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Zhang Y, Callaghan-Koru JA, Koru G. The challenges and opportunities of continuous data quality improvement for healthcare administration data. JAMIA Open 2024; 7:ooae058. [PMID: 39091510 PMCID: PMC11293638 DOI: 10.1093/jamiaopen/ooae058] [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: 10/02/2023] [Revised: 05/12/2024] [Accepted: 06/18/2024] [Indexed: 08/04/2024] Open
Abstract
Background Various data quality issues have prevented healthcare administration data from being fully utilized when dealing with problems ranging from COVID-19 contact tracing to controlling healthcare costs. Objectives (i) Describe the currently adopted approaches and practices for understanding and improving the quality of healthcare administration data. (ii) Explore the challenges and opportunities to achieve continuous quality improvement for such data. Materials and Methods We used a qualitative approach to obtain rich contextual data through semi-structured interviews conducted at a state health agency regarding Medicaid claims and reimbursement data. We interviewed all data stewards knowledgeable about the data quality issues experienced at the agency. The qualitative data were analyzed using the Framework method. Results Sixteen themes emerged from our analysis, collected under 4 categories: (i) Defect characteristics: Data defects showed variability, frequently remained obscure, and led to negative outcomes. Detecting and resolving them was often difficult, and the work required often exceeded the organizational boundaries. (ii) Current process and people issues: The agency adopted primarily ad-hoc, manual approaches to resolving data quality problems leading to work frustration. (iii) Challenges: Communication and lack of knowledge about legacy software systems and the data maintained in them constituted challenges, followed by different standards used by various organizations and vendors, and data verification difficulties. (iv) Opportunities: Training, tool support, and standardization of data definitions emerged as immediate opportunities to improve data quality. Conclusions Our results can be useful to similar agencies on their journey toward becoming learning health organizations leveraging data assets effectively and efficiently.
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Affiliation(s)
- Yili Zhang
- Innovation Center for Biomedical Informatics, Georgetown University, Washington, DC 20007, United States
| | - Jennifer A Callaghan-Koru
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR 72703, United States
| | - Güneş Koru
- Departments of Health Policy and Management & Biomedical Informatics, University of Arkansas for Medical Sciences, Fayetteville, AR 72703, United States
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Förstel S, Förstel M, Gallistl M, Zanca D, Eskofier BM, Rothgang EM. Data quality in hospital information systems: Lessons learned from analyzing 30 years of patient data in a regional German hospital. Int J Med Inform 2024; 192:105636. [PMID: 39357217 DOI: 10.1016/j.ijmedinf.2024.105636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 09/17/2024] [Accepted: 09/18/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND The integration of Hospital Information Systems (HIS) into healthcare delivery has significantly enhanced patient care and operational efficiency. Nonetheless, the rapid acceleration of digital transformation has led to a substantial increase in the volume of data managed by these systems. This emphasizes the need for robust mechanisms for data management and quality assurance. OBJECTIVE This study addresses data quality issues related to patient identifiers within the Hospital Information System (HIS) of a regional German hospital, focusing on improving the accuracy and consistency of these administrative data entries. METHODS Employing a combination of data analysis and expert interviews, this study reviews and programmatically cleanses a dataset with over 2,000,000 patient data entries extracted from the HIS. The areas of investigation are patient admissions, discharges, and geographical data. RESULTS The analysis revealed that roughly 25% of the dataset was rendered unusable by errors and inconsistencies. By implementing a thorough data cleansing process, we significantly enhanced the utility of the dataset. In doing so, we identified the primary issues affecting data quality, including ambiguities among similar variables and a gap between the intended and actual use of the system. CONCLUSION The findings highlight the critical importance of enhancing data quality in healthcare information systems. This study shows the necessity of a careful review of data extracted from the HIS before it can be reliably utilized for machine learning tasks, thereby rendering the data more usable for both clinical and analytical purposes.
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Affiliation(s)
- Stefan Förstel
- Department of Industrial Engineering and Health, Technical University Amberg-Weiden, Hetzenrichter Weg 15, Weiden in der Oberpfalz, 92637, Bavaria, Germany; Department Artificial Intelligence in Biomedical Engineering, Technische Fakultät, Friedrich-Alexander Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, Erlangen, 91052, Bavaria, Germany.
| | - Markus Förstel
- Department of Industrial Engineering and Health, Technical University Amberg-Weiden, Hetzenrichter Weg 15, Weiden in der Oberpfalz, 92637, Bavaria, Germany
| | - Markus Gallistl
- Kliniken Nordoberpfalz AG, Söllnerstraße 16, Weiden in der Oberpfalz, 92637, Bavaria, Germany
| | - Dario Zanca
- Department Artificial Intelligence in Biomedical Engineering, Technische Fakultät, Friedrich-Alexander Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, Erlangen, 91052, Bavaria, Germany
| | - Bjoern M Eskofier
- Department Artificial Intelligence in Biomedical Engineering, Technische Fakultät, Friedrich-Alexander Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, Erlangen, 91052, Bavaria, Germany
| | - Eva M Rothgang
- Department of Industrial Engineering and Health, Technical University Amberg-Weiden, Hetzenrichter Weg 15, Weiden in der Oberpfalz, 92637, Bavaria, Germany
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Ghalavand H, Shirshahi S, Rahimi A, Zarrinabadi Z, Amani F. Common data quality elements for health information systems: a systematic review. BMC Med Inform Decis Mak 2024; 24:243. [PMID: 39223578 PMCID: PMC11367888 DOI: 10.1186/s12911-024-02644-7] [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: 04/17/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Data quality in health information systems has a complex structure and consists of several dimensions. This research conducted for identify Common data quality elements for health information systems. METHODS A literature review was conducted and search strategies run in Web of Knowledge, Science Direct, Emerald, PubMed, Scopus and Google Scholar search engine as an additional source for tracing references. We found 760 papers, excluded 314 duplicates, 339 on abstract review and 167 on full-text review; leaving 58 papers for critical appraisal. RESULTS Current review shown that 14 criteria are categorized as the main dimensions for data quality for health information system include: Accuracy, Consistency, Security, Timeliness, Completeness, Reliability, Accessibility, Objectivity, Relevancy, Understandability, Navigation, Reputation, Efficiency and Value- added. Accuracy, Completeness, and Timeliness, were the three most-used dimensions in literature. CONCLUSIONS At present, there is a lack of uniformity and potential applicability in the dimensions employed to evaluate the data quality of health information system. Typically, different approaches (qualitative, quantitative and mixed methods) were utilized to evaluate data quality for health information system in the publications that were reviewed. Consequently, due to the inconsistency in defining dimensions and assessing methods, it became imperative to categorize the dimensions of data quality into a limited set of primary dimensions.
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Affiliation(s)
- Hossein Ghalavand
- Department of Medical library and Information Science, Abadan University of Medical Sciences, Abadan, Iran.
| | - Saied Shirshahi
- Department of Medical library and Information Science, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Rahimi
- Department of Medical library and Information Science, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zarrin Zarrinabadi
- Department of Medical library and Information Science, Abadan University of Medical Sciences, Abadan, Iran
| | - Fatemeh Amani
- Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran
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Banschbach KM, Singleton J, Wang X, Vora SS, Harris JG, Lytch A, Pan N, Klauss J, Fair D, Hammelev E, Gilbert M, Kreese C, Machado A, Tarczy-Hornoch P, Morgan EM. Assessing disparities through missing race and ethnicity data: results from a juvenile arthritis registry. Front Pediatr 2024; 12:1430981. [PMID: 39114853 PMCID: PMC11303283 DOI: 10.3389/fped.2024.1430981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/01/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Ensuring high-quality race and ethnicity data within the electronic health record (EHR) and across linked systems, such as patient registries, is necessary to achieving the goal of inclusion of racial and ethnic minorities in scientific research and detecting disparities associated with race and ethnicity. The project goal was to improve race and ethnicity data completion within the Pediatric Rheumatology Care Outcomes Improvement Network and assess impact of improved data completion on conclusions drawn from the registry. Methods This is a mixed-methods quality improvement study that consisted of five parts, as follows: (1) Identifying baseline missing race and ethnicity data, (2) Surveying current collection and entry, (3) Completing data through audit and feedback cycles, (4) Assessing the impact on outcome measures, and (5) Conducting participant interviews and thematic analysis. Results Across six participating centers, 29% of the patients were missing data on race and 31% were missing data on ethnicity. Of patients missing data, most patients were missing both race and ethnicity. Rates of missingness varied by data entry method (electronic vs. manual). Recovered data had a higher percentage of patients with Other race or Hispanic/Latino ethnicity compared with patients with non-missing race and ethnicity data at baseline. Black patients had a significantly higher odds ratio of having a clinical juvenile arthritis disease activity score (cJADAS10) of ≥5 at first follow-up compared with White patients. There was no significant change in odds ratio of cJADAS10 ≥5 for race and ethnicity after data completion. Patients missing race and ethnicity were more likely to be missing cJADAS values, which may affect the ability to detect changes in odds ratio of cJADAS ≥5 after completion. Conclusions About one-third of the patients in a pediatric rheumatology registry were missing race and ethnicity data. After three audit and feedback cycles, centers decreased missing data by 94%, primarily via data recovery from the EHR. In this sample, completion of missing data did not change the findings related to differential outcomes by race. Recovered data were not uniformly distributed compared with those with non-missing race and ethnicity data at baseline, suggesting that differences in outcomes after completing race and ethnicity data may be seen with larger sample sizes.
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Affiliation(s)
- Katelyn M. Banschbach
- Division of Pediatric Rheumatology, Seattle Children’s Hospital, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jade Singleton
- Biostatistics Epidemiology and Analytics in Research (BEAR), Seattle Children’s Research Institute, Seattle, WA, United States
| | - Xing Wang
- Biostatistics Epidemiology and Analytics in Research (BEAR), Seattle Children’s Research Institute, Seattle, WA, United States
| | - Sheetal S. Vora
- Division of Pediatric Rheumatology, Department of Pediatrics, Atrium Health Levine Children’s Hospital and Wake Forest University School of Medicine, Charlotte, NC, United States
| | - Julia G. Harris
- Division of Pediatric Rheumatology, Department of Pediatrics, Children’s Mercy Kansas City and University of Missouri-Kansas City School of Medicine, Kansas, MO, United States
| | - Ashley Lytch
- Children’s Mercy Research Institute, Children’s Mercy Kansas City, Kansas, MO, United States
| | - Nancy Pan
- Department of Pediatrics, Weill Medical College of Cornell University, New York, NY, United States
- Division of Pediatric Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Julia Klauss
- Division of Pediatric Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Danielle Fair
- Division of Pediatric Rheumatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Erin Hammelev
- Division of Pediatric Rheumatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mileka Gilbert
- Division of Pediatric Rheumatology, Department of Pediatrics, Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC, United States
| | - Connor Kreese
- Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC, United States
| | - Ashley Machado
- Division of Pediatric Rheumatology, Department of Pediatrics, Northwell Health, Cohen Children’s Medical Center, New York, NY, United States
| | - Peter Tarczy-Hornoch
- Department of Biomedical Informatics and Medial Education, University of Washington, Seattle, WA, United States
- Division of Neonatology Department of Pediatrics, University of Washington, Seattle, WA, United States
- Paul Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
| | - Esi M. Morgan
- Division of Pediatric Rheumatology, Seattle Children’s Hospital, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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Wallnöfer A, Burgstaller JM, Weiss K, Rosemann T, Senn O, Markun S. Developing and testing a framework for coding general practitioners' free-text diagnoses in electronic medical records - a reliability study for generating training data in natural language processing. BMC PRIMARY CARE 2024; 25:257. [PMID: 39014311 PMCID: PMC11251376 DOI: 10.1186/s12875-024-02514-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Diagnoses entered by general practitioners into electronic medical records have great potential for research and practice, but unfortunately, diagnoses are often in uncoded format, making them of little use. Natural language processing (NLP) could assist in coding free-text diagnoses, but NLP models require local training data to unlock their potential. The aim of this study was to develop a framework of research-relevant diagnostic codes, to test the framework using free-text diagnoses from a Swiss primary care database and to generate training data for NLP modelling. METHODS The framework of diagnostic codes was developed based on input from local stakeholders and consideration of epidemiological data. After pre-testing, the framework contained 105 diagnostic codes, which were then applied by two raters who independently coded randomly drawn lines of free text (LoFT) from diagnosis lists extracted from the electronic medical records of 3000 patients of 27 general practitioners. Coding frequency and mean occurrence rates (n and %) and inter-rater reliability (IRR) of coding were calculated using Cohen's kappa (Κ). RESULTS The sample consisted of 26,980 LoFT and in 56.3% no code could be assigned because it was not a specific diagnosis. The most common diagnostic codes were, 'dorsopathies' (3.9%, a code covering all types of back problems, including non-specific lower back pain, scoliosis, and others) and 'other diseases of the circulatory system' (3.1%). Raters were in almost perfect agreement (Κ ≥ 0.81) for 69 of the 105 diagnostic codes, and 28 codes showed a substantial agreement (K between 0.61 and 0.80). Both high coding frequency and almost perfect agreement were found in 37 codes, including codes that are particularly difficult to identify from components of the electronic medical record, such as musculoskeletal conditions, cancer or tobacco use. CONCLUSION The coding framework was characterised by a subset of very frequent and highly reliable diagnostic codes, which will be the most valuable targets for training NLP models for automated disease classification based on free-text diagnoses from Swiss general practice.
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Affiliation(s)
- Audrey Wallnöfer
- Institute of primary care, University and University Hospital Zurich, Pestalozzistr. 24, Zürich, 8091, Switzerland
| | - Jakob M Burgstaller
- Institute of primary care, University and University Hospital Zurich, Pestalozzistr. 24, Zürich, 8091, Switzerland
| | - Katja Weiss
- Institute of primary care, University and University Hospital Zurich, Pestalozzistr. 24, Zürich, 8091, Switzerland
| | - Thomas Rosemann
- Institute of primary care, University and University Hospital Zurich, Pestalozzistr. 24, Zürich, 8091, Switzerland
| | - Oliver Senn
- Institute of primary care, University and University Hospital Zurich, Pestalozzistr. 24, Zürich, 8091, Switzerland
| | - Stefan Markun
- Institute of primary care, University and University Hospital Zurich, Pestalozzistr. 24, Zürich, 8091, Switzerland.
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Esserman D, Greene EJ, Latham NK, Kane M, Lu C, Peduzzi PN, Gill TM, Ganz DA. Assessing readiness to use electronic health record data for outcome ascertainment in clinical trials - A case study. Contemp Clin Trials 2024; 142:107572. [PMID: 38740298 DOI: 10.1016/j.cct.2024.107572] [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: 09/28/2023] [Revised: 04/04/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Variable data quality poses a challenge to using electronic health record (EHR) data to ascertain acute clinical outcomes in multi-site clinical trials. Differing EHR platforms and data comprehensiveness across clinical trial sites, especially if patients received care outside of the clinical site's network, can also affect validity of results. Overcoming these challenges requires a structured approach. METHODS We propose a framework and create a checklist to assess the readiness of clinical sites to contribute EHR data to a clinical trial for the purpose of outcome ascertainment, based on our experience with the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, which enrolled 5451 participants in 86 primary care practices across 10 healthcare systems (sites). RESULTS The site readiness checklist includes assessment of the infrastructure (i.e., size and structure of the site's healthcare system or clinical network), data procurement (i.e., quality of the data), and cost of obtaining study data. The checklist emphasizes the importance of understanding how data are captured and integrated across a site's catchment area and having a protocol in place for data procurement to ensure consistent and uniform extraction across each site. CONCLUSIONS We suggest rigorous, prospective vetting of the data quality and infrastructure of each clinical site before launching a multi-site trial dependent on EHR data. The proposed checklist serves as a guiding tool to help investigators ensure robust and unbiased data capture for their clinical trials. ORIGINAL TRIAL REGISTRATION NUMBER NCT02475850.
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Affiliation(s)
- Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
| | - Erich J Greene
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Nancy K Latham
- Boston Claude D. Pepper Older Americans Independence Center; Research Program in Men's Health: Aging and Metabolism; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Kane
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Charles Lu
- Biomedical Informatics and Data Science, Yale School of Medicine, USA
| | - Peter N Peduzzi
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, USA
| | - David A Ganz
- Department of Medicine, David Geffen School of Medicine at UCLA, Panama; Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, USA
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Tsumura H, Brandon D, Vacchiano C, Krishnamoorthy V, Bartz R, Pan W. Exploring phenotype-based ventilator parameter optimization to mitigate postoperative pulmonary complications: a retrospective observational cohort study. Surg Today 2024; 54:722-733. [PMID: 38095709 PMCID: PMC11176264 DOI: 10.1007/s00595-023-02785-8] [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: 02/21/2023] [Accepted: 11/01/2023] [Indexed: 06/15/2024]
Abstract
PURPOSE To identify tidal volume (VT) and positive end-expiratory pressure (PEEP) associated with the lowest incidence and severity of postoperative pulmonary complications (PPCs) for each phenotype based on preoperative characteristics. METHODS The subjects of this retrospective observational cohort study were 34,910 adults who underwent surgery, using general anesthesia with mechanical ventilation. Initially, the least absolute shrinkage and selection operator regression was employed to select relevant preoperative characteristics. Then, the classification and regression tree (CART) was built to identify phenotypes. Finally, we computed the area under the receiver operating characteristic curves from logistic regressions to identify VT and PEEP associated with the lowest incidence and severity of PPCs for each phenotype. RESULTS CARTs classified seven phenotypes for each outcome. A probability of the development of PPCs ranged from the lowest (3.51%) to the highest (68.57%), whereas the probability of the development of the highest level of PPC severity ranged from 3.3% to 91.0%. Across all phenotypes, the VT and PEEP associated with the most desirable outcomes were within a small range of VT 7-8 ml/kg predicted body weight with PEEP of between 6 and 8 cmH2O. CONCLUSIONS The ranges of optimal VT and PEEP were small, regardless of the phenotypes, which had a wide range of risk profiles.
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Affiliation(s)
- Hideyo Tsumura
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA.
- Duke University Health System, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Debra Brandon
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Department of Pediatrics, Duke University School of Medicine, DUMC 3352, Durham, NC, 27710, USA
| | - Charles Vacchiano
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, DUMC 309427710, USA
- Department of Population Health Sciences Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Raquel Bartz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Wei Pan
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Department of Population Health Sciences Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
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Wright MA, Kinlaw AC, McClurg AB, Carey E, Doll KM, Vines AI, Olshan AF, Robinson WR. Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions. J Womens Health (Larchmt) 2024. [PMID: 38864118 DOI: 10.1089/jwh.2024.0142] [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: 06/13/2024] Open
Abstract
Objective: To assess the appropriateness of hysterectomies performed at a large tertiary health system using the 1997 RAND appropriateness classification system and an updated algorithm. Design: We abstracted structured and unstructured data from electronic medical records on patient demographics, primary indication(s) for hysterectomy, diagnosis codes associated with the hysterectomy, previous treatments, and laboratory results. Subjects: Patients aged 18-44 years. Exposure: Receipt of hysterectomy for benign and nonobstetric conditions from October 2014 to December 2017. Main Outcome Measures: Using these data, we provided a RAND-based (dichotomous: inappropriate/appropriate) and Wright-based (3-level: inappropriate/ambiguous/appropriate) appropriateness rating and characterized missing information patterns associated with inappropriate ratings. Results: We analyzed 1,829 hysterectomies across 30 nonmutually exclusive primary indications for surgery. Nearly a third (32.8%) of surgeries had only one primary indication for surgery. Using the RAND-based classifier, 31.3% of hysterectomies were rated as appropriate and 68.7% as inappropriate. Using the Wright-based algorithm, 58.1% of hysterectomies were rated as appropriate, 15.7% as ambiguous, and 26.2% as inappropriate. Missing information on diagnostic procedures was the most common characteristic related to both RAND-based (46.1%) and Wright-based (51.2%) inappropriate ratings. Conclusions: The 1997 RAND classification lacked guidance for several contemporary indications, including gender-affirming care. RAND also has an outdated requirement for diagnostic surgeries such as laparoscopies, which have decreased in practice as diagnostic imaging has improved. Sensitivity analyses suggest that inappropriate surgeries cannot all be attributed to bias from missing electronic medical record data. Accurately documenting care delivery for benign gynecological conditions is key to ensuring quality and equity in gynecological care.
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Affiliation(s)
- Maya A Wright
- Tanaq Support Services LLC, Atlanta, Georgia, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alan C Kinlaw
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Asha B McClurg
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin Carey
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kemi M Doll
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
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Soleymani T, Lehman EB, Kong L, Poger JM, Yeh HC, Kraschnewski JL. Bariatric surgery and COVID-19 outcomes: results from the PaTH to Health: Diabetes study. Surg Obes Relat Dis 2024:S1550-7289(24)00644-0. [PMID: 38991937 DOI: 10.1016/j.soard.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Obesity and type 2 diabetes mellitus (T2DM) are risk factors for severe COVID-19 infection. Bariatric surgery (BSG) is an effective treatment of obesity through weight loss and may reduce COVID-19 severity. OBJECTIVES We examined the effect of BSG on COVID-19 outcomes in patients with or at risk of T2DM. SETTING Electronic health record data from the PaTH Clinical Data Research Network, a partnership of 5 health systems reviewed from March 1, 2020, to December 31, 2020. METHODS Ambulatory and in-hospital patient encounters with COVID-19 diagnosis and obesity were identified. We constructed 2 patient groups: BSG and non-BSG (NBSG). The BSG group included patients with at least 1 encounter for the BSG procedure code and/or 1 BSG diagnosis code; the NBSG group included patients with no procedure or diagnosis code for BSG with body mass index (BMI) ≥40 or BMI ≥35 and at least 2 obesity-related co-morbidities. We matched 1 patient in the BSG group to 2 patients in the NBSG group based on age, gender (sex defined at birth), race and ethnicity, group (T2DM and at risk of T2DM), and site. The primary outcome was 30-day outcomes of COVID-19 severity. RESULTS After matching, we found that patients with BSG had lower odds of respiratory failure (41%) and ventilation/intensive care unit (ICU) admission/death (52%). Patients in the BSG group had lower odds of hospitalization, pneumonia, respiratory failure, and the most severe COVID-19 outcomes combined (ventilation/ICU admission/death). T2DM was identified as a risk factor for COVID-19 severity in the BSG group. CONCLUSIONS This retrospective, matched-cohort analysis found BSG to have a protective effect against severe COVID-19 outcomes.
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Affiliation(s)
- Taraneh Soleymani
- Division of General Internal Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jennifer M Poger
- Division of General Internal Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Hsin-Chieh Yeh
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer L Kraschnewski
- Division of General Internal Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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10
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Bye A, Carter B, Leightley D, Trevillion K, Liakata M, Branthonne-Foster S, Cross S, Zenasni Z, Carr E, Williamson G, Vega Viyuela A, Dutta R. Cohort profile: The Social media, smartphone use and Self-harm in Young People (3S-YP) study-A prospective, observational cohort study of young people in contact with mental health services. PLoS One 2024; 19:e0299059. [PMID: 38776261 PMCID: PMC11111019 DOI: 10.1371/journal.pone.0299059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/04/2024] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVES The Social media, Smartphone use and Self-Harm (3S-YP) study is a prospective observational cohort study to investigate the mechanisms underpinning associations between social media and smartphone use and self-harm in a clinical youth sample. We present here a comprehensive description of the cohort from baseline data and an overview of data available from baseline and follow-up assessments. METHODS Young people aged 13-25 years were recruited from a mental health trust in England and followed up for 6 months. Self-report data was collected at baseline and monthly during follow-up and linked with electronic health records (EHR) and user-generated data. FINDINGS A total of 362 young people enrolled and provided baseline questionnaire data. Most participants had a history of self-harm according to clinical (n = 295, 81.5%) and broader definitions (n = 296, 81.8%). At baseline, there were high levels of current moderate/severe anxiety (n = 244; 67.4%), depression (n = 255; 70.4%) and sleep disturbance (n = 171; 47.2%). Over half used social media and smartphones after midnight on weekdays (n = 197, 54.4%; n = 215, 59.4%) and weekends (n = 241, 66.6%; n = 263, 72.7%), and half met the cut-off for problematic smartphone use (n = 177; 48.9%). Of the cohort, we have questionnaire data at month 6 from 230 (63.5%), EHR data from 345 (95.3%), social media data from 110 (30.4%) and smartphone data from 48 (13.3%). CONCLUSION The 3S-YP study is the first prospective study with a clinical youth sample, for whom to investigate the impact of digital technology on youth mental health using novel data linkages. Baseline findings indicate self-harm, anxiety, depression, sleep disturbance and digital technology overuse are prevalent among clinical youth. Future analyses will explore associations between outcomes and exposures over time and compare self-report with user-generated data in this cohort.
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Affiliation(s)
- Amanda Bye
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Daniel Leightley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Institute of Psychiatry, King’s Centre for Military Health Research, Psychology and Neuroscience, King’s College London, London, United Kingdom
- School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Kylee Trevillion
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Maria Liakata
- School of Electronic Engineering & Computer Science, Queen Mary, University of London, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
- University of Warwick, Warwick, United Kingdom
| | | | - Samantha Cross
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Zohra Zenasni
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Grace Williamson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Institute of Psychiatry, King’s Centre for Military Health Research, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Alba Vega Viyuela
- National Institute for Health and Care Research (NIHR) Clinical Research Network (CRN) South London, London, United Kingdom
- Cardiology Research Department, Health Research Institute, Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Rina Dutta
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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11
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El Burai Felix S, Yusuf H, Ritchey M, Romano S, Namulanda G, Wilkins N, Boehmer TK. A Standard Framework for Evaluating Large Health Care Data and Related Resources. MMWR Suppl 2024; 73:1-13. [PMID: 38713639 PMCID: PMC11078514 DOI: 10.15585/mmwr.su7303a1] [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: 05/09/2024] Open
Abstract
Since 2000, the availability and use of large health care data and related resources for conducting surveillance, research, and evaluations to guide clinical and public health decision-making has increased rapidly. These trends have been related to transformations in health care information technology and public as well as private-sector efforts for collecting, compiling, and supplying large volumes of data. This growing collection of robust and often timely data has enhanced the capability to increase the knowledge base guiding clinical and public health activities and also has increased the need for effective tools to assess the attributes of these resources and identify the types of scientific questions they are best suited to address. This MMWR supplement presents a standard framework for evaluating large health care data and related resources, including constructs, criteria, and tools that investigators and evaluators can apply and adapt.
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12
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Kookal KK, Walji MF, Brandon R, Kivanc F, Mertz E, Kottek A, Mullins J, Liang S, Jenson LE, White JM. Systematically assessing the quality of dental electronic health record data for an investigation into oral health care disparities. J Public Health Dent 2024. [PMID: 38659337 DOI: 10.1111/jphd.12618] [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: 12/09/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This work describes the process by which the quality of electronic health care data for a public health study was determined. The objectives were to adapt, develop, and implement data quality assessments (DQAs) based on the National Institutes of Health Pragmatic Trials Collaboratory (NIHPTC) data quality framework within the three domains of completeness, accuracy, and consistency, for an investigation into oral health care disparities of a preventive care program. METHODS Electronic health record data for eligible children in a dental accountable care organization of 30 offices, in Oregon, were extracted iteratively from January 1, 2014, through March 31, 2022. Baseline eligibility criteria included: children ages 0-18 with a baseline examination, Oregon home address, and either Medicaid or commercial dental benefits at least once between 2014 and 2108. Using the NIHPTC framework as a guide, DQAs were conducted throughout data element identification, extraction, staging, profiling, review, and documentation. RESULTS The data set included 91,487 subjects, 11 data tables comprising 75 data variables (columns), with a total of 6,861,525 data elements. Data completeness was 97.2%, the accuracy of EHR data elements in extracts was 100%, and consistency between offices was strong; 29 of 30 offices within 2 standard deviations of the mean (s = 94%). CONCLUSIONS The NIHPTC framework proved to be a useful approach, to identify, document, and characterize the dataset. The concepts of completeness, accuracy, and consistency were adapted by the multidisciplinary research team and the overall quality of the data are demonstrated to be of high quality.
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Affiliation(s)
- Krishna Kumar Kookal
- Technology Services and Informatics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Muhammad F Walji
- Department of Clinical and Health Informatics, D. Bradley McWIlliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ryan Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Ferit Kivanc
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Elizabeth Mertz
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Aubri Kottek
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Joanna Mullins
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Shuang Liang
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Larry E Jenson
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Joel M White
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
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Declerck J, Kalra D, Vander Stichele R, Coorevits P. Frameworks, Dimensions, Definitions of Aspects, and Assessment Methods for the Appraisal of Quality of Health Data for Secondary Use: Comprehensive Overview of Reviews. JMIR Med Inform 2024; 12:e51560. [PMID: 38446534 PMCID: PMC10955383 DOI: 10.2196/51560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/07/2023] [Accepted: 01/09/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Health care has not reached the full potential of the secondary use of health data because of-among other issues-concerns about the quality of the data being used. The shift toward digital health has led to an increase in the volume of health data. However, this increase in quantity has not been matched by a proportional improvement in the quality of health data. OBJECTIVE This review aims to offer a comprehensive overview of the existing frameworks for data quality dimensions and assessment methods for the secondary use of health data. In addition, it aims to consolidate the results into a unified framework. METHODS A review of reviews was conducted including reviews describing frameworks of data quality dimensions and their assessment methods, specifically from a secondary use perspective. Reviews were excluded if they were not related to the health care ecosystem, lacked relevant information related to our research objective, and were published in languages other than English. RESULTS A total of 22 reviews were included, comprising 22 frameworks, with 23 different terms for dimensions, and 62 definitions of dimensions. All dimensions were mapped toward the data quality framework of the European Institute for Innovation through Health Data. In total, 8 reviews mentioned 38 different assessment methods, pertaining to 31 definitions of the dimensions. CONCLUSIONS The findings in this review revealed a lack of consensus in the literature regarding the terminology, definitions, and assessment methods for data quality dimensions. This creates ambiguity and difficulties in developing specific assessment methods. This study goes a step further by assigning all observed definitions to a consolidated framework of 9 data quality dimensions.
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Affiliation(s)
- Jens Declerck
- Department of Public Health and Primary Care, Unit of Medical Informatics and Statistics, Ghent University, Ghent, Belgium
- The European Institute for Innovation through Health Data, Ghent, Belgium
| | - Dipak Kalra
- Department of Public Health and Primary Care, Unit of Medical Informatics and Statistics, Ghent University, Ghent, Belgium
- The European Institute for Innovation through Health Data, Ghent, Belgium
| | - Robert Vander Stichele
- Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent, Belgium
| | - Pascal Coorevits
- Department of Public Health and Primary Care, Unit of Medical Informatics and Statistics, Ghent University, Ghent, Belgium
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14
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Dowding D. Commentary: Artificial Intelligence in nursing: trustworthy or reliable? J Res Nurs 2024; 29:154-155. [PMID: 39070564 PMCID: PMC11271673 DOI: 10.1177/17449871231215746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Affiliation(s)
- Dawn Dowding
- Professor in Clinical Decision Making, Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
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15
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Taye BK, Gezie LD, Atnafu A, Mengiste SA, Tilahun B. Data completeness and consistency in individual medical records of institutional births: retrospective crossectional study from Northwest Ethiopia, 2022. BMC Health Serv Res 2023; 23:1189. [PMID: 37907881 PMCID: PMC10619314 DOI: 10.1186/s12913-023-10127-0] [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: 05/04/2023] [Accepted: 10/06/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Ensuring the data quality of Individual Medical Records becomes a crucial strategy in mitigating maternal and newborn morbidity and mortality during and around childbirth. However, previous research in Ethiopia primarily focused on studying data quality of institutional birth at the facility level, overlooking the data quality within Individual Medical Records. This study examined the data completeness and consistency within Individual Medical Records of the institutional birth service and associated factors. METHODS An institution-based retrospective cross-sectional study was conducted in two districts of Northwest Ethiopia. Data were obtained by reviewing three sets of Individual Medical Records of 651 women: the delivery register, Integrated Individual Folder, and integrated card. The proportions of completeness and consistency were computed. A multilevel binary logistic regression was used to identify factors of completeness and consistency. An odds ratio with a 95% confidence interval was used to assess the level of significance. RESULTS Overall, 74.0% of women's Individual Medical Records demonstrated good data completeness ( > = 70%), 95%CI (70.5, 77.3), while 26% exhibited good consistency, 95%CI (22.9, 29.7). The presence of trained providers in data quality (AOR = 2.9, 95%CI: (1.5, 5.7)) and supportive supervision (AOR = 11.5, 95%CI: (4.8, 27.2)) were found to be associated with completeness. Health facilities' practice of root cause analysis on data quality gaps (AOR = 8.7, 9%CI: (1.5, 50.9)) was statistically significantly associated with the consistency. CONCLUSIONS Most medical records were found to have good completeness, but nearly only a quarter of them found to contain consistent data. Completeness and consistency varied on the type of medical record. Health facility's root cause analysis of data quality gaps, the presence of trained providers in data quality, and supportive supervision from higher officials were identified as factors affecting data quality in institutional birth service. These results emphasize the importance of focused efforts to enhance data completeness and consistency within Individual Medical Records, particularly through consideration of Individual Medical Records in future provider training, supervision, and the implementation of root cause analysis practices.
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Affiliation(s)
- Biniam Kefyalew Taye
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Ministry of Health, The Federal Democratic Republic of Ethiopia, Addis Ababa, Ethiopia.
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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16
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Bernardi FA, Alves D, Crepaldi N, Yamada DB, Lima VC, Rijo R. Data Quality in Health Research: Integrative Literature Review. J Med Internet Res 2023; 25:e41446. [PMID: 37906223 PMCID: PMC10646672 DOI: 10.2196/41446] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Decision-making and strategies to improve service delivery must be supported by reliable health data to generate consistent evidence on health status. The data quality management process must ensure the reliability of collected data. Consequently, various methodologies to improve the quality of services are applied in the health field. At the same time, scientific research is constantly evolving to improve data quality through better reproducibility and empowerment of researchers and offers patient groups tools for secured data sharing and privacy compliance. OBJECTIVE Through an integrative literature review, the aim of this work was to identify and evaluate digital health technology interventions designed to support the conducting of health research based on data quality. METHODS A search was conducted in 6 electronic scientific databases in January 2022: PubMed, SCOPUS, Web of Science, Institute of Electrical and Electronics Engineers Digital Library, Cumulative Index of Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and flowchart were used to visualize the search strategy results in the databases. RESULTS After analyzing and extracting the outcomes of interest, 33 papers were included in the review. The studies covered the period of 2017-2021 and were conducted in 22 countries. Key findings revealed variability and a lack of consensus in assessing data quality domains and metrics. Data quality factors included the research environment, application time, and development steps. Strategies for improving data quality involved using business intelligence models, statistical analyses, data mining techniques, and qualitative approaches. CONCLUSIONS The main barriers to health data quality are technical, motivational, economical, political, legal, ethical, organizational, human resources, and methodological. The data quality process and techniques, from precollection to gathering, postcollection, and analysis, are critical for the final result of a study or the quality of processes and decision-making in a health care organization. The findings highlight the need for standardized practices and collaborative efforts to enhance data quality in health research. Finally, context guides decisions regarding data quality strategies and techniques. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1101/2022.05.31.22275804.
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Affiliation(s)
| | - Domingos Alves
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Nathalia Crepaldi
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Diego Bettiol Yamada
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Vinícius Costa Lima
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Rui Rijo
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
- Polytechnic Institute of Leiria, Leiria, Portugal
- Institute for Systems and Computers Engineering, Coimbra, Portugal
- Center for Research in Health Technologies and Services, Porto, Portugal
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Saleh GA, Batouty NM, Gamal A, Elnakib A, Hamdy O, Sharafeldeen A, Mahmoud A, Ghazal M, Yousaf J, Alhalabi M, AbouEleneen A, Tolba AE, Elmougy S, Contractor S, El-Baz A. Impact of Imaging Biomarkers and AI on Breast Cancer Management: A Brief Review. Cancers (Basel) 2023; 15:5216. [PMID: 37958390 PMCID: PMC10650187 DOI: 10.3390/cancers15215216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leading cause of global cancer-related deaths. The American College of Radiology (ACR) introduced the Breast Imaging Reporting and Data System (BI-RADS) as a standard terminology facilitating communication between radiologists and clinicians; however, an update is now imperative to encompass the latest imaging modalities developed subsequent to the 5th edition of BI-RADS. Within this review article, we provide a concise history of BI-RADS, delve into advanced mammography techniques, ultrasonography (US), magnetic resonance imaging (MRI), PET/CT images, and microwave breast imaging, and subsequently furnish comprehensive, updated insights into Molecular Breast Imaging (MBI), diagnostic imaging biomarkers, and the assessment of treatment responses. This endeavor aims to enhance radiologists' proficiency in catering to the personalized needs of breast cancer patients. Lastly, we explore the augmented benefits of artificial intelligence (AI), machine learning (ML), and deep learning (DL) applications in segmenting, detecting, and diagnosing breast cancer, as well as the early prediction of the response of tumors to neoadjuvant chemotherapy (NAC). By assimilating state-of-the-art computer algorithms capable of deciphering intricate imaging data and aiding radiologists in rendering precise and effective diagnoses, AI has profoundly revolutionized the landscape of breast cancer radiology. Its vast potential holds the promise of bolstering radiologists' capabilities and ameliorating patient outcomes in the realm of breast cancer management.
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Affiliation(s)
- Gehad A. Saleh
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Nihal M. Batouty
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Abdelrahman Gamal
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elnakib
- Electrical and Computer Engineering Department, School of Engineering, Penn State Erie, The Behrend College, Erie, PA 16563, USA;
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Centre, Mansoura University, Mansoura 35516, Egypt;
| | - Ahmed Sharafeldeen
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ali Mahmoud
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Mohammed Ghazal
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Jawad Yousaf
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Marah Alhalabi
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Amal AbouEleneen
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elsaid Tolba
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
- The Higher Institute of Engineering and Automotive Technology and Energy, New Heliopolis, Cairo 11829, Egypt
| | - Samir Elmougy
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Sohail Contractor
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
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18
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Kjær J, Milling L, Wittrock D, Nielsen LB, Mikkelsen S. The data quality and applicability of a Danish prehospital electronic health record: A mixed-methods study. PLoS One 2023; 18:e0293577. [PMID: 37883522 PMCID: PMC10602337 DOI: 10.1371/journal.pone.0293577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Without accurate documentation, it can be difficult to assess the quality of care and the impact of quality improvement initiatives. Prehospital lack of documentation of the basic measurements is associated with a twofold risk of mortality. The aim of this study was to investigate data quality in the electronic prehospital patient record (ePPR) system in the Region of Southern Denmark. In addition, we investigated ambulance professionals' attitudes toward the use of ePPR and identified barriers and facilitators to its use. METHOD We used an explanatory sequential mixed-methods design. Phase one consisted of a retrospective assessment of the data quality of ePPR information, and phase two included semi-structured interviews with ambulance professionals combined with observations. We included patients who were acutely transported to an emergency department by ambulance in the Region of Southern Denmark from 2016 to 2020. Data completeness was calculated for each vital sign using a two-way table of frequency. Vital signs were summarised to calculate data correctness. Interviews and observations were analysed using thematic analysis. RESULTS Overall, an improvement in data completeness and correctness was observed from 2016-2020. When stratified by age group, children (<12 years) accounted for the majority of missing vital sign registrations. In the thematic analysis, we identified four themes; ambulance professionals' attitudes, emergency setting, training and guidelines, and tablet and software. CONCLUSION We found high data quality, but there is room for improvement. The ambulance professionals' attitudes toward the ePPR, working in an emergency setting, a notion of insufficient training in completing the ePPR, and challenges related to the tablet and software could be barriers to data completeness and correctness. It would be beneficial to include the end-user when developing an ePPR system and to consider that the tablet should be used in emergency situations.
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Affiliation(s)
- Jeannett Kjær
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Louise Milling
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Søren Mikkelsen
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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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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Dhingra LS, Shen M, Mangla A, Khera R. Cardiovascular Care Innovation through Data-Driven Discoveries in the Electronic Health Record. Am J Cardiol 2023; 203:136-148. [PMID: 37499593 PMCID: PMC10865722 DOI: 10.1016/j.amjcard.2023.06.104] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
The electronic health record (EHR) represents a rich source of patient information, increasingly being leveraged for cardiovascular research. Although its primary use remains the seamless delivery of health care, the various longitudinally aggregated structured and unstructured data elements for each patient within the EHR can define the computational phenotypes of disease and care signatures and their association with outcomes. Although structured data elements, such as demographic characteristics, laboratory measurements, problem lists, and medications, are easily extracted, unstructured data are underused. The latter include free text in clinical narratives, documentation of procedures, and reports of imaging and pathology. Rapid scaling up of data storage and rapid innovation in natural language processing and computer vision can power insights from unstructured data streams. However, despite an array of opportunities for research using the EHR, specific expertise is necessary to adequately address confidentiality, accuracy, completeness, and heterogeneity challenges in EHR-based research. These often require methodological innovation and best practices to design and conduct successful research studies. Our review discusses these challenges and their proposed solutions. In addition, we highlight the ongoing innovations in federated learning in the EHR through a greater focus on common data models and discuss ongoing work that defines such an approach to large-scale, multicenter, federated studies. Such parallel improvements in technology and research methods enable innovative care and optimization of patient outcomes.
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Affiliation(s)
| | - Miles Shen
- Section of Cardiovascular Medicine, Department of Internal Medicine; Department of Internal Medicine
| | - Anjali Mangla
- Section of Cardiovascular Medicine, Department of Internal Medicine; Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine; Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut; Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.; Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut.
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21
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Scola G, Chis Ster A, Bean D, Pareek N, Emsley R, Landau S. Implementation of the trial emulation approach in medical research: a scoping review. BMC Med Res Methodol 2023; 23:186. [PMID: 37587484 PMCID: PMC10428565 DOI: 10.1186/s12874-023-02000-9] [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: 11/16/2022] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND When conducting randomised controlled trials is impractical, an alternative is to carry out an observational study. However, making valid causal inferences from observational data is challenging because of the risk of several statistical biases. In 2016 Hernán and Robins put forward the 'target trial framework' as a guide to best design and analyse observational studies whilst preventing the most common biases. This framework consists of (1) clearly defining a causal question about an intervention, (2) specifying the protocol of the hypothetical trial, and (3) explaining how the observational data will be used to emulate it. METHODS The aim of this scoping review was to identify and review all explicit attempts of trial emulation studies across all medical fields. Embase, Medline and Web of Science were searched for trial emulation studies published in English from database inception to February 25, 2021. The following information was extracted from studies that were deemed eligible for review: the subject area, the type of observational data that they leveraged, and the statistical methods they used to address the following biases: (A) confounding bias, (B) immortal time bias, and (C) selection bias. RESULTS The search resulted in 617 studies, 38 of which we deemed eligible for review. Of those 38 studies, most focused on cardiology, infectious diseases or oncology and the majority used electronic health records/electronic medical records data and cohort studies data. Different statistical methods were used to address confounding at baseline and selection bias, predominantly conditioning on the confounders (N = 18/49, 37%) and inverse probability of censoring weighting (N = 7/20, 35%) respectively. Different approaches were used to address immortal time bias, assigning individuals to treatment strategies at start of follow-up based on their data available at that specific time (N = 21, 55%), using the sequential trial emulations approach (N = 11, 29%) or the cloning approach (N = 6, 16%). CONCLUSION Different methods can be leveraged to address (A) confounding bias, (B) immortal time bias, and (C) selection bias. When working with observational data, and if possible, the 'target trial' framework should be used as it provides a structured conceptual approach to observational research.
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Affiliation(s)
- Giulio Scola
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Anca Chis Ster
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Bean
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Health Data Research UK London, Institute of Health Informatics, University College London, London, UK
| | - Nilesh Pareek
- King's College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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22
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Tumilty E, Smith E. "A Community-Engaged Approach to Address Collateral Findings in Embedded Research". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:61-63. [PMID: 37450538 PMCID: PMC10361628 DOI: 10.1080/15265161.2023.2217113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Emma Tumilty
- Department of Bioethics and Health Humanities, School of Public Health, University of Texas Medical Branch
| | - Elise Smith
- Department of Bioethics and Health Humanities, School of Public Health, University of Texas Medical Branch
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23
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Mohamed Y, Song X, McMahon TM, Sahil S, Zozus M, Wang Z, Waitman LR. Electronic health record data quality variability across a multistate clinical research network. J Clin Transl Sci 2023; 7:e130. [PMID: 37396818 PMCID: PMC10308424 DOI: 10.1017/cts.2023.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 07/04/2023] Open
Abstract
Background Electronic health record (EHR) data have many quality problems that may affect the outcome of research results and decision support systems. Many methods have been used to evaluate EHR data quality. However, there has yet to be a consensus on the best practice. We used a rule-based approach to assess the variability of EHR data quality across multiple healthcare systems. Methods To quantify data quality concerns across healthcare systems in a PCORnet Clinical Research Network, we used a previously tested rule-based framework tailored to the PCORnet Common Data Model to perform data quality assessment at 13 clinical sites across eight states. Results were compared with the current PCORnet data curation process to explore the differences between both methods. Additional analyses of testosterone therapy prescribing were used to explore clinical care variability and quality. Results The framework detected discrepancies across sites, revealing evident data quality variability between sites. The detailed requirements encoded the rules captured additional data errors with a specificity that aids in remediation of technical errors compared to the current PCORnet data curation process. Other rules designed to detect logical and clinical inconsistencies may also support clinical care variability and quality programs. Conclusion Rule-based EHR data quality methods quantify significant discrepancies across all sites. Medication and laboratory sources are causes of data errors.
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Affiliation(s)
- Yahia Mohamed
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Xing Song
- University of Missouri School of Medicine, Columbia, MO, USA
| | - Tamara M. McMahon
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Suman Sahil
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Meredith Zozus
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zhan Wang
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Lemuel R. Waitman
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- University of Missouri School of Medicine, Columbia, MO, USA
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24
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Jonsdottir G, Haraldsdottir E, Sigurdardottir V, Thoroddsen A, Vilhjalmsson R, Tryggvadottir GB, Jonsdottir H. Developing and testing inter-rater reliability of a data collection tool for patient health records on end-of-life care of neurological patients in an acute hospital ward. Nurs Open 2023. [PMID: 37141442 DOI: 10.1002/nop2.1789] [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: 07/14/2021] [Revised: 11/21/2022] [Accepted: 04/16/2023] [Indexed: 05/06/2023] Open
Abstract
AIM Develop and test a data collection tool-Neurological End-Of-Life Care Assessment Tool (NEOLCAT)-for extracting data from patient health records (PHRs) on end-of-life care of neurological patients in an acute hospital ward. DESIGN Instrument development and inter-rater reliability (IRR) assessment. METHOD NEOLCAT was constructed from patient care items obtained from clinical guidelines and literature on end-of-life care. Expert clinicians reviewed the items. Using percentage agreement and Fleiss' kappa we calculated IRR on 32 nominal items, out of 76 items. RESULTS IRR of NEOLCAT showed 89% (range 83%-95%) overall categorical percentage agreement. The Fleiss' kappa categorical coefficient was 0.84 (range 0.71-0.91). There was fair or moderate agreement on six items, and moderate or almost perfect agreement on 26 items. CONCLUSION The NEOLCAT shows promising psychometric properties for studying clinical components of care of neurological patients at the end-of-life on an acute hospital ward but could be further developed in future studies.
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Affiliation(s)
- Gudrun Jonsdottir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Asta Thoroddsen
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Runar Vilhjalmsson
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Helga Jonsdottir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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25
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Ozonze O, Scott PJ, Hopgood AA. Automating Electronic Health Record Data Quality Assessment. J Med Syst 2023; 47:23. [PMID: 36781551 PMCID: PMC9925537 DOI: 10.1007/s10916-022-01892-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/15/2022] [Indexed: 02/15/2023]
Abstract
Information systems such as Electronic Health Record (EHR) systems are susceptible to data quality (DQ) issues. Given the growing importance of EHR data, there is an increasing demand for strategies and tools to help ensure that available data are fit for use. However, developing reliable data quality assessment (DQA) tools necessary for guiding and evaluating improvement efforts has remained a fundamental challenge. This review examines the state of research on operationalising EHR DQA, mainly automated tooling, and highlights necessary considerations for future implementations. We reviewed 1841 articles from PubMed, Web of Science, and Scopus published between 2011 and 2021. 23 DQA programs deployed in real-world settings to assess EHR data quality (n = 14), and a few experimental prototypes (n = 9), were identified. Many of these programs investigate completeness (n = 15) and value conformance (n = 12) quality dimensions and are backed by knowledge items gathered from domain experts (n = 9), literature reviews and existing DQ measurements (n = 3). A few DQA programs also explore the feasibility of using data-driven techniques to assess EHR data quality automatically. Overall, the automation of EHR DQA is gaining traction, but current efforts are fragmented and not backed by relevant theory. Existing programs also vary in scope, type of data supported, and how measurements are sourced. There is a need to standardise programs for assessing EHR data quality, as current evidence suggests their quality may be unknown.
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Affiliation(s)
- Obinwa Ozonze
- School of Computing, University of Portsmouth, Buckingham Building, Lion Terrace, Portsmouth, PO1 3HE, UK
| | - Philip J Scott
- Institute of Management and Health, University of Wales Trinity Saint David, Lampeter, SA48 7ED, UK
| | - Adrian A Hopgood
- School of Computing, University of Portsmouth, Buckingham Building, Lion Terrace, Portsmouth, PO1 3HE, UK.
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Mashoufi M, Ayatollahi H, Khorasani-Zavareh D, Talebi Azad Boni T. Data Quality in Health Care: Main Concepts and Assessment Methodologies. Methods Inf Med 2023; 62:5-18. [PMID: 36716776 DOI: 10.1055/s-0043-1761500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION In the health care environment, a huge volume of data is produced on a daily basis. However, the processes of collecting, storing, sharing, analyzing, and reporting health data usually face with numerous challenges that lead to producing incomplete, inaccurate, and untimely data. As a result, data quality issues have received more attention than before. OBJECTIVE The purpose of this article is to provide an insight into the data quality definitions, dimensions, and assessment methodologies. METHODS In this article, a scoping literature review approach was used to describe and summarize the main concepts related to data quality and data quality assessment methodologies. Search terms were selected to find the relevant articles published between January 1, 2012 and September 31, 2022. The retrieved articles were then reviewed and the results were reported narratively. RESULTS In total, 23 papers were included in the study. According to the results, data quality dimensions were various and different methodologies were used to assess them. Most studies used quantitative methods to measure data quality dimensions either in paper-based or computer-based medical records. Only two studies investigated respondents' opinions about data quality. CONCLUSION In health care, high-quality data not only are important for patient care, but also are vital for improving quality of health care services and better decision making. Therefore, using technical and nontechnical solutions as well as constant assessment and supervision is suggested to improve data quality.
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Affiliation(s)
- Mehrnaz Mashoufi
- Department of Health Information Management, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.,Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Davoud Khorasani-Zavareh
- Department of Health in Emergencies and Disasters, Safety Promotion and Injury Prevention Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahere Talebi Azad Boni
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
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27
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Sauer CM, Chen LC, Hyland SL, Girbes A, Elbers P, Celi LA. Leveraging electronic health records for data science: common pitfalls and how to avoid them. Lancet Digit Health 2022; 4:e893-e898. [PMID: 36154811 DOI: 10.1016/s2589-7500(22)00154-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 12/29/2022]
Abstract
Analysis of electronic health records (EHRs) is an increasingly common approach for studying real-world patient data. Use of routinely collected data offers several advantages compared with other study designs, including reduced administrative costs, the ability to update analysis as practice patterns evolve, and larger sample sizes. Methodologically, EHR analysis is subject to distinct challenges because data are not collected for research purposes. In this Viewpoint, we elaborate on the importance of in-depth knowledge of clinical workflows and describe six potential pitfalls to be avoided when working with EHR data, drawing on examples from the literature and our experience. We propose solutions for prevention or mitigation of factors associated with each of these six pitfalls-sample selection bias, imprecise variable definitions, limitations to deployment, variable measurement frequency, subjective treatment allocation, and model overfitting. Ultimately, we hope that this Viewpoint will guide researchers to further improve the methodological robustness of EHR analysis.
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Affiliation(s)
- Christopher M Sauer
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands; Laboratory for Computational Physiology, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Li-Ching Chen
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | | | - Armand Girbes
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Paul Elbers
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Leo A Celi
- Laboratory for Computational Physiology, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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28
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von Gerich H, Moen H, Peltonen L. Identifying nursing sensitive indicators from electronic health records in acute cardiac care-Towards intelligent automated assessment of care quality. J Nurs Manag 2022; 30:3726-3735. [PMID: 36124426 PMCID: PMC10086830 DOI: 10.1111/jonm.13802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/24/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
AIM The aim of this study is to explore the potential of using electronic health records for assessment of nursing care quality through nursing-sensitive indicators in acute cardiac care. BACKGROUND Nursing care quality is a multifaceted phenomenon, making a holistic assessment of it difficult. Quality assessment systems in acute cardiac care units could benefit from big data-based solutions that automatically extract and help interpret data from electronic health records. METHODS This is a deductive descriptive study that followed the theory of value-added analysis. A random sample from electronic health records of 230 patients was analysed for selected indicators. The data included documentation in structured and free-text format. RESULTS One thousand six hundred seventy-six expressions were extracted and divided into (1) established and (2) unestablished expressions, providing positive, neutral and negative descriptions related to care quality. CONCLUSIONS Electronic health records provide a potential source of information for information systems to support assessment of care quality. More research is warranted to develop, test and evaluate the effectiveness of such tools in practice. IMPLICATIONS FOR NURSING MANAGEMENT Knowledge-based health care management would benefit from the development and implementation of advanced information systems, which use continuously generated already available real-time big data for improved data access and interpretation to better support nursing management in quality assessment.
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Affiliation(s)
- Hanna von Gerich
- Turku University Hospital, Department of Nursing ScienceUniversity of TurkuTurkuFinland
| | - Hans Moen
- Department of Computer ScienceAalto UniversityEspooFinland
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29
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Jiang Y, Mason M, Cho Y, Chittiprolu A, Zhang X, Harden K, Gong Y, Harris MR, Barton DL. Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes. BMC Cancer 2022; 22:950. [PMID: 36057578 PMCID: PMC9440580 DOI: 10.1186/s12885-022-10026-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/16/2022] [Indexed: 12/27/2022] Open
Abstract
Background More than 60% of cancer cases occur in older adults, and many are treated with oral anticancer agents. Yet, the treatment tolerability in older adults has not been fully understood due to their underrepresentation in oncology clinical trials, creating challenges for treatment decision-making and symptom management. The objective of this study was to investigate the tolerance of capecitabine, an example of oral chemotherapy, among older adults with cancer and explore factors associated with capecitabine-related side effects and treatment changes, to enhance supportive care. Methods A secondary analysis used combined data from electronic health records and a pilot study of patient-reported outcomes, with a total of 97 adult patients taking capecitabine during 2016–2017, including older adult patients aged 65 years or older (n = 43). The data extracted included patient socio-demographics, capecitabine information, side effects, and capecitabine treatment changes (dose reductions and dose interruptions). Bivariate correlations, negative binomial regression, and multiple linear regression were conducted for data analysis. Results Older adults were more likely to experience fatigue (86% vs. 51%, p = .001) and experienced more severe fatigue (β = 0.44, p = 0.03) and hand-foot syndrome (HFS) (β = 1.15, p = 0.004) than younger adults. The severity of fatigue and HFS were associated with the number of outpatient medications (β = 0.06, p = 0.006) and the duration of treatment (β = 0.50, p = 0.009), respectively. Correlations among side effects presented different patterns between younger and older adults. Although more older adults experienced dose reductions (21% vs. 13%) and dose interruptions (33% vs. 28%) than younger adults, the differences were not statistically different. Female sex, breast cancer diagnosis, capecitabine monotherapy, and severe HFS were found to be associated with dose reductions (p-values < 0.05). Conclusions Older adults were less likely to tolerate capecitabine treatment and had different co-occurring side effects compared to younger adults. While dose reductions are common among older adults, age 65 years or older may not be an independent factor of treatment changes. Other socio-demographic and clinical factors may be more likely to be associated. Future studies can be conducted to further explore older adults’ tolerance to a variety of oral anticancer agents to generate more evidence to support optimal treatment decision-making and symptom management.
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Affiliation(s)
- Yun Jiang
- University of Michigan School of Nursing, Ann Arbor, MI, USA. .,Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, 400 North Ingalls Building, Room 4160, Ann Arbor, MI, 48109, USA.
| | - Madilyn Mason
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Youmin Cho
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | - Xingyu Zhang
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen Harden
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Yang Gong
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, TX, USA
| | | | - Debra L Barton
- University of Michigan School of Nursing, Ann Arbor, MI, USA
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Honeyford K, Expert P, Mendelsohn E, Post B, Faisal A, Glampson B, Mayer E, Costelloe C. Challenges and recommendations for high quality research using electronic health records. Front Digit Health 2022; 4:940330. [PMID: 36060540 PMCID: PMC9437583 DOI: 10.3389/fdgth.2022.940330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
Harnessing Real World Data is vital to improve health care in the 21st Century. Data from Electronic Health Records (EHRs) are a rich source of patient centred data, including information on the patient's clinical condition, laboratory results, diagnoses and treatments. They thus reflect the true state of health systems. However, access and utilisation of EHR data for research presents specific challenges. We assert that using data from EHRs effectively is dependent on synergy between researchers, clinicians and health informaticians, and only this will allow state of the art methods to be used to answer urgent and vital questions for patient care. We propose that there needs to be a paradigm shift in the way this research is conducted - appreciating that the research process is iterative rather than linear. We also make specific recommendations for organisations, based on our experience of developing and using EHR data in trusted research environments.
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Affiliation(s)
- K Honeyford
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
- Health Informatics Team, Division of Clinical studies, Institute of Cancer Research, London, United Kingdom
| | - P Expert
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
- Global Business School for Health, University College London, London, United Kingdom
| | - E.E Mendelsohn
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - B Post
- Department of Computing, Imperial College London, London, United Kingdom
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
| | - A.A Faisal
- Department of Computing, Imperial College London, London, United Kingdom
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
- Chair in Digital Health, Faculty of Life Sciences, University of Bayreuth, Bayreuth, Germany
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - B Glampson
- Translational Data Analytics and Informatics in Healthcare, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Imperial Clinical Analytics, Informatics and Evaluation (iCARE), NIHR Imperial BRC, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - E.K Mayer
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
- Translational Data Analytics and Informatics in Healthcare, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Imperial Clinical Analytics, Informatics and Evaluation (iCARE), NIHR Imperial BRC, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - C.E Costelloe
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
- Health Informatics Team, Division of Clinical studies, Institute of Cancer Research, London, United Kingdom
- Health Informatics Team, Royal Marsden Hospital, London, United Kingdom
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31
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Shih YJ, Wang JY, Wang YH, Shih RR, Yang YJ. Analyses and identification of ICD codes for dementias in the research based on the NHIRD: a scoping review protocol. BMJ Open 2022; 12:e062654. [PMID: 35948384 PMCID: PMC9379469 DOI: 10.1136/bmjopen-2022-062654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Studies based on health claims data (HCD) have been increasingly adopted in medical research for their strengths in large sample size and abundant information, and the Taiwan National Health Insurance Research Database (NHIRD) has been widely used in medical research across disciplines, including dementia. How the diagnostic codes are applied to define the diseases/conditions of interest is pivotal in HCD-related research, but the consensus on the issue that diagnostic codes most appropriately define dementias in the NHIRD is lacking. The objectives of this scoping review are (1) to investigate the relevant characteristics in the published reports targeting dementias based on the NHIRD, and (2) to address the diversity by a case study. METHODS AND ANALYSIS This scoping review protocol follows the methodological framework of the Joanna Briggs Institute Reviewer's Manual and the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The review will be performed between 1 March and 31 December 2022 in five stages, including identifying the relevant studies, developing search strategies, individually screening and selecting evidence, collecting and extracting data, and summarising and reporting the results. The electronic databases of MEDLINE, EMBASE, CENTRAL, CINAHL, and PsycINFO, Airiti Library Academic Database, the National Health Insurance Administration's repository, and Taiwan Government Research Bulletin will be searched. We will perform narrative syntheses of the results to address research questions and will analyse the prevalence across the included individual studies as a case study. ETHICS AND DISSEMINATION Our scoping review is a review of the published reports and ethical approval is not required. The results will provide a panorama of the dementia studies based on the NHIRD. We will disseminate our findings through peer-reviewed journals and conferences, and share with stakeholders by distributing the summaries in social media and emails.
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Affiliation(s)
- Ying-Jyun Shih
- Department of Healthcare Administration, Asia University College of Medical and Health Science, Taichung City, Taiwan
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Tsaotun Township, Nan-Tou County, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, Asia University College of Medical and Health Science, Taichung City, Taiwan
| | - Ya-Hui Wang
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Tsaotun Township, Nan-Tou County, Taiwan
| | - Rong-Rong Shih
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Tsaotun Township, Nan-Tou County, Taiwan
| | - Yung-Jen Yang
- Social Science Research Unit (SSRU), Institue of Education, University College London, London, UK
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McDonald N, Kriellaars D, Doupe M, Giesbrecht G, Pryce RT. Database quality assessment in research in paramedicine: a scoping review protocol. BMJ Open 2022; 12:e063372. [PMID: 35835522 PMCID: PMC9289022 DOI: 10.1136/bmjopen-2022-063372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The paramedic practice environment presents unique challenges to data documentation and access, as well as linkage to other parts of the healthcare system. Variable or unknown data quality can influence the validity of research in paramedicine. A number of database quality assessment (DQA) frameworks have been developed and used to evaluate data quality in other areas of healthcare. The extent these or other DQA practices have been applied to paramedic research is not known. Accordingly, this scoping review aims to describe the range, extent and nature of DQA practices within research in paramedicine. METHODS AND ANALYSIS This scoping review will follow established methods for the conduct (Johanna Briggs Institute; Arksey and O'Malley) and reporting (Preferred Reporting Items in Systematic Reviews and Meta-Analyses extension for scoping reviews) of scoping reviews. In consultation with a professional librarian, a search strategy was developed representing the applicable population, concept and context. This strategy will be applied to MEDLINE (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier) and CINAHL (EBSCO) to identify studies published from 2011 through 2021 that assess paramedic data quality as a stated goal. Studies will be included if they report quantitative results of DQA using data that relate primarily to the paramedic practice environment. Protocols, commentaries, case studies, interviews, simulations and experimental data-processing techniques will be excluded. No restrictions will be placed on language. Study selection will be performed by two reviewers, with a third available to resolve conflicts. Data will be extracted from included studies using a data-charting form piloted and iteratively revised based on studies known to be relevant. Results will be summarised in a chart of study characteristics, DQA-specific outcomes and key findings. ETHICS AND DISSEMINATION Ethical approval is not required. Results will be submitted to relevant conferences and peer-reviewed journals. TRIAL REGISTRATION 10.17605/OSF.IO/Z287T.
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Affiliation(s)
- Neil McDonald
- Applied Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Dean Kriellaars
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Malcolm Doupe
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gordon Giesbrecht
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rob T Pryce
- Kinesiology and Applied Health, The University of Winnipeg, Winnipeg, Manitoba, Canada
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Infants With Congenital Muscular Torticollis: Demographic Factors, Clinical Characteristics, and Physical Therapy Episode of Care. Pediatr Phys Ther 2022; 34:343-351. [PMID: 35616483 DOI: 10.1097/pep.0000000000000907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe demographic factors, baseline characteristics, and physical therapy episodes in infants with congenital muscular torticollis (CMT), examine groups based on physical therapy completion, and identify implications for clinical practice. METHODS Retrospective data were extracted from a single-site registry of 445 infants with CMT. RESULTS Most infants were male (57%), Caucasian (63%), and firstborn (50%), with torticollis detected by 3 months old (89%) with a left (51%), mild (72%) CMT presentation. Cervical range of motion (ROM) limitations were greatest in passive lateral flexion and active rotation. Sixty-seven percent of infants completed an episode of physical therapy, 25% completed a partial episode, and 8% did not attend visits following the initial examination. Age at examination, ROM, and muscle function differed significantly between groups. CONCLUSIONS Physical therapists may use clinical registry data to inform practice for timing of referral, frequency of care, and clinician training to manage infants with CMT.
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Hamlin L, Banaag A. Women's Health Care in the Deployed Setting 2013-2020: A Health Services Research Approach. Mil Med 2022; 188:usac025. [PMID: 35253048 DOI: 10.1093/milmed/usac025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION With the management and oversight of MTFs moving under the authority of the Defense Health Agency, coupled with a careful examination of the composition of uniformed medical personnel, it is imperative to ensure that active duty servicewomen who are in deployed settings receive timely, appropriate, and quality health care. This study sought to examine the amount and types of gynecological and obstetric care provided in the deployed setting and to examine that data by the socioeconomic and demographic characteristics of the women receiving that care. MATERIALS AND METHODS Using the Military Health System's Theater Medical Data Store, we identified women aged 15 to 54 years old who received care at a theater-based MTF between 2013 and 2020. Within our study population, we subsequently identified obstetric and gynecologic (OBGYN) health services during the study period, and ran descriptive statistics on patient demographics (age group, race, rank, and U.S. military branch of service) and OBGYN health services. Patient age was assessed at the time of data extraction and race was categorized as Black, White, Other, and Unknown. The military branch of service was categorized as Army, Navy/Marines, Air Force, and Other. Rank was used as a proxy for socioeconomic status and categorized as Junior Enlisted, Senior Enlisted, Junior Officer, Senior Officer, Warrant Officer, and Other. Multivariable logistic regressions were also conducted and used to assess the odds of OBGYN health service utilization, with all patient demographics included as predictor variables. RESULTS A total of 490,482 women were identified and received OBGYN health services at theater-based MTFs between 2013 and 2020. The majority of our population consisted of women aged 25 to 34 years (56.98%), associated with a Junior Enlisted rank (39.27%) and with the Navy/Marines (37.27%). Race was severely underreported, with 51.58% associated with an unknown race; however, 20.88% of our population were White women, 16.81% were Black women, and 10.72% of women identified their race as Other. The top five diagnoses for women seen in the deployed environment were for a contraceptive prescription (12.13%), followed by sexually transmitted infection (STI) screening (8.14%), breast disorder (7.89%), GYN exam (6.86%), and menstrual abnormalities (6.35%). Compared to White women, Black women had higher odds of seeking the contraceptive prescription (3.03 OR, 2.91-3.17 95% CI), obtaining STI screening (5.34 OR, 5.16-5.54 95% CI), being seen for a breast disorder (4.88 OR, 4.71-5.06 95% CI), GYN exam (3.21 OR, 3.10-3.32 95% CI), and menstrual abnormalities (3.71 OR, 3.58-3.85 95% CI). CONCLUSIONS Almost consistently, senior officers were more likely to receive OBGYN services during deployment. Policymakers and health-care providers need to identify interventions to close this care gap, particularly in preventive OBGYN services (contraception, GYN exams, STI screenings). Fully implementing the Comprehensive Contraceptive Counseling and Access to the Full Range of Methods of Contraception policy and developing one standard Defense Health Affairs policy on pre-deployment evaluation standards and deployment follow-up care for women's health care may also assist in closing care gaps.
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Affiliation(s)
- Lynette Hamlin
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Amanda Banaag
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
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Razzaghi H, Greenberg J, Bailey LC. Developing a systematic approach to assessing data quality in secondary use of clinical data based on intended use. Learn Health Syst 2022; 6:e10264. [PMID: 35036548 PMCID: PMC8753309 DOI: 10.1002/lrh2.10264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Secondary use of electronic health record (EHR) data for research requires that the data are fit for use. Data quality (DQ) frameworks have traditionally focused on structural conformance and completeness of clinical data extracted from source systems. In this paper, we propose a framework for evaluating semantic DQ that will allow researchers to evaluate fitness for use prior to analyses. METHODS We reviewed current DQ literature, as well as experience from recent multisite network studies, and identified gaps in the literature and current practice. Derived principles were used to construct the conceptual framework with attention to both analytic fitness and informatics practice. RESULTS We developed a systematic framework that guides researchers in assessing whether a data source is fit for use for their intended study or project. It combines tools for evaluating clinical context with DQ principles, as well as factoring in the characteristics of the data source, in order to develop semantic DQ checks. CONCLUSIONS Our framework provides a systematic process for DQ development. Further work is needed to codify practices and metadata around both structural and semantic data quality.
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Affiliation(s)
- Hanieh Razzaghi
- Department of Pediatrics and Biomedical and Health InformaticsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Metadata Research CenterCollege of Computing and Informatics, Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Jane Greenberg
- Metadata Research CenterCollege of Computing and Informatics, Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - L. Charles Bailey
- Department of Pediatrics and Biomedical and Health InformaticsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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McGuckin T, Crick K, Myroniuk TW, Setchell B, Yeung RO, Campbell-Scherer D. Understanding challenges of using routinely collected health data to address clinical care gaps: a case study in Alberta, Canada. BMJ Open Qual 2022; 11:e001491. [PMID: 34996811 PMCID: PMC8744094 DOI: 10.1136/bmjoq-2021-001491] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/16/2021] [Indexed: 12/19/2022] Open
Abstract
High-quality data are fundamental to healthcare research, future applications of artificial intelligence and advancing healthcare delivery and outcomes through a learning health system. Although routinely collected administrative health and electronic medical record data are rich sources of information, they have significant limitations. Through four example projects from the Physician Learning Program in Edmonton, Alberta, Canada, we illustrate barriers to using routinely collected health data to conduct research and engage in clinical quality improvement. These include challenges with data availability for variables of clinical interest, data completeness within a clinical visit, missing and duplicate visits, and variability of data capture systems. We make four recommendations that highlight the need for increased clinical engagement to improve the collection and coding of routinely collected data. Advancing the quality and usability of health systems data will support the continuous quality improvement needed to achieve the quintuple aim.
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Affiliation(s)
- Taylor McGuckin
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
| | - Katelynn Crick
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
| | | | - Brock Setchell
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
| | - Roseanne O Yeung
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
- Division of Endocrinology & Metabolism, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Denise Campbell-Scherer
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Bay Júnior ODG, Diniz Vieira Silva CR, Santos Martiniano C, de Figueiredo Melo LM, Barros de Souza M, Lopes MDS, Coelho AA, de Medeiros Rocha P, de Albuquerque Pinheiro TX, de Sá Pinto Dantas Rocha N, da Costa Uchôa SA. The relationship between the use of PMAQ-AB mobile application and management system and the evaluation quality Primary Health Care in Brazil: A qualitative case study (Preprint). JMIR Form Res 2021; 6:e35996. [PMID: 35904848 PMCID: PMC9377477 DOI: 10.2196/35996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/29/2022] [Accepted: 05/22/2022] [Indexed: 11/13/2022] Open
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Laing S, Johnston S. Estimated impact of COVID-19 on preventive care service delivery: an observational cohort study. BMC Health Serv Res 2021; 21:1107. [PMID: 34656114 PMCID: PMC8520349 DOI: 10.1186/s12913-021-07131-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COVID-19 has caused significant healthcare service disruptions. Surgical backlogs have been estimated but not for other healthcare services. This study aims to estimate the backlog of preventive care services caused by COVID-19. METHODS This observational study assessed preventive care screening rates at three primary care clinics in Ottawa, Ontario from March to November 2020 using data from 22,685 electronic medical records. The change in cervical cancer, colorectal cancer, and type 2 diabetes screening rates were crudely estimated using 2016 census data, estimating the volume of key services delayed by COVID-19 across Ontario and Canada. RESULTS The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (- 0.3% to - 14.7%; 95% CI), colorectal cancer decreased by 8.1% (- 0.3% to - 15.8%; 95% CI), and type 2 diabetes decreased by 4.5% (- 0.2% to - 8.7%; 95% CI). Crude estimates imply 288,000 cervical cancer (11,000 to 565,000; 95% CI), 326,000 colorectal cancer (13,000 to 638,000; 95% CI), and 274,000 type 2 diabetes screenings (13,000 to 535,000; 95% CI) may be overdue in Ontario. Nationally the deficits may be tripled these numbers. Re-opening measures have not reversed these trends. INTERPRETATION COVID-19 decreased the delivery of preventive care services, which may cause delayed diagnoses, increased mortality, and increased health care costs. Virtual care and reopening measures have not restored the provision of preventive care services. Electronic medical record data could be leveraged to improve screening via panel management. Additional, system-wide primary care and laboratory capacity will be needed to restore pre-COVID-19 screening rates.
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Affiliation(s)
- Scott Laing
- University of Ottawa Department of Family Medicine, Telfer School of Management, Ottawa, Canada
| | - Sharon Johnston
- University of Ottawa Department of Family Medicine, Institut du Savoir Montfort, Bruyère Research Institute, Ottawa, Canada
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Shi X, Prins C, Van Pottelbergh G, Mamouris P, Vaes B, De Moor B. An automated data cleaning method for Electronic Health Records by incorporating clinical knowledge. BMC Med Inform Decis Mak 2021; 21:267. [PMID: 34535146 PMCID: PMC8449435 DOI: 10.1186/s12911-021-01630-7] [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: 01/16/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of Electronic Health Records (EHR) data in clinical research is incredibly increasing, but the abundancy of data resources raises the challenge of data cleaning. It can save time if the data cleaning can be done automatically. In addition, the automated data cleaning tools for data in other domains often process all variables uniformly, meaning that they cannot serve well for clinical data, as there is variable-specific information that needs to be considered. This paper proposes an automated data cleaning method for EHR data with clinical knowledge taken into consideration. METHODS We used EHR data collected from primary care in Flanders, Belgium during 1994-2015. We constructed a Clinical Knowledge Database to store all the variable-specific information that is necessary for data cleaning. We applied Fuzzy search to automatically detect and replace the wrongly spelled units, and performed the unit conversion following the variable-specific conversion formula. Then the numeric values were corrected and outliers were detected considering the clinical knowledge. In total, 52 clinical variables were cleaned, and the percentage of missing values (completeness) and percentage of values within the normal range (correctness) before and after the cleaning process were compared. RESULTS All variables were 100% complete before data cleaning. 42 variables had a drop of less than 1% in the percentage of missing values and 9 variables declined by 1-10%. Only 1 variable experienced large decline in completeness (13.36%). All variables had more than 50% values within the normal range after cleaning, of which 43 variables had a percentage higher than 70%. CONCLUSIONS We propose a general method for clinical variables, which achieves high automation and is capable to deal with large-scale data. This method largely improved the efficiency to clean the data and removed the technical barriers for non-technical people.
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Affiliation(s)
- Xi Shi
- Department of Electrical Engineering (ESAT), Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Kasteelpark Arenberg 10 - Box 2446, 3001, Leuven, Belgium.
| | - Charlotte Prins
- Leuven Statistics Research Center, KU Leuven, 3000, Leuven, Belgium
| | | | - Pavlos Mamouris
- Academic Center for General Practice, KU Leuven, 3000, Leuven, Belgium
| | - Bert Vaes
- Academic Center for General Practice, KU Leuven, 3000, Leuven, Belgium
| | - Bart De Moor
- Department of Electrical Engineering (ESAT), Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Kasteelpark Arenberg 10 - Box 2446, 3001, Leuven, Belgium
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A new fuzzy approach for managing data governance implementation relevant activities. TQM JOURNAL 2021. [DOI: 10.1108/tqm-01-2021-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to propose an approach for managing relevant factors and activities for implementing data governance in an organization. The process of assessing the establishment of data governance in an organization is intrinsically imprecise, due to the characteristics of new problem settings, particularly in relation to newly generated alternatives or vaguely defined qualitative assessment criteria.
Design/methodology/approach
To reject the inherent subjectiveness and imprecision involved in the evaluation process, the authors use the concept of fuzzy logic in this approach for developing the assessment model and analyzing the model for allocating the management efforts in the most efficient way to improve the data governance deployment level.
Findings
This paper identifies relevant factors and activities for implementing data governance in an organization and evaluates the state of data governance based on causal relationships between influential factors. In this study, factors are prioritized for effective allocation of limited management efforts in any improvement plan.
Research limitations/implications
The interrelationships among factors are contextual and based on the perceptions of experts who may be biased as per their background and area of expertise. Meanwhile, lack of a data governance plan may cause failure during its implementation in an organization, as the worth of an organization's data will not be determined precisely. The paper has tremendous practical implications for organizations that intend to implement the data governance program and evaluate its state to design an improvement plan.
Originality/value
The paper proposes an approach for implementing data governance in an organization faced with limited resources for improvement.
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Validity of Incident Opioid Use Disorder (OUD) Diagnoses in Administrative Data: a Chart Verification Study. J Gen Intern Med 2021; 36:1264-1270. [PMID: 33179145 PMCID: PMC8131432 DOI: 10.1007/s11606-020-06339-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/31/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND An important strategy to address the opioid overdose epidemic involves identifying people at elevated risk of overdose, particularly those with opioid use disorder (OUD). However, it is unclear to what degree OUD diagnoses in administrative data are inaccurate. OBJECTIVE To estimate the prevalence of inaccurate diagnoses of OUD among patients with incident OUD diagnoses. SUBJECTS A random sample of 90 patients with incident OUD diagnoses associated with an index in-person encounter between October 1, 2016, and June 1, 2018, in three Veterans Health Administration medical centers. DESIGN Direct chart review of all encounter notes, referrals, prescriptions, and laboratory values within a 120-day window before and after the index encounter. Using all available chart data, we determined whether the diagnosis of OUD was likely accurate, likely inaccurate, or of indeterminate accuracy. We then performed a bivariate analysis to assess demographic or clinical characteristics associated with likely inaccurate diagnoses. KEY RESULTS We identified 1337 veterans with incident OUD diagnoses. In the chart verification subsample, we assessed 26 (29%) OUD diagnoses as likely inaccurate; 20 due to systems error and 6 due to clinical error; additionally, 8 had insufficient information to determine accuracy. Veterans with likely inaccurate diagnoses were more likely to be younger and prescribed opioids for pain. Clinical settings associated with likely inaccurate diagnoses were non-mental health clinical settings, group visits, and non-patient care settings. CONCLUSIONS Our study identified significant levels of likely inaccurate OUD diagnoses among veterans with incident OUD diagnoses. The majority of these cases reflected readily addressable systems errors. The smaller proportion due to clinical errors and those with insufficient documentation may be addressed by increased training for clinicians. If these inaccuracies are prevalent throughout the VHA, they could complicate health services research and health systems responses.
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Beckmann M, Dittmer K, Jaschke J, Karbach U, Köberlein-Neu J, Nocon M, Rusniok C, Wurster F, Pfaff H. Electronic patient record and its effects on social aspects of interprofessional collaboration and clinical workflows in hospitals (eCoCo): a mixed methods study protocol. BMC Health Serv Res 2021; 21:377. [PMID: 33892703 PMCID: PMC8063171 DOI: 10.1186/s12913-021-06377-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
Background The need for and usage of electronic patient records within hospitals has steadily increased over the last decade for economic reasons as well as the proceeding digitalization. While there are numerous benefits from this system, the potential risks of using electronic patient records for hospitals, patients and healthcare professionals must also be discussed. There is a lack in research, particularly regarding effects on healthcare professionals and their daily work in health services. The study eCoCo aims to gain insight into changes in interprofessional collaboration and clinical workflows resulting from introducing electronic patient records. Methods eCoCo is a multi-center case study integrating mixed methods from qualitative and quantitative social research. The case studies include three hospitals that undergo the process of introducing electronic patient records. Data are collected before and after the introduction of electronic patient records using participant observation, interviews, focus groups, time measurement, patient and employee questionnaires and a questionnaire to measure the level of digitalization. Furthermore, documents (patient records) as well as structural and administrative data are gathered. To analyze the interprofessional collaboration qualitative network analyses, reconstructive-hermeneutic analyses and document analyses are conducted. The workflow analyses, patient and employee assessment analyses and classification within the clinical adoption meta-model are conducted to provide insights into clinical workflows. Discussion This study will be the first to investigate the effects of introducing electronic patient records on interprofessional collaboration and clinical workflows from the perspective of healthcare professionals. Thereby, it will consider patients’ safety, legal and ethical concerns and quality of care. The results will help to understand the organization and thereby improve the performance of health services working with electronic patient records. Trial registration The study was registered at the German clinical trials register (DRKS00023343, Pre-Results) on November 17, 2020.
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Affiliation(s)
- Marina Beckmann
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany.
| | - Kerstin Dittmer
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Julia Jaschke
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Ute Karbach
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Maya Nocon
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Carsten Rusniok
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Florian Wurster
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Holger Pfaff
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
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Bian J, Lyu T, Loiacono A, Viramontes TM, Lipori G, Guo Y, Wu Y, Prosperi M, George TJ, Harle CA, Shenkman EA, Hogan W. Assessing the practice of data quality evaluation in a national clinical data research network through a systematic scoping review in the era of real-world data. J Am Med Inform Assoc 2021; 27:1999-2010. [PMID: 33166397 PMCID: PMC7727392 DOI: 10.1093/jamia/ocaa245] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/13/2020] [Accepted: 09/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objective To synthesize data quality (DQ) dimensions and assessment methods of real-world data, especially electronic health records, through a systematic scoping review and to assess the practice of DQ assessment in the national Patient-centered Clinical Research Network (PCORnet). Materials and Methods We started with 3 widely cited DQ literature—2 reviews from Chan et al (2010) and Weiskopf et al (2013a) and 1 DQ framework from Kahn et al (2016)—and expanded our review systematically to cover relevant articles published up to February 2020. We extracted DQ dimensions and assessment methods from these studies, mapped their relationships, and organized a synthesized summarization of existing DQ dimensions and assessment methods. We reviewed the data checks employed by the PCORnet and mapped them to the synthesized DQ dimensions and methods. Results We analyzed a total of 3 reviews, 20 DQ frameworks, and 226 DQ studies and extracted 14 DQ dimensions and 10 assessment methods. We found that completeness, concordance, and correctness/accuracy were commonly assessed. Element presence, validity check, and conformance were commonly used DQ assessment methods and were the main focuses of the PCORnet data checks. Discussion Definitions of DQ dimensions and methods were not consistent in the literature, and the DQ assessment practice was not evenly distributed (eg, usability and ease-of-use were rarely discussed). Challenges in DQ assessments, given the complex and heterogeneous nature of real-world data, exist. Conclusion The practice of DQ assessment is still limited in scope. Future work is warranted to generate understandable, executable, and reusable DQ measures.
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Affiliation(s)
- Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA.,Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, Florida, USA
| | - Tianchen Lyu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Alexander Loiacono
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Tonatiuh Mendoza Viramontes
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Gloria Lipori
- Clinical and Translational Institute, University of Florida, Gainesville, Florida, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas J George
- Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Christopher A Harle
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - William Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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Mathieu A, Sauthier M, Jouvet P, Emeriaud G, Brossier D. Validation process of a high-resolution database in a paediatric intensive care unit-Describing the perpetual patient's validation. J Eval Clin Pract 2021; 27:316-324. [PMID: 32372537 DOI: 10.1111/jep.13411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 01/02/2023]
Abstract
RATIONALE High data quality is essential to ensure the validity of clinical and research inferences based on it. However, these data quality assessments are often missing even though these data are used in daily practice and research. AIMS AND OBJECTIVES Our objective was to evaluate the data quality of our high-resolution electronic database (HRDB) implemented in our paediatric intensive care unit (PICU). METHODS We conducted a prospective validation study of a HRDB in a 32-bed paediatric medical, surgical, and cardiac PICU in a tertiary care freestanding maternal-child health centre in Canada. All patients admitted to the PICU with at least one vital sign monitored using a cardiorespiratory monitor connected to the central monitoring station. RESULTS Between June 2017 and August 2018, data from 295 patient days were recorded from medical devices and 4645 data points were video recorded and compared to the corresponding data collected in the HRDB. Statistical analysis showed an excellent overall correlation (R2 = 1), accuracy (100%), agreement (bias = 0, limits of agreement = 0), completeness (2% missing data), and reliability (ICC = 1) between recorded and collected data within clinically significant pre-defined limits of agreement. Divergent points could all be explained. CONCLUSIONS This prospective validation of a representative sample showed an excellent overall data quality.
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Affiliation(s)
- Audrey Mathieu
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Michael Sauthier
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Philippe Jouvet
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - David Brossier
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada.,CHU de Caen, Pediatric Intensive Care Unit, Caen, France.,Université Caen Normandie, school of medicine, Caen, France.,Laboratoire de Psychologie Caen Normandie, Université Caen Normandie, Caen, France
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45
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Nomura ATG, Pruinelli L, Barreto LNM, Graeff MDS, Swanson EA, Silveira T, Almeida MDA. Pain Management in Clinical Practice Research Using Electronic Health Records. Pain Manag Nurs 2021; 22:446-454. [PMID: 33678588 DOI: 10.1016/j.pmn.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of electronic health record (EHR) systems encourages and facilitates the use of data for the development and surveillance of quality indicators, including pain management. AIM to conduct an integrative review on pain management research using data extracted from EHR in order to synthesize and analyze the following elements: pain management (assessments, interventions, and outcomes) and study results with potential clinical implications, data source, clinical sample characteristics, and method description. DESIGN An integrative review of the literature was undertaken to identify exemplars of scientific research studies that explore pain management using data from EHR, using Cooper's framework. RESULTS Our search of 1,061 records from PubMed, Scopus, and Cinahl was narrowed down to 28 eligible articles to be analyzed. CONCLUSION Results of this integrative review will make a critical contribution, assisting others in developing research proposals and sound research methods, as well as providing an overview of such studies over the past 10 years. Through this review it is therefore possible to guide new research on clinical pain management using EHR.
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Affiliation(s)
- Aline Tsuma Gaedke Nomura
- School of Nursing, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Murilo Dos Santos Graeff
- School of Nursing, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Thamiris Silveira
- School of Nursing, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Miriam de Abreu Almeida
- School of Nursing, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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46
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Wood NM, Davis S, Lewing K, Noel-MacDonnell J, Glynn EF, Caragea D, Hoffman MA. Aligning EHR Data for Pediatric Leukemia With Standard Protocol Therapy. JCO Clin Cancer Inform 2021; 5:239-251. [PMID: 33656914 PMCID: PMC8140784 DOI: 10.1200/cci.20.00144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Children with acute lymphoblastic leukemia (ALL) are treated according to risk-based protocols defined by the Children's Oncology Group (COG). Alignment between real-world clinical practice and protocol milestones is not widely understood. Aggregate deidentified electronic health record (EHR) data offer a useful resource to evaluate real-world clinical practice.
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Affiliation(s)
- Nicole M Wood
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.,Children's Mercy Research Institute, Kansas City, MO.,Department of Pediatrics, University of Missouri, Kansas City, MO
| | - Sierra Davis
- Children's Mercy Research Institute, Kansas City, MO
| | - Karen Lewing
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.,Department of Pediatrics, University of Missouri, Kansas City, MO
| | - Janelle Noel-MacDonnell
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.,Children's Mercy Research Institute, Kansas City, MO.,Department of Pediatrics, University of Missouri, Kansas City, MO
| | - Earl F Glynn
- Children's Mercy Research Institute, Kansas City, MO
| | | | - Mark A Hoffman
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.,Children's Mercy Research Institute, Kansas City, MO.,Department of Pediatrics, University of Missouri, Kansas City, MO.,Department of Biomedical and Health Informatics, University of Missouri, Kansas City, MO
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Mc Cord KA, Ewald H, Agarwal A, Glinz D, Aghlmandi S, Ioannidis JPA, Hemkens LG. Treatment effects in randomised trials using routinely collected data for outcome assessment versus traditional trials: meta-research study. BMJ 2021; 372:n450. [PMID: 33658187 PMCID: PMC7926294 DOI: 10.1136/bmj.n450] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare effect estimates of randomised clinical trials that use routinely collected data (RCD-RCT) for outcome ascertainment with traditional trials not using routinely collected data. DESIGN Meta-research study. DATA SOURCE Studies included in the same meta-analysis in a Cochrane review. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised clinical trials using any type of routinely collected data for outcome ascertainment, including from registries, electronic health records, and administrative databases, that were included in a meta-analysis of a Cochrane review on any clinical question and any health outcome together with traditional trials not using routinely collected data for outcome measurement. REVIEW METHODS Effect estimates from trials using or not using routinely collected data were summarised in random effects meta-analyses. Agreement of (summary) treatment effect estimates from trials using routinely collected data and those not using such data was expressed as the ratio of odds ratios. Subgroup analyses explored effects in trials based on different types of routinely collected data. Two investigators independently assessed the quality of each data source. RESULTS 84 RCD-RCTs and 463 traditional trials on 22 clinical questions were included. Trials using routinely collected data for outcome ascertainment showed 20% less favourable treatment effect estimates than traditional trials (ratio of odds ratios 0.80, 95% confidence interval 0.70 to 0.91, I2=14%). Results were similar across various types of outcomes (mortality outcomes: 0.92, 0.74 to 1.15, I2=12%; non-mortality outcomes: 0.71, 0.60 to 0.84, I2=8%), data sources (electronic health records: 0.81, 0.59 to 1.11, I2=28%; registries: 0.86, 0.75 to 0.99, I2=20%; administrative data: 0.84, 0.72 to 0.99, I2=0%), and data quality (high data quality: 0.82, 0.72 to 0.93, I2=0%). CONCLUSIONS Randomised clinical trials using routinely collected data for outcome ascertainment show smaller treatment benefits than traditional trials not using routinely collected data. These differences could have implications for healthcare decision making and the application of real world evidence.
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Affiliation(s)
- Kimberly A Mc Cord
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Hannah Ewald
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
- University Medical Library, University of Basel, Basel, Switzerland
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dominik Glinz
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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Hamlin L, Grunwald L, Sturdivant RX, Koehlmoos TP. Comparison of Nurse-Midwife and Physician Birth Outcomes in the Military Health System. Policy Polit Nurs Pract 2021; 22:105-113. [PMID: 33615908 DOI: 10.1177/1527154421994071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America's largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012-2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women's health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.
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Affiliation(s)
- Lynette Hamlin
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Lindsay Grunwald
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | | | - Tracey P Koehlmoos
- Health Services Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
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Ma Q, Mack M, Shambhu S, McTigue K, Haynes K. Characterization of bariatric surgery and outcomes using administrative claims data in the research network of a nationwide commercial health plan. BMC Health Serv Res 2021; 21:116. [PMID: 33541346 PMCID: PMC7860025 DOI: 10.1186/s12913-021-06074-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background The supplementation of electronic health records data with administrative claims data may be used to capture outcome events more comprehensively in longitudinal observational studies. This study investigated the utility of administrative claims data to identify outcomes across health systems using a comparative effectiveness study of different types of bariatric surgery as a model. Methods This observational cohort study identified patients who had bariatric surgery between 2007 and 2015 within the HealthCore Anthem Research Network (HCARN) database in the National Patient-Centered Clinical Research Network (PCORnet) common data model. Patients whose procedures were performed in a member facility affiliated with PCORnet Clinical Research Networks (CRNs) were selected. The outcomes included a 30-day composite adverse event (including venous thromboembolism, percutaneous/operative intervention, failure to discharge and death), and all-cause hospitalization, abdominal operation or intervention, and in-hospital death up to 5 years after the procedure. Outcomes were classified as occurring within or outside PCORnet CRN health systems using facility identifiers. Results We identified 4899 patients who had bariatric surgery in one of the PCORnet CRN health systems. For 30-day composite adverse event, the inclusion of HCARN multi-site claims data marginally increased the incidence rate based only on HCARN single-site claims data for PCORnet CRNs from 3.9 to 4.2%. During the 5-year follow-up period, 56.8% of all-cause hospitalizations, 31.2% abdominal operations or interventions, and 32.3% of in-hospital deaths occurred outside PCORnet CRNs. Incidence rates (events per 100 patient-years) were significantly lower when based on claims from a single PCORnet CRN only compared to using claims from all health systems in the HCARN: all-cause hospitalization, 11.0 (95% Confidence Internal [CI]: 10.4, 11.6) to 25.3 (95% CI: 24.4, 26.3); abdominal operations or interventions, 4.2 (95% CI: 3.9, 4.6) to 6.1 (95% CI: 5.7, 6.6); in-hospital death, 0.2 (95% CI: 0.11, 0.27) to 0.3 (95% CI: 0.19, 0.38). Conclusions Short-term inclusion of multi-site claims data only marginally increased the incidence rate computed from single-site claims data alone. Longer-term follow up captured a notable number of events outside of PCORnet CRNs. The findings suggest that supplementing claims data improves the outcome ascertainment in longitudinal observational comparative effectiveness studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06074-3.
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Affiliation(s)
- Qinli Ma
- Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, DE, USA.
| | - Michael Mack
- Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, DE, USA
| | - Sonali Shambhu
- Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, DE, USA
| | - Kathleen McTigue
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin Haynes
- Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, DE, USA
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50
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Kraschnewski J, Yeh HC, Francis E, Kong L, Lehman E, Rovito S, Poger J, Bryce C. Utilization of intensive behavioural treatment for obesity in patients with diabetes. Clin Obes 2021; 11:e12426. [PMID: 33147654 DOI: 10.1111/cob.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
Obesity is a leading public health concern. The Centers for Medicare and Medicaid Services implemented a healthcare procedure code for intensive behavioural therapy (IBT) in 2012 to facilitate payment for addressing obesity in primary care settings, followed by universal coverage by insurers for all adults. Our objective was to understand utilization of IBT from 2009 to 2017 in patients with a diabetes diagnosis. Leveraging electronic health record data from the PaTH Clinical Data Research Network (CDRN), a partnership of six health systems, utilization of IBT was summarized at a yearly basis. The trend of IBT prevalence was examined for patients with diabetes by gender, race, age (>=65 vs <65) and rurality. A total of 205, 913 patients were included. While utilization of IBT is low (0.24% in 2017), use of IBT increased among patients with commercial insurance and Medicaid (codes S9449 and S9470) in 2011, and among patients with Medicare (code G0447) in 2012. IBT users tended to be less than 65 years of age, female, non-White (Black or Hispanic), and reside in urban areas. Overall, use of IBT in patients with diabetes remains low. Future work is necessary to understand the impact of IBT and, if effective, how to increase use within primary care.
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Affiliation(s)
| | | | - Erica Francis
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lan Kong
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Erik Lehman
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Jennifer Poger
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Cindy Bryce
- University of Pittsburgh, Pittsburgh, PA, USA
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