How to Develop an Electronic Clinical Endometriosis Research File Integrated in Clinical Practice

Leveraging electronic health record data for endometriosis research

Endometriosis is a chronic, complex disease for which there are vast disparities in diagnosis and treatment between sociodemographic groups. Clinical presentation of endometriosis can vary from asymptomatic disease-often identified during (in)fertility consultations-to dysmenorrhea and debilitating pelvic pain. Because of this complexity, delayed diagnosis (mean time to diagnosis is 1.7-3.6 years) and misdiagnosis is common. Early and accurate diagnosis of endometriosis remains a research priority for patient advocates and healthcare providers. Electronic health records (EHRs) have been widely adopted as a data source in biomedical research. However, they remain a largely untapped source of data for endometriosis research. EHRs capture diverse, real-world patient populations and care trajectories and can be used to learn patterns of underlying risk factors for endometriosis which, in turn, can be used to inform screening guidelines to help clinicians efficiently and effectively recognize and diagnose the disease in all patient populations reducing inequities in care. Here, we provide an overview of the advantages and limitations of using EHR data to study endometriosis. We describe the prevalence of endometriosis observed in diverse populations from multiple healthcare institutions, examples of variables that can be extracted from EHRs to enhance the accuracy of endometriosis prediction, and opportunities to leverage longitudinal EHR data to improve our understanding of long-term health consequences for all patients.

Are There Predictors of Early Diagnosis of Endometriosis Based on Clinical Profile? A Retrospective Study

Objectives

Significant delays occur in referring cases for care of endometriosis, despite women suffering for years. This study was conducted to assess whether there is a specific symptom profile characteristic of endometriosis to alert physicians for earlier referrals.

Methods

In this retrospective observational cohort study, patient data of the women who attended Sultan Qaboos University Hospital from January 2011 to December 2019 with a diagnosis of endometriosis was collected from the hospital's electronic data archive and analyzed.

Results

Cases of N = 262 endometriosis patients were studied. The diagnosis was surgical in 198 (75.6%) of patients and the remaining 64 (24.4%) were diagnosed by clinical assessment and imaging. The mean age at diagnosis was 30.7±6.8 years (range = 15-51). The presence of ovarian endometrioma on ultrasound served as an alert for earlier referral. The mean age at diagnosis for those who had an endometrioma was 30.3±6.7 years and 32.4±7.1 years for those without an endometrioma without a significant difference. The mean age at diagnosis for those who did not have pain was 31.2 years and those with pain was 30.0 years (p =0.894; CI: -2.58^-2.91). Among the 163 married women in the sample, 88 (54.0%) had primary infertility, and 31 (19.0%) had secondary infertility. There was no significant difference between the groups in the mean age at diagnosis (analysis of variance test; p =0.056). Over the nine-year period, diagnosis was made at progressively younger ages (p =0.047).

Conclusions

Based on this study, no specific symptom profile appears to predict an early diagnosis of endometriosis. However, over the years the diagnosis of endometriosis is made earlier likely due to increasing awareness of women and their physicians about the disease.

A retrospective analysis of boarding times for adolescents in psychiatric crisis

The boarding of children and adolescents with identified psychiatric conditions at medical facilities has numerous negative effects on the patients and the systems that treat them. Efforts to minimize boarding times serves to increase patients' access to appropriate levels of care, redirect medical resources to patients who need them most, and reduce safety risks to people and property. This study explores the role Clinical Social Workers can play in facilitation of care and highlights the advantages of a coordinated data collection process facilitated by the effective use of the Electronic Medical Record. A retrospective chart analysis of 100 patients admitted to the Emergency department at a pediatric hospital in Central Florida was conducted for patients seen between 1 January 2015 and 30 June 2016. The data suggest key correlates that may impact the boarding times of pediatric patients presenting in a psychiatric crisis and the average duration of boarding time in hours (M = 5.11, SD = 2.07) was found to be significantly lower than prior published studies in the adult and pediatric literature. Discussion of these data implications on behavioral health practice is discussed.