Baldwin Park, California
- Anthony Palmeri, BS, Kaiser Permanente, Anaheim, California
- An H. Ly, BA, Kaiser Permanente, Pasadena, California
- Jiaxiao M. Shi, PhD, Kaiser Permanente, Pasadena, California
- Christine Berringer, MSN, Kaiser Permanente, Anaheim, California
- Juji Resurreccion, MSN, Kaiser Permanente, Irvine, California
| | - Juji Resurreccion
- David Shieh, MD, Kaiser Permanente, Anaheim, California
- Mia Sevilla, BSN, Kaiser Permanente, Baldwin Park, California
- Anthony Palmeri, BS, Kaiser Permanente, Anaheim, California
- An H. Ly, BA, Kaiser Permanente, Pasadena, California
- Jiaxiao M. Shi, PhD, Kaiser Permanente, Pasadena, California
- Christine Berringer, MSN, Kaiser Permanente, Anaheim, California
- Juji Resurreccion, MSN, Kaiser Permanente, Irvine, California
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Wornow M, Xu Y, Thapa R, Patel B, Steinberg E, Fleming S, Pfeffer MA, Fries J, Shah NH. The shaky foundations of large language models and foundation models for electronic health records. NPJ Digit Med 2023; 6:135. [PMID: 37516790 PMCID: PMC10387101 DOI: 10.1038/s41746-023-00879-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023] Open
Abstract
The success of foundation models such as ChatGPT and AlphaFold has spurred significant interest in building similar models for electronic medical records (EMRs) to improve patient care and hospital operations. However, recent hype has obscured critical gaps in our understanding of these models' capabilities. In this narrative review, we examine 84 foundation models trained on non-imaging EMR data (i.e., clinical text and/or structured data) and create a taxonomy delineating their architectures, training data, and potential use cases. We find that most models are trained on small, narrowly-scoped clinical datasets (e.g., MIMIC-III) or broad, public biomedical corpora (e.g., PubMed) and are evaluated on tasks that do not provide meaningful insights on their usefulness to health systems. Considering these findings, we propose an improved evaluation framework for measuring the benefits of clinical foundation models that is more closely grounded to metrics that matter in healthcare.
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Affiliation(s)
- Michael Wornow
- Department of Computer Science, Stanford University, Stanford, CA, USA.
| | - Yizhe Xu
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Rahul Thapa
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Birju Patel
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Ethan Steinberg
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Scott Fleming
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael A Pfeffer
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA
- Technology and Digital Services, Stanford Health Care, Palo Alto, CA, USA
| | - Jason Fries
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Nigam H Shah
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA
- Technology and Digital Services, Stanford Health Care, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
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6
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Rodriguez-Watson CV, Sheils NE, Louder AM, Eldridge EH, Lin ND, Pollock BD, Gatz JL, Grannis SJ, Vashisht R, Ghauri K, Valo G, Chakravarty AG, Lasky T, Jung M, Lovell SL, Major JM, Kabelac C, Knepper C, Leonard S, Embi PJ, Jenkinson WG, Klesh R, Garner OB, Patel A, Dahm L, Barin A, Cooper DM, Andriola T, Byington CL, Crews BO, Butte AJ, Allen J. Real-world utilization of SARS-CoV-2 serological testing in RNA positive patients across the United States. PLoS One 2023; 18:e0281365. [PMID: 36763574 PMCID: PMC9916659 DOI: 10.1371/journal.pone.0281365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/22/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND As diagnostic tests for COVID-19 were broadly deployed under Emergency Use Authorization, there emerged a need to understand the real-world utilization and performance of serological testing across the United States. METHODS Six health systems contributed electronic health records and/or claims data, jointly developed a master protocol, and used it to execute the analysis in parallel. We used descriptive statistics to examine demographic, clinical, and geographic characteristics of serology testing among patients with RNA positive for SARS-CoV-2. RESULTS Across datasets, we observed 930,669 individuals with positive RNA for SARS-CoV-2. Of these, 35,806 (4%) were serotested within 90 days; 15% of which occurred <14 days from the RNA positive test. The proportion of people with a history of cardiovascular disease, obesity, chronic lung, or kidney disease; or presenting with shortness of breath or pneumonia appeared higher among those serotested compared to those who were not. Even in a population of people with active infection, race/ethnicity data were largely missing (>30%) in some datasets-limiting our ability to examine differences in serological testing by race. In datasets where race/ethnicity information was available, we observed a greater distribution of White individuals among those serotested; however, the time between RNA and serology tests appeared shorter in Black compared to White individuals. Test manufacturer data was available in half of the datasets contributing to the analysis. CONCLUSION Our results inform the underlying context of serotesting during the first year of the COVID-19 pandemic and differences observed between claims and EHR data sources-a critical first step to understanding the real-world accuracy of serological tests. Incomplete reporting of race/ethnicity data and a limited ability to link test manufacturer data, lab results, and clinical data challenge the ability to assess the real-world performance of SARS-CoV-2 tests in different contexts and the overall U.S. response to current and future disease pandemics.
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Affiliation(s)
| | | | | | | | - Nancy D. Lin
- Health Catalyst, Salt Lake City, Utah, United States of America
| | | | - Jennifer L. Gatz
- Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Shaun J. Grannis
- Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Informatics and Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Rohit Vashisht
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
| | - Kanwal Ghauri
- Reagan-Udall Foundation for the FDA, Washington, District of Columbia, United States of America
| | - Gina Valo
- Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Aloka G. Chakravarty
- Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Tamar Lasky
- Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Mary Jung
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Stephen L. Lovell
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Jacqueline M. Major
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Carly Kabelac
- Aetion, New York, New York, United States of America
| | | | - Sandy Leonard
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Peter J. Embi
- Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Informatics and Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | | | - Reyna Klesh
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Omai B. Garner
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, California, United States of America
| | - Ayan Patel
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Lisa Dahm
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Aiden Barin
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Dan M. Cooper
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Pediatric Exercise and Genomics Research Center, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Tom Andriola
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Office of Data and Information Technology, University of California, Irvine, California, United States of America
| | - Carrie L. Byington
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Bridgit O. Crews
- Department of Pathology and Laboratory Medicine, University of California, Irvine, California, United States of America
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Jeff Allen
- Friends of Cancer Research, Washington, District of Columbia, United States of America
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Hansen AV, Mortensen LH, Ekstrøm CT, Trompet S, Westendorp R. Predicting mortality and visualizing health care spending by predicted mortality in Danes over age 65. Sci Rep 2023; 13:1203. [PMID: 36681729 PMCID: PMC9867694 DOI: 10.1038/s41598-023-28102-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023] Open
Abstract
Health care expenditure in the last year of life makes up a high proportion of medical spending across the world. This is often framed as waste, but this framing is only meaningful if it is known at the time of treatment who will go on to die. We analyze the distribution of health care spending by predicted mortality for the Danish population over age 65 over the year 2016, with one-year mortality predicted by a machine learning model based on sociodemographics and use of health care services for the two years before entry into follow-up. While a reasonably good model can be built, extremely few individuals have high ex-ante probability of dying, and those with a predicted mortality of more than 50% account for only 2.8% of total health care expenditure. Decedents outspent survivors by a factor of more than ten, but compared to survivors with similar predicted mortality they spent only 2.5 times as much. Our results suggest that while spending in the last year of life is indeed high, this is nearly all spent in situations where there is a reasonable expectation that the patient can survive.
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Affiliation(s)
- Anne Vinkel Hansen
- Methods and Analysis, Statistics Denmark, , Danmarks Statistik, Sejrøgade 11, 2100, Copenhagen, Denmark.
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.
| | - Laust Hvas Mortensen
- Methods and Analysis, Statistics Denmark, , Danmarks Statistik, Sejrøgade 11, 2100, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rudi Westendorp
- Methods and Analysis, Statistics Denmark, , Danmarks Statistik, Sejrøgade 11, 2100, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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8
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Garland A, Marrie RA, Wunsch H, Yogendran M, Chateau D. Administrative Data Is Insufficient to Identify Near-Future Critical Illness: A Population-Based Retrospective Cohort Study. FRONTIERS IN EPIDEMIOLOGY 2022; 2:944216. [PMID: 38455278 PMCID: PMC10910992 DOI: 10.3389/fepid.2022.944216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/13/2022] [Indexed: 03/09/2024]
Abstract
Background Prediction of future critical illness could render it practical to test interventions seeking to avoid or delay the coming event. Objective Identify adults having >33% probability of near-future critical illness. Research Design Retrospective cohort study, 2013-2015. Subjects Community-dwelling residents of Manitoba, Canada, aged 40-89 years. Measures The outcome was a near-future critical illness, defined as intensive care unit admission with invasive mechanical ventilation, or non-palliative death occurring 30-180 days after 1 April each year. By dividing the data into training and test cohorts, a Classification and Regression Tree analysis was used to identify subgroups with ≥33% probability of the outcome. We considered 72 predictors including sociodemographics, chronic conditions, frailty, and health care utilization. Sensitivity analysis used logistic regression methods. Results Approximately 0.38% of each yearly cohort experienced near-future critical illness. The optimal Tree identified 2,644 mutually exclusive subgroups. Socioeconomic status was the most influential variable, followed by nursing home residency and frailty; age was sixth. In the training data, the model performed well; 41 subgroups containing 493 subjects had ≥33% members who developed the outcome. However, in the test data, those subgroups contained 429 individuals, with 20 (4.7%) experiencing the outcome, which comprised 0.98% of all subjects with the outcome. While logistic regression showed less model overfitting, it likewise failed to achieve the stated objective. Conclusions High-fidelity prediction of near-future critical illness among community-dwelling adults was not successful using population-based administrative data. Additional research is needed to ascertain whether the inclusion of additional types of data can achieve this goal.
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Affiliation(s)
- Allan Garland
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Hannah Wunsch
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Marina Yogendran
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Daniel Chateau
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
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Chang HY, Kitchen C, Bishop MA, Shermock KM, Gudzune KA, Kharrazi H, Weiner JP. Claims-based pharmacy markers for comprehensive medication management program case identification: Validation against concurrent and prospective healthcare costs and utilization. Res Social Adm Pharm 2022; 18:3800-3813. [DOI: 10.1016/j.sapharm.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/22/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
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10
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Matsui H, Yamana H, Fushimi K, Yasunaga H. Development of Deep Learning Models for Predicting In-Hospital Mortality Using an Administrative Claims Database: Retrospective Cohort Study. JMIR Med Inform 2022; 10:e27936. [PMID: 34997958 PMCID: PMC8881780 DOI: 10.2196/27936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/05/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Administrative claims databases have been used widely in studies because they have large sample sizes and are easily available. However, studies using administrative databases lack information on disease severity, so a risk adjustment method needs to be developed. OBJECTIVE We aimed to develop and validate deep learning-based prediction models for in-hospital mortality of acute care patients. METHODS The main model was developed using only administrative claims data (age, sex, diagnoses, and procedures on the day of admission). We also constructed disease-specific models for acute myocardial infarction, heart failure, stroke, and pneumonia using common severity indices for these diseases. Using the Japanese Diagnosis Procedure Combination data from July 2010 to March 2017, we identified 46,665,933 inpatients and divided them into derivation and validation cohorts in a ratio of 95:5. The main model was developed using a 9-layer deep neural network with 4 hidden dense layers that had 1000 nodes and were fully connected to adjacent layers. We evaluated model discrimination ability by an area under the receiver operating characteristic curve (AUC) and calibration ability by calibration plot. RESULTS Among the eligible patients, 2,005,035 (4.3%) died. Discrimination and calibration of the models were satisfactory. The AUC of the main model in the validation cohort was 0.954 (95% CI 0.954-0.955). The main model had higher discrimination ability than the disease-specific models. CONCLUSIONS Our deep learning-based model using diagnoses and procedures produced valid predictions of in-hospital mortality.
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Affiliation(s)
- Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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11
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Kinsky S, Liang Q, Bellon J, Helwig A, McCracken P, Minnier T, Thirumala PD, Hanmer J. Predicting Unplanned Health Care Utilization and Cost: Comparing Patient-reported Outcomes Measurement Information System and Claims. Med Care 2021; 59:921-928. [PMID: 34183621 DOI: 10.1097/mlr.0000000000001601] [Citation(s) in RCA: 3] [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
OBJECTIVES There is little literature describing if and how payers are utilizing patient-reported outcomes to predict future costs. This study assessed if Patient-reported Outcomes Measurement Information System (PROMIS) domain scores, collected in routine practice at neurology clinics, improved payer predictive models for unplanned care utilization and cost. STUDY DESIGN Retrospective cohort analysis of private Health Plan-insured patients with visits at 18 Health Plan-affiliated neurology clinics. METHODS PROMIS domains (Anxiety v1.0, Cognitive Function Abilities v2.0, Depression v1.0, Fatigue v1.0, Pain Interference v1.0, Physical Function v2.0, Sleep Disturbance v1.0, and Ability to Participate in Social Roles and Activities v2.0) are collected as part of routine care. Data from patients' first PROMIS measures between June 27, 2018 and April 16, 2019 were extracted and combined with claims data. Using (1) claims data alone and (2) PROMIS and claims data, we examined the association of covariates to utilization (using a logit model) and cost (using a generalized linear model). We evaluated model fit using area under the receiver operating characteristic curve (for unplanned care utilization), akaike information criterion (for unplanned care costs), and sensitivity and specificity in predicting top 15% of unplanned care costs. RESULTS Area under the receiver operating curve values were slightly higher, and akaike information criterion values were similar, for PROMIS plus claims covariates compared with claims alone. The PROMIS plus claims model had slightly higher sensitivity and equivalent specificity compared with claims-only models. CONCLUSION One-time PROMIS measure data combined with claims data slightly improved predictive model performance compared with claims alone, but likely not to an extent that indicates improved practical utility for payers.
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Affiliation(s)
| | | | | | | | - Polly McCracken
- School of General Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Janel Hanmer
- School of General Medicine, University of Pittsburgh, Pittsburgh, PA
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12
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Jhaveri R, John J, Rosenman M. Electronic Health Record Network Research in Infectious Diseases. Clin Ther 2021; 43:1668-1681. [PMID: 34629175 PMCID: PMC8498653 DOI: 10.1016/j.clinthera.2021.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/04/2022]
Abstract
With the marked increases in electronic health record (EHR) use for providing clinical care, there have been parallel efforts to leverage EHR data for research. EHR repositories offer the promise of vast amounts of clinical data not easily captured with traditional research methods and facilitate clinical epidemiology and comparative effectiveness research, including analyses to identify patients at higher risk for complications or who are better candidates for treatment. These types of studies have been relatively slow to penetrate the field of infectious diseases, but the need for rapid turnaround during the COVID-19 global pandemic has accelerated the uptake. This review discusses the rationale for her network projects, opportunities and challenges that such networks present, and some prior studies within the field of infectious diseases.
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Affiliation(s)
- Ravi Jhaveri
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Jordan John
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marc Rosenman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois,Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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13
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Shmueli E, Mansuri R, Porcilan M, Amir T, Yosha L, Yechezkel M, Patalon T, Handelman-Gotlib S, Gazit S, Yamin D. A multi-layer model for the early detection of COVID-19. J R Soc Interface 2021; 18:20210284. [PMID: 34343454 PMCID: PMC8331231 DOI: 10.1098/rsif.2021.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
Current COVID-19 screening efforts mainly rely on reported symptoms and the potential exposure to infected individuals. Here, we developed a machine-learning model for COVID-19 detection that uses four layers of information: (i) sociodemographic characteristics of the individual, (ii) spatio-temporal patterns of the disease, (iii) medical condition and general health consumption of the individual and (iv) information reported by the individual during the testing episode. We evaluated our model on 140 682 members of Maccabi Health Services who were tested for COVID-19 at least once between February and October 2020. These individuals underwent, in total, 264 516 COVID-19 PCR tests, out of which 16 512 were positive. Our multi-layer model obtained an area under the curve (AUC) of 81.6% when evaluated over all the individuals in the dataset, and an AUC of 72.8% when only individuals who did not report any symptom were included. Furthermore, considering only information collected before the testing episode-i.e. before the individual had the chance to report on any symptom-our model could reach a considerably high AUC of 79.5%. Our ability to predict early on the outcomes of COVID-19 tests is pivotal for breaking transmission chains, and can be used for a more efficient testing policy.
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Affiliation(s)
- Erez Shmueli
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
- MIT Media Lab, Cambridge, MA 02139-4307, USA
| | - Ronen Mansuri
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Matan Porcilan
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tamar Amir
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Lior Yosha
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Matan Yechezkel
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sharon Handelman-Gotlib
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Dan Yamin
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
- Center for Combatting Pandemics, Tel Aviv University, Tel Aviv 6997801, Israel
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14
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Schultz MA, Walden RL, Cato K, Coviak CP, Cruz C, D'Agostino F, Douthit BJ, Forbes T, Gao G, Lee MA, Lekan D, Wieben A, Jeffery AD. Data Science Methods for Nursing-Relevant Patient Outcomes and Clinical Processes: The 2019 Literature Year in Review. Comput Inform Nurs 2021; 39:654-667. [PMID: 34747890 PMCID: PMC8578863 DOI: 10.1097/cin.0000000000000705] [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] [Indexed: 11/26/2022]
Abstract
Data science continues to be recognized and used within healthcare due to the increased availability of large data sets and advanced analytics. It can be challenging for nurse leaders to remain apprised of this rapidly changing landscape. In this article, we describe our findings from a scoping literature review of papers published in 2019 that use data science to explore, explain, and/or predict 15 phenomena of interest to nurses. Fourteen of the 15 phenomena were associated with at least one paper published in 2019. We identified the use of many contemporary data science methods (eg, natural language processing, neural networks) for many of the outcomes. We found many studies exploring Readmissions and Pressure Injuries. The topics of Artificial Intelligence/Machine Learning Acceptance, Burnout, Patient Safety, and Unit Culture were poorly represented. We hope that the studies described in this article help readers: (1) understand the breadth and depth of data science's ability to improve clinical processes and patient outcomes that are relevant to nurses and (2) identify gaps in the literature that are in need of exploration.
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Affiliation(s)
- Mary Anne Schultz
- Author Affiliations: California State University (Dr Schultz); Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University (Ms Walden); Department of Emergency Medicine, Columbia University School of Nursing (Dr Cato); Grand Valley State University (Dr Coviak); Global Health Technology & Informatics, Chevron, San Ramon, CA (Mr Cruz); Saint Camillus International University of Health Sciences, Rome, Italy (Dr D'Agostino); Duke University School of Nursing (Mr Douthit); East Carolina University College of Nursing (Dr Forbes); St Catherine University Department of Nursing (Dr Gao); Texas Woman's University College of Nursing (Dr Lee); Assistant Professor, University of North Carolina at Greensboro School of Nursing (Dr Lekan); University of Wisconsin School of Nursing (Ms Wieben); and Vanderbilt University School of Nursing, and Tennessee Valley Healthcare System, US Department of Veterans Affairs (Dr Jeffery)
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15
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Shieh D, Li Q, Shi JM, Tovar S. The Shieh Score as a Risk Assessment Tool for Hospital-Acquired Pressure Injuries: A Retrospective Cohort Study. Adv Skin Wound Care 2021; 34:132-138. [PMID: 33587474 DOI: 10.1097/01.asw.0000732736.89356.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To design a new risk assessment tool to identify patients at high risk for hospital-acquired pressure injuries. METHODS The researchers developed the Shieh Score using retrospective data of 406,032 hospital admissions from January 2014 to December 2016 with 1,299 pressure injury cases from the pressure injury registry. A decision tree and best subset logistic regression were used to select predictors from demographic and clinical candidate variables, which were then used to construct the Shieh Score. RESULTS The final Shieh Score included the following measures: sex, age, diabetes, glomerular filtration rate, albumin level, level of function, use of IV norepinephrine, mechanical ventilation, and level of consciousness. The Shieh Score had a higher Youden Index, specificity, and positive predictive value than the Braden Scale. However, the Braden Scale had a higher sensitivity compared with the Shieh Score. CONCLUSIONS The Shieh Score is an alternative risk assessment tool that may effectively identify a smaller number of patients at high risk for hospital-acquired pressure injuries with a higher specificity and positive predictive value than the Braden Scale.
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Affiliation(s)
- David Shieh
- At Kaiser Permanente, Pasadena, California, David Shieh, MD, is Internal Medicine Physician; Qiaowu Li, MS, is Biostatistician; Jiaxiao M. Shi, PhD, is Research Biostatistician; and Stephanie Tovar, MS, is Clinical Trials Research Project Manager. The authors have disclosed no financial relationships related to this article. Submitted April 5, 2020; accepted in revised form June 29, 2020
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16
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Kharrazi H, Ma X, Chang HY, Richards TM, Jung C. Comparing the Predictive Effects of Patient Medication Adherence Indices in Electronic Health Record and Claims-Based Risk Stratification Models. Popul Health Manag 2021; 24:601-609. [PMID: 33544044 DOI: 10.1089/pop.2020.0306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Multiple indices are available to measure medication adherence behaviors. Medication adherence measures, however, have rarely been extracted from electronic health records (EHRs) for population-level risk predictions. This study assessed the value of medication adherence indices in improving predictive models of cost and hospitalization. This study included a 2-year retrospective cohort of patients younger than age 65 years with linked EHR and insurance claims data. Three medication adherence measures were calculated: medication regimen complexity index (MRCI), medication possession ratio (MPR), and prescription fill rate (PFR). The authors examined the effects of adding these measures to 3 predictive models of utilization: a demographics model, a conventional model (Charlson index), and an advanced diagnosis-based model. Models were trained using EHR and claims data. The study population had an overall MRCI, MPR, and PFR of 14.6 ± 17.8, .624 ± .310, and .810 ± .270, respectively. Adding MRCI and MPR to the demographic and the morbidity models using claims data improved forecasting of next-year hospitalization substantially (eg, AUC of the demographic model increased from .605 to .656 using MRCI). Nonetheless, such boosting effects were attenuated for the advanced diagnosis-based models. Although EHR models performed inferior to claims models, adding adherence indices improved EHR model performances at a larger scale (eg, adding MRCI increased AUC by 4.4% for the Charlson model using EHR data compared to 3.8% using claims). This study shows that medication adherence measures can modestly improve EHR- and claims-derived predictive models of cost and hospitalization in non-elderly patients; however, the improvements are minimal for advanced diagnosis-based models.
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Affiliation(s)
- Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore Maryland, USA
| | - Xiaomeng Ma
- Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluations, University of Toronto, Toronto, Canada
| | - Hsien-Yen Chang
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas M Richards
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Changmi Jung
- Carey Business School, Johns Hopkins University, Baltimore, Maryland, USA
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17
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Using Health Administrative Data to Predict Chronic Obstructive Pulmonary Disease Exacerbations. Ann Am Thorac Soc 2020; 17:1056-1057. [PMID: 32870058 PMCID: PMC7462322 DOI: 10.1513/annalsats.202006-704ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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18
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Banerjee S, Davidson R, McLaurin K, Sawyer W, Long GH. Adverse events in women switching from olaparib capsules to tablets: retrospective observational study of US claims data. Future Oncol 2020; 16:643-654. [PMID: 32228096 DOI: 10.2217/fon-2020-0142] [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: 11/21/2022] Open
Abstract
Aim: Describe rates of prespecified adverse events in patients who switched from olaparib capsules to tablets. Patients & methods: Retrospective, observational cohort analysis using self-controlled, pre-post design. Data on patients with ovarian cancer who switched from olaparib capsules to tablets between January 2015 and February 2019 were obtained from a US claims database. Results: Among all patients (n = 48), proportion with any prespecified adverse event was 45.8% (95% confidence interval: 31.4-60.8) during initial 90 days' capsule use and 35.4% (22.2-50.5) during initial 90 days' tablets use; difference -10.4% (-28.8-9.0). Conclusion: Switching from olaparib capsules to tablets was manageable with no evidence of increased toxicity. This real-world study supports the manageable tolerability of olaparib in women with ovarian cancer.
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Affiliation(s)
- Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust & Institute of Cancer Research, Fulham Road, London, SW3 6JJ, UK
| | - Richard Davidson
- AstraZeneca UK Limited, Cambridge Biomedical Campus, Cambridge, CB2 0AA, UK
| | - Kimmie McLaurin
- AstraZeneca Pharmaceuticals LP, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - William Sawyer
- AstraZeneca UK Limited, Cambridge Biomedical Campus, Cambridge, CB2 0AA, UK
| | - Gráinne H Long
- AstraZeneca UK Limited, Cambridge Biomedical Campus, Cambridge, CB2 0AA, UK
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