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Sikorskii A, Badger T, Segrin C, Crane TE, Cunicelli N, Chalasani P, Arslan W, Given C. Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers. Qual Life Res 2024; 33:1143-1155. [PMID: 38291312 DOI: 10.1007/s11136-023-03595-8] [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] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
CONTEXT Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment. OBJECTIVES Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time. METHODS Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor. RESULTS Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms. CONCLUSION Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.
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Affiliation(s)
- Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, 909 Wilson Road, Road 321, East Lansing, MI, 48824, USA.
| | - Terry Badger
- College of Nursing, Department of Psychiatry and Mel and Enid Zuckerman College of Public Health, University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, USA
| | - Chris Segrin
- Department of Communication, University of Arizona, Tucson, USA
| | - Tracy E Crane
- Miller School of Medicine, Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, USA
| | | | - Pavani Chalasani
- Division of Hematology-Oncology, George Washington University, Washington, DC, USA
| | - Waqas Arslan
- College of Medicine, University of Arizona, Phoenix, AZ, USA
| | - Charles Given
- College of Nursing, Michigan State University, East Lansing, USA
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Pavon JM, Previll L, Woo M, Henao R, Solomon M, Rogers U, Olson A, Fischer J, Leo C, Fillenbaum G, Hoenig H, Casarett D. Machine learning functional impairment classification with electronic health record data. J Am Geriatr Soc 2023; 71:2822-2833. [PMID: 37195174 PMCID: PMC10524844 DOI: 10.1111/jgs.18383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Poor functional status is a key marker of morbidity, yet is not routinely captured in clinical encounters. We developed and evaluated the accuracy of a machine learning algorithm that leveraged electronic health record (EHR) data to provide a scalable process for identification of functional impairment. METHODS We identified a cohort of patients with an electronically captured screening measure of functional status (Older Americans Resources and Services ADL/IADL) between 2018 and 2020 (N = 6484). Patients were classified using unsupervised learning K means and t-distributed Stochastic Neighbor Embedding into normal function (NF), mild to moderate functional impairment (MFI), and severe functional impairment (SFI) states. Using 11 EHR clinical variable domains (832 variable input features), we trained an Extreme Gradient Boosting supervised machine learning algorithm to distinguish functional status states, and measured prediction accuracies. Data were randomly split into training (80%) and test (20%) sets. The SHapley Additive Explanations (SHAP) feature importance analysis was used to list the EHR features in rank order of their contribution to the outcome. RESULTS Median age was 75.3 years, 62% female, 60% White. Patients were classified as 53% NF (n = 3453), 30% MFI (n = 1947), and 17% SFI (n = 1084). Summary of model performance for identifying functional status state (NF, MFI, SFI) was AUROC (area under the receiving operating characteristic curve) 0.92, 0.89, and 0.87, respectively. Age, falls, hospitalization, home health use, labs (e.g., albumin), comorbidities (e.g., dementia, heart failure, chronic kidney disease, chronic pain), and social determinants of health (e.g., alcohol use) were highly ranked features in predicting functional status states. CONCLUSION A machine learning algorithm run on EHR clinical data has potential utility for differentiating functional status in the clinical setting. Through further validation and refinement, such algorithms can complement traditional screening methods and result in a population-based strategy for identifying patients with poor functional status who need additional health resources.
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Affiliation(s)
- Juliessa M Pavon
- Department of Medicine/Division of Geriatrics, Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
- Claude D. Pepper Center, Duke University, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
| | - Laura Previll
- Department of Medicine/Division of Geriatrics, Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
| | - Myung Woo
- AI Health, Duke University, Durham, North Carolina, USA
- Department of Medicine/Division of General Internal Medicine/Hospital Medicine, Duke University, Durham, North Carolina, USA
| | - Ricardo Henao
- AI Health, Duke University, Durham, North Carolina, USA
| | - Mary Solomon
- AI Health, Duke University, Durham, North Carolina, USA
| | - Ursula Rogers
- AI Health, Duke University, Durham, North Carolina, USA
| | - Andrew Olson
- AI Health, Duke University, Durham, North Carolina, USA
| | - Jonathan Fischer
- Department of Community and Family Medicine, Duke University, Durham, North Carolina, USA
| | - Christopher Leo
- Department of Medicine/Division of Geriatrics, Duke University, Durham, North Carolina, USA
- Department of Medicine/Division of General Internal Medicine/Hospital Medicine, Duke University, Durham, North Carolina, USA
| | - Gerda Fillenbaum
- Claude D. Pepper Center, Duke University, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Helen Hoenig
- Department of Medicine/Division of Geriatrics, Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
- Claude D. Pepper Center, Duke University, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
- Physical Medicine & Rehabilitation Service, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
| | - David Casarett
- Department of Medicine/Division of General Internal Medicine/Palliative Care, Duke University, Durham, North Carolina, USA
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Sinno ZC, Shay D, Kruppa J, Klopfenstein SA, Giesa N, Flint AR, Herren P, Scheibe F, Spies C, Hinrichs C, Winter A, Balzer F, Poncette AS. The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study. Sci Rep 2022; 12:21801. [PMID: 36526892 PMCID: PMC9758124 DOI: 10.1038/s41598-022-26261-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15-5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16-1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19-1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10-1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13-1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18-1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13-1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.
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Affiliation(s)
- Zeena-Carola Sinno
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Denys Shay
- grid.189504.10000 0004 1936 7558Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA USA
| | - Jochen Kruppa
- grid.434095.f0000 0001 1864 9826Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
| | - Sophie A.I. Klopfenstein
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Core Facility Digital Medicine and Interoperability, Charitéplatz 1, 10117 Berlin, Germany
| | - Niklas Giesa
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Anne Rike Flint
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Patrick Herren
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Franziska Scheibe
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany ,grid.517316.7NeuroCure Clinical Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Claudia Spies
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Carl Hinrichs
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Nephrology and Medical Intensive Care, Charitéplatz 1, 10117 Berlin, Germany
| | - Axel Winter
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Balzer
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Akira-Sebastian Poncette
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany ,grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany
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Steinkirchner AB, Zimmermann ME, Donhauser FJ, Dietl A, Brandl C, Koller M, Loss J, Heid IM, Stark KJ. Self-report of chronic diseases in old-aged individuals: extent of agreement with general practitioner medical records in the German AugUR study. J Epidemiol Community Health 2022; 76:jech-2022-219096. [PMID: 36028306 PMCID: PMC9554083 DOI: 10.1136/jech-2022-219096] [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: 03/31/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND To estimate prevalence and incidence of diseases through self-reports in observational studies, it is important to understand the accuracy of participant reports. We aimed to quantify the agreement of self-reported and general practitioner-reported diseases in an old-aged population and to identify socio-demographic determinants of agreement. METHODS This analysis was conducted as part of the AugUR study (n=2449), a prospective population-based cohort study in individuals aged 70-95 years, including 2321 participants with consent to contact physicians. Self-reported chronic diseases of participants were compared with medical data provided by their respective general practitioners (n=589, response rate=25.4%). We derived overall agreement, over-reporting/under-reporting, and Cohen's kappa and used logistic regression to evaluate the dependency of agreement on participants' sociodemographic characteristics. RESULTS Among the 589 participants (53.1% women), 96.9% reported at least one of the evaluated chronic diseases. Overall agreement was >80% for hypertension, diabetes, myocardial infarction, stroke, cancer, asthma, bronchitis/chronic obstructive pulmonary disease and rheumatoid arthritis, but lower for heart failure, kidney disease and arthrosis. Cohen's kappa was highest for diabetes and cancer and lowest for heart failure, musculoskeletal, kidney and lung diseases. Sex was the primary determinant of agreement on stroke, kidney disease, cancer and rheumatoid arthritis. Agreement for myocardial infarction and stroke was most compromised by older age and for cancer by lower educational level. CONCLUSION Self-reports may be an effective tool to assess diabetes and cancer in observational studies in the old and very old aged. In contrast, self-reports on heart failure, musculoskeletal, kidney or lung diseases may be substantially imprecise.
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Affiliation(s)
- Anna B Steinkirchner
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Martina E Zimmermann
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | | | - Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Caroline Brandl
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Julika Loss
- Department for Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Regensburg, Germany
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Iris M Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Klaus J Stark
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
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McEntee ML, Gandek B, Ware JE. Improving multimorbidity measurement using individualized disease-specific quality of life impact assessments: predictive validity of a new comorbidity index. Health Qual Life Outcomes 2022; 20:108. [PMID: 35820890 PMCID: PMC9277868 DOI: 10.1186/s12955-022-02016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Interpretation of health-related quality of life (QOL) outcomes requires improved methods to control for the effects of multiple chronic conditions (MCC). This study systematically compared legacy and improved method effects of aggregating MCC on the accuracy of predictions of QOL outcomes. METHODS Online surveys administered generic physical (PCS) and mental (MCS) QOL outcome measures, the Charlson Comorbidity Index (CCI), an expanded chronic condition checklist (CCC), and individualized QOL Disease-specific Impact Scale (QDIS) ratings in a developmental sample (N = 5490) of US adults. Controlling for sociodemographic variables, regression models compared 12- and 35-condition checklists, mortality vs. population QOL-weighting, and population vs. individualized QOL weighting methods. Analyses were cross-validated in an independent sample (N = 1220) representing the adult general population. Models compared estimates of variance explained (adjusted R2) and model fit (AIC) for generic PCS and MCS across aggregation methods at baseline and nine-month follow-up. RESULTS In comparison with sociodemographic-only regression models (MCS R2 = 0.08, PCS = 0.09) and Charlson CCI models (MCS R2 = 0.12, PCS = 0.16), increased variance was accounted for using the 35-item CCC (MCS R2 = 0.22, PCS = 0.31), population MCS/PCS QOL weighting (R2 = 0.31-0.38, respectively) and individualized QDIS weighting (R2 = 0.33 & 0.42). Model R2 and fit were replicated upon cross-validation. CONCLUSIONS Physical and mental outcomes were more accurately predicted using an expanded MCC checklist, population QOL rather than mortality CCI weighting, and individualized rather than population QOL weighting for each reported condition. The 3-min combination of CCC and QDIS ratings (QDIS-MCC) warrant further testing for purposes of predicting and interpreting QOL outcomes affected by MCC.
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Affiliation(s)
- Mindy L McEntee
- College of Health Solutions, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004-0698, USA.
| | - Barbara Gandek
- University of Massachusetts Medical School, Worchester, MA, USA
- John Ware Research Group, Inc., Watertown, MA, USA
| | - John E Ware
- College of Health Solutions, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004-0698, USA
- University of Massachusetts Medical School, Worchester, MA, USA
- John Ware Research Group, Inc., Watertown, MA, USA
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Characteristics of New Biologic Users Among the Moderate-to-Severe Psoriasis Population-Retrospective Cohort Study Leveraging the Modernizing Medicine Data Services Database. Dermatol Ther (Heidelb) 2022; 12:741-752. [PMID: 35212934 PMCID: PMC8941060 DOI: 10.1007/s13555-022-00691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/08/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Biologics have expanded the treatment options in the management of patients with moderate-to-severe psoriasis. The objective of this study was to describe patient characteristics and previous treatments in psoriasis patients newly treated with guselkumab, secukinumab, or ixekizumab. Methods This retrospective study included patients ≥ 18 years old with psoriasis in the USA who were newly treated with guselkumab, secukinumab, or ixekizumab between 1 July 2017 and 31 March 2019 in the Modernizing Medicine Data Services database (MMDS). Patients were indexed on their first prescription or injection record of guselkumab, secukinumab, or ixekizumab, and three mutually exclusive cohorts were created. Patients were required to have evidence of moderate-to-severe psoriasis, defined as Physician Global Assessment (PGA) score of 3 or 4, or body surface area (BSA) ≥ 10% on index date or within 12 months before index. Baseline characteristics, including treatment history, were reported for each cohort. Results The study population included 461 guselkumab, 619 secukinumab, and 375 ixekizumab patients. The median age across cohorts was 51–52 years. Median baseline BSA ranged from 15% to 20%; 16.1–29.3% of patients had a PGA of 4 and over half of patients were obese prior to index. Approximately 40% of patients had comorbid cardiovascular disease and 20.8–24.2% of patients had a psychiatric disorder. About half of patients in each cohort had prior biologic use, of which adalimumab was most common (28.2–34.9%) across the cohorts. Conclusion This real-world study describes the characteristics of patients with moderate-to-severe psoriasis receiving biologic treatments.
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Nguyen OT, Hong YR, Alishahi Tabriz A, Hanna K, Turner K. Prevalence and Factors Associated with Patient-Requested Corrections to the Medical Record through Use of a Patient Portal: Findings from a National Survey. Appl Clin Inform 2022; 13:242-251. [PMID: 35196717 PMCID: PMC8866035 DOI: 10.1055/s-0042-1743236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Providing patients with medical records access is one strategy that health systems can utilize to reduce medical errors. However, how often patients request corrections to their records on a national scale is unknown. OBJECTIVES We aimed to develop population-level estimates of patients who request corrections to their medical records using national-level data. We also identified patient-level correlates of requesting corrections. METHODS We used the 2017 and 2019 Health Information National Trends Survey and examined all patient portal adopters. We applied jackknife replicate weights to develop population-representative estimates of the prevalence of requesting medical record corrections. We conducted a multivariable logistic regression analysis to identify correlates of requesting corrections while controlling for demographic factors, health care utilization patterns, health status, technology/internet use patterns, and year. RESULTS Across 1,657 respondents, 125 (weighted estimate: 6.5%) reported requesting corrections to their medical records. In unadjusted models, greater odds of requesting corrections were observed among patients who reported their race/ethnicity as non-Hispanic black (odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.10-4.43), had frequent portal visits (OR: 3.92, 95% CI: 1.51-10.23), and had entered data into the portal (OR: 7.51, 95% CI: 4.08-13.81). In adjusted models, we found greater odds of requesting corrections among those who reported frequent portal visits (OR: 3.39, 95% CI: 1.24-9.33) and those who reported entering data into the portal (OR: 6.43, 95% CI: 3.20-12.94). No other significant differences were observed. CONCLUSION Prior to the Information Blocking Final Rule in April 2021, approximately 6.5% of patients requested corrections of errors in their medical records at the national level. Those who reported higher engagement with their health, as proxied by portal visit frequency and entering data into the portal, were more likely to request corrections.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, United States,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States,Address for correspondence Oliver T. Nguyen, MSHI Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute12902 Magnolia Dr, Tampa, FL 32612-9416United States
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida, United States
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States,Department of Oncologic Sciences, University of South Florida, Tampa, Florida, United States
| | - Karim Hanna
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States,Department of Oncologic Sciences, University of South Florida, Tampa, Florida, United States,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States
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King LK, Waugh EJ, Jones CA, Bohm E, Dunbar M, Woodhouse L, Noseworthy T, Marshall DA, Hawker GA. Comorbidities do not limit improvement in pain and physical function after total knee arthroplasty in patients with knee osteoarthritis: the BEST-Knee prospective cohort study. BMJ Open 2021; 11:e047061. [PMID: 34145017 PMCID: PMC8215258 DOI: 10.1136/bmjopen-2020-047061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the relationship between comorbidities and amount of improvement in pain and physical function in recipients of total knee arthroplasty (TKA) for knee osteoarthritis (OA). DESIGN Prospective cohort study. SETTING Two provincial central intake hip and knee centres in Alberta, Canada. PARTICIPANTS 1051 participants (278 in 6-minute walk test (6MWT) subset), ≥30 years of age with primary knee OA referred for consultation regarding elective primary TKA; assessed 1 month prior and 12 months after TKA. PRIMARY AND SECONDARY OUTCOME MEASURES Pre-post TKA change in knee OA pain (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), physical function (Knee injury and Osteoarthritis Outcome Score (KOOS) Physical Function Short-Form) and 6MWT walking distance; and the reporting of an acceptable symptom state (Patient Acceptable Symptom State (PASS)) at 12 months after TKA. RESULTS Mean participant age was 67 years (SD 8.8), 59% were female and 85% reported at least one comorbidity. Individuals with a higher number of comorbidities had worse pre-TKA and post-TKA scores for pain, physical function and 6MWT distance. At 12-month follow-up, mean changes in pain, function and 6MWT distance, and proportion reporting a PASS, were similar for those with and without comorbidities. In multivariable regression analysis, adjusted for potential confounders and clustering by surgeon, no specific comorbidities nor total number of comorbidities were associated with less improvement in pain, physical function or 6MWT distance at 12 months after TKA. Patients with diabetes (OR 0.64, 95% CI 0.44 to 0.94) and a higher number of lower extremity troublesome joints (OR 0.85, 95% CI 0.76 to 0.96) had lower odds of reporting a PASS. CONCLUSION For individuals with knee OA, comorbid conditions do not limit improvement in pain, physical function or walking ability after TKA, and most conditions do not impact achieving an acceptable symptom state.
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Affiliation(s)
- Lauren K King
- Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Esther J Waugh
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - C Allyson Jones
- Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Bohm
- Division of Orthopaedic Surgery and Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Dunbar
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Woodhouse
- School of Physiotherapy & Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Thomas Noseworthy
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gillian A Hawker
- Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Dong X, Randolph DA, Weng C, Kho AN, Rogers JM, Wang X. Developing High Performance Secure Multi-Party Computation Protocols in Healthcare: A Case Study of Patient Risk Stratification. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2021; 2021:200-209. [PMID: 34457134 PMCID: PMC8378657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We demonstrate that secure multi-party computation (MPC) using garbled circuits is viable technology for solving clinical use cases that require cross-institution data exchange and collaboration. We describe two MPC protocols, based on Yao's garbled circuits and tested using large and realistically synthesized datasets. Linking records using private set intersection (PSI), we compute two metrics often used in patient risk stratification: high utilizer identification (PSI-HU) and comorbidity index calculation (PSI-CI). Cuckoo hashing enables our protocols to achieve extremely fast run times, with answers to clinically meaningful questions produced in minutes instead of hours. Also, our protocols are provably secure against any computationally bounded adversary in a semi-honest setting, the de-facto mode for cross-institution data analytics. Finally, these protocols eliminate the need for an implicitly trusted third-party "honest broker" to mediate the information linkage and exchange.
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Affiliation(s)
- Xiao Dong
- Center for Clinical and Translational Science, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - David A Randolph
- Center for Clinical and Translational Science, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Chenkai Weng
- Department of Computer Science, Northwestern University, Evanston, Illinois, USA
| | - Abel N Kho
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jennie M Rogers
- Department of Computer Science, Northwestern University, Evanston, Illinois, USA
| | - Xiao Wang
- Department of Computer Science, Northwestern University, Evanston, Illinois, USA
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10
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Noble N, Bryant J, Maher L, Jackman D, Bonevski B, Shakeshaft A, Paul C. Patient self-report versus medical records for smoking status and alcohol consumption at Aboriginal Community Controlled Health Services. Aust N Z J Public Health 2021; 45:277-282. [PMID: 33970509 DOI: 10.1111/1753-6405.13114] [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: 08/01/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study assessed the level of agreement, and predictors of agreement, between patient self-report and medical records for smoking status and alcohol consumption among patients attending one of four Aboriginal Community Controlled Health Service (ACCHSs). METHODS A convenience sample of 110 ACCHS patients self-reported whether they were current smokers or currently consumed alcohol. ACCHS staff completed a medical record audit for corresponding items for each patient. The level of agreement was evaluated using the kappa statistic. Factors associated with levels of agreement were explored using logistic regression. RESULTS The level of agreement between self-report and medical records was strong for smoking status (kappa=0.85; 95%CI: 0.75-0.96) and moderate for alcohol consumption (kappa=0.74; 95%CI: 0.60-0.88). None of the variables explored were significantly associated with levels of agreement for smoking status or alcohol consumption. CONCLUSIONS Medical records showed good agreement with patient self-report for smoking and alcohol status and are a reliable means of identifying potentially at-risk ACCHS patients. Implications for public health: ACCHS medical records are accurate for identifying smoking and alcohol risk factors for their patients. However, strategies to increase documentation and reduce missing data in the medical records are needed.
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Affiliation(s)
- Natasha Noble
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Louise Maher
- Centre for Epidemiology and Evidence, NSW Ministry of Health, New South Wales
| | - Daniel Jackman
- Maari Ma Health Aboriginal Corporation, New South Wales.,Outback Division of General Practice, New South Wales
| | - Billie Bonevski
- Hunter Medical Research Institute, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Anthony Shakeshaft
- School of Medicine and Public Health, University of Newcastle, New South Wales.,National Drug and Alcohol Research Centre, University of NSW Sydney, New South Wales
| | - Christine Paul
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
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11
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Kim H, Sung YK. Epidemiology of Rheumatoid Arthritis in Korea. JOURNAL OF RHEUMATIC DISEASES 2021; 28:60-67. [PMID: 37476013 PMCID: PMC10324889 DOI: 10.4078/jrd.2021.28.2.60] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 07/22/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterised by symmetrical involvement of the joints, associated extra-articular manifestations and functional disability. In Korea, several epidemiologic studies reporting prevalence and incidence rates of RA have been conducted using large databases such as claims databases, national surveys, prospective cohort databases or electronic health records; according to these data sources, the estimated prevalence ranged from 0.27% to 1.85%. The prevalence of extra-articular manifestations such as interstitial lung disease (ILD) and Sjögren's syndrome (SS) were also reported, but an issue of external validity of the study results persisted. In this review, we detail the epidemiology of Korean RA patients, focusing on the prevalence of RA and the frequency of systemic extra-articular manifestations including ILD and SS reported in previous studies. In addition, we discuss the current methodological issues which are inherent in Korean epidemiologic studies for patients with RA with understanding of the characteristics of each database.
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Affiliation(s)
- Hyoungyoung Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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12
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Leroy-Melamed M, Zhao Q, Belmonte MA, Archer J, Peipert JF. Contraceptive Preference, Continuation Rates, and Unintended Pregnancies in Patients with Comorbidities: A Prospective Cohort Study. J Womens Health (Larchmt) 2021; 30:1469-1475. [PMID: 33404367 DOI: 10.1089/jwh.2020.8536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients with comorbidities are more susceptible to adverse pregnancy outcomes, morbidity, and mortality than healthy patients. The goal of this study was to evaluate how comorbidities influence contraceptive choice, continuation rates, and the unintended pregnancy rate in reproductive-age participants. Methods: We analyzed data from the Contraceptive CHOICE Project. Baseline data included demographic, reproductive, and medical history, including self-reported hypertension (HTN), venous thromboembolism (VTE), migraines, cerebrovascular accidents (CVA), transient ischemic attack (TIA), or stroke. Participants were provided contraceptive counseling and their method of choice at no cost. Results: Among 9253 participants included in our analysis, 659 participants reported a history of HTN (7%), 20 participants reported a history of CVA/TIA/stroke (<1%), 1803 participants reported a history of migraine (19%), and 85 reported a history of VTE (<1%). Compared to baseline, use of long-acting reversible contraceptive methods (long-acting reversible contraception [LARC]: intrauterine devices and implants) increased for participants with all comorbidities: HTN 2.3%-84.2%; CVA/TIA/stroke 0%-85%; migraines 1.7%-77%, and VTE 1.2%-88.2%. Participants with HTN, VTE, and migraines were more likely to choose LARC than those without those conditions: HTN: relative risk (RR) = 1.14, 95% confidence interval (CI) 1.10-1.18; migraines RR = 1.04, 95% CI 1.01-1.07; and VTE RR = 1.18, 95% CI 1.09-1.28. Twelve-month continuation and unintended pregnancy rates did not differ significantly based on comorbidity status. Conclusions: Participants with serious comorbidities were more likely to choose LARC than healthy participants. Contraceptive counseling should always be individualized to the patient. Clinical Trials.gov Identifier: NCT01986439.
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Affiliation(s)
- Maayan Leroy-Melamed
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Qiuhong Zhao
- Department of Obstetrics/Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael A Belmonte
- Department of Obstetrics/Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Johanna Archer
- Department of Obstetrics/Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeffrey F Peipert
- Department of Obstetrics/Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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13
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Jakasania A, Shringarpure K, Kapadia D, Sharma R, Mehta K, Prajapati A, Kathirvel S. "Side effects--part of the package": a mixed methods approach to study adverse events among patients being programmatically treated for DR-TB in Gujarat, India. BMC Infect Dis 2020; 20:918. [PMID: 33267826 PMCID: PMC7709264 DOI: 10.1186/s12879-020-05660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022] Open
Abstract
Background High rates of Adverse Events (AEs) during treatment is one of the leading causes of unsuccessful treatment outcomes among patients with drug resistant tuberculosis (DR-TB). However, information related to AEs is not systematically collected and managed under programmatic setting. The present study assessed the a) incidence and pattern of adverse events in first three months of DR-TB treatment initiation; b) treatment seeking behaviour for AE management; and c) explore the challenges in seeking treatment and reporting AEs. Methods This mixed methods study included all patients diagnosed and initiated on treatment under RNTCP during July–September 2018 at Ahmedabad DR-TB centre. The patients were interviewed telephonically and assessed for all AEs experienced by them. In-depth interviews and key-informant interviews were conducted among patients, DOTS supervisors and programme staff (treatment supervisors, medical officer and district program managers). Results Total 207 AEs were reported by the 74 DR-TB patients. All patients experienced at least one AE during initial treatment period. Incidence rate of AEs (experienced) was 3.11 (1st month-4.6, 2nd month-2.7, 3rd month-2.02) per 100 person days. Of the 207 AEs, gastro-intestinal (59, 28.3%), ophthalmic (32, 15.4%) and otolaryngology (25, 11.9%) system related AEs were commonly experienced. Treatment was not sought in two-fifths of the AEs. Themes and sub-themes related to challenges in treatment seeking or reporting of AEs were 1) Patient related-Misconceptions, accessibility and affordability of management, lack of counselling support, stigma and discrimination, and past treatment experience; 2) Health system related- lack of guidelines and training for AE management, 3) Poor coordination between hospital and tuberculosis centre. Conclusion The incidence of AEs was high among patients with DR-TB in the first three months of treatment and treatment seeking/reporting was low. Adequate health education and counselling of the patient and orientation of the health systems is the need of the hour. An efficient real-time reporting and management of AE should be developed and tested for effective DR-TB control. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05660-w.
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Affiliation(s)
| | - Kalpita Shringarpure
- Department of Preventive and Social Medicine, Medical College Baroda, Vadodara, Gujarat, India
| | - Dixit Kapadia
- District Tuberculosis officer, Ahmedabad, Gujarat, India
| | - Radhika Sharma
- Department of Community Medicine, BJ Medical College, Ahmedabad, Gujarat, India
| | - Kedar Mehta
- GMERS medical college, Gotri, Vadodara, Gujarat, India
| | - Arpit Prajapati
- Department of Community Medicine, GCS Medical College, Ahmedabad, Gujarat, India
| | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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14
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Berete F, Demarest S, Charafeddine R, Bruyère O, Van der Heyden J. Comparing health insurance data and health interview survey data for ascertaining chronic disease prevalence in Belgium. ACTA ACUST UNITED AC 2020; 78:120. [PMID: 33292534 PMCID: PMC7672883 DOI: 10.1186/s13690-020-00500-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/04/2020] [Indexed: 11/11/2022]
Abstract
Background Health administrative data were increasingly used for chronic diseases (CDs) surveillance purposes. This cross sectional study explored the agreement between Belgian compulsory health insurance (BCHI) data and Belgian health interview survey (BHIS) data for asserting CDs. Methods Individual BHIS 2013 data were linked with BCHI data using the unique national register number. The study population included all participants of the BHIS 2013 aged 15 years and older. Linkage was possible for 93% of BHIS-participants, resulting in a study sample of 8474 individuals. For seven CDs disease status was available both through self-reported information from the BHIS and algorithms based on ATC-codes of disease-specific medication, developed on demand of the National Institute for Health and Disability Insurance (NIHDI). CD prevalence rates from both data sources were compared. Agreement was measured using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) assuming BHIS data as gold standard. Kappa statistic was also calculated. Participants’ sociodemographic and health status characteristics associated with agreement were tested using logistic regression for each CD. Results Prevalence from BCHI data was significantly higher for CVDs but significantly lower for COPD and asthma. No significant difference was found between the two data sources for the remaining CDs. Sensitivity was 83% for CVDs, 78% for diabetes and ranged from 27 to 67% for the other CDs. Specificity was excellent for all CDs (above 98%) except for CVDs. The highest PPV was found for Parkinson’s disease (83%) and ranged from 41 to 75% for the remaining CDs. Irrespective of the CDs, the NPV was excellent. Kappa statistic was good for diabetes, CVDs, Parkinson’s disease and thyroid disorders, moderate for epilepsy and fair for COPD and asthma. Agreement between BHIS and BCHI data is affected by individual sociodemographic characteristics and health status, although these effects varied across CDs. Conclusions NHIDI’s CDs case definitions are an acceptable alternative to identify cases of diabetes, CVDs, Parkinson’s disease and thyroid disorders but yield in a significant underestimated number of patients suffering from asthma and COPD. Further research is needed to refine the definitions of CDs from administrative data. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-020-00500-4.
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Affiliation(s)
- Finaba Berete
- SD Epidemiology and public health, Sciensano, Juliette Wytsmanstraat, 14 1050, Brussels, Belgium. .,Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - Stefaan Demarest
- SD Epidemiology and public health, Sciensano, Juliette Wytsmanstraat, 14 1050, Brussels, Belgium
| | - Rana Charafeddine
- SD Epidemiology and public health, Sciensano, Juliette Wytsmanstraat, 14 1050, Brussels, Belgium
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health aspects of musculoskeletal health and ageing, Department of Public Health, Epidemiology and Health Economics, University of Liege, Liège, Belgium
| | - Johan Van der Heyden
- SD Epidemiology and public health, Sciensano, Juliette Wytsmanstraat, 14 1050, Brussels, Belgium
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15
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Abstract
AbstractSince the strong predictive power of self-reported health (SRH) for prospective health and social outcomes has been established, researchers have been in a quest to build a theoretical understanding of this widely used health measure. Current literature based predominantly in a biomedical perspective asserts a linear relationship between physical conditions and perception of health. Discrepancies from this expected relationship are considered an important weakness of SRH. Systematic discrepancies between physical conditions and reporting of SRH have been documented across different socio-economic groups. Evidence identified for educational groups shows that for the same level of health status, lower-educated groups report poorer levels of perceived health. This raised doubts whether it is useful to use SRH to measure social inequalities in health within and between countries. To date, sociologists of health have not engaged in the discussion of reporting heterogeneity in SRH. After reviewing existing evidence, we contend that the discrepancy in SRH reporting across social groups argued to be a weakness of SRH as a health measure is a strength from a sociological perspective. SRH as a social measure of health is a better predictor than objective measures of health precisely because it captures the lived experience of the embodied agent.
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16
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Mannion C, Hughes J, Moriarty F, Bennett K, Cahir C. Agreement between self-reported morbidity and pharmacy claims data for prescribed medications in an older community based population. BMC Geriatr 2020; 20:283. [PMID: 32778067 PMCID: PMC7419222 DOI: 10.1186/s12877-020-01684-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Studies have indicated variability around prevalence estimates of multimorbidity due to poor consensus regarding its definition and measurement. Medication-based measures of morbidity may be valuable resources in the primary-care setting where access to medical data can be limited. We compare the agreement between patient self-reported and medication-based morbidity; and examine potential patient-level predictors of discordance between these two measures of morbidity in an older (≥ 50 years) community-based population. Methods A retrospective cohort study was performed using national pharmacy claims data linked to The Irish LongituDinal study on Ageing (TILDA). Morbidity was measured by patient self-report (TILDA) and two medication-based measures, the Rx-Risk (< 65 years) and Rx-Risk-V (≥65 years), which classify drug claims into chronic disease classes. The kappa statistic measured agreement between self-reported and medication-based morbidity at the individual patient-level. Multivariate logistic regression was used to examine patient-level characteristics associated with discordance between measures of morbidity. Results Two thousand nine hundred twenty-five patients were included (< 65 years: N = 1095, 37.44%; and ≥ 65 years: N = 1830 62.56%). Hypertension and high cholesterol were the most prevalent self-reported morbidities in both age cohorts. Agreement was good or very good (κ = 0.61–0.81) for diabetes, osteoporosis and glaucoma; and moderate for high cholesterol, asthma, Parkinson’s and angina (κ = 0.44–0.56). All other conditions had fair or poor agreement. Age, gender, marital status, education, poor-delayed recall, depression and polypharmacy were significantly associated with discordance between morbidity measures. Conclusions Most conditions achieved only moderate or fair agreement between self-reported and medication-based morbidity. In order to improve the accuracy in prevalence estimates of multimorbidity, multiple measures of multimorbidity may be necessary. Future research should update the current Rx-Risk algorithms in-line with current treatment guidelines, and re-assess the feasibility of using these indices alone, or in combination with other methods, to yield more accurate estimates of multimorbidity.
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Affiliation(s)
- Clionadh Mannion
- Department of Pharmacology and Therapeutics, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - John Hughes
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Moriarty
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
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17
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Abu HO, Saczynski JS, Ware J, Mehawej J, Paul T, Awad H, Bamgbade BA, Pierre-Louis IC, Tisminetzky M, Kiefe CI, Goldberg RJ, McManus DD. Impact of comorbid conditions on disease-specific quality of life in older men and women with atrial fibrillation. Qual Life Res 2020; 29:3285-3296. [PMID: 32656722 DOI: 10.1007/s11136-020-02578-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Older persons with atrial fibrillation (AF) experience significant impairment in quality of life (QoL), which may be partly attributable to their comorbid diseases. A greater understanding of the impact of comorbidities on QoL could optimize patient-centered care among older persons with AF. OBJECTIVE To assess impairment in disease-specific QoL due to comorbid conditions in older adults with AF. METHODS Patients aged ≥ 65 years diagnosed with AF were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. At 1 year of follow-up, the Quality of Life Disease Impact Scale-for Multiple Chronic Conditions was used to provide standardized assessment of patient self-reported impairment in QoL attributable to 34 comorbid conditions grouped in 10 clusters. RESULTS The mean age of study participants (n = 1097) was 75 years and 48% were women. Overall, cardiometabolic, musculoskeletal, and pulmonary conditions were the most prevalent comorbidity clusters. A high proportion of participants (82%) reported that musculoskeletal conditions exerted the greatest impact on their QoL. Men were more likely than women to report that osteoarthritis and stroke severely impacted their QoL. Patients aged < 75 years were more likely to report that obesity, hip/knee joint problems, and fibromyalgia extremely impacted their QoL than older participants. CONCLUSIONS Among older persons with AF, while cardiometabolic diseases were highly prevalent, musculoskeletal conditions exerted the greatest impact on patients' disease-specific QoL. Understanding the extent of impairment in QoL due to underlying comorbidities provides an opportunity to develop interventions targeted at diseases that may cause significant impairment in QoL.
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Affiliation(s)
- Hawa O Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Jane S Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - John Ware
- John Ware Research Group, Watertown, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Hamza Awad
- Departments of Community Medicine and Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Benita A Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Isabelle C Pierre-Louis
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Mayra Tisminetzky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
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Salemi JL, Hansen MA, Modak S, Matas JL, Germanos GJ, Raza SA, Agana DFG, Louis JM. Estimating the obstetric co-morbidity burden using administrative data: The impact of the pregnancy-related assessment window. Paediatr Perinat Epidemiol 2020; 34:440-451. [PMID: 31976579 DOI: 10.1111/ppe.12593] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite increased research using large administrative databases to identify determinants of maternal morbidity and mortality, the extent to which these databases capture obstetric co-morbidities is unknown. OBJECTIVE To evaluate the impact that the time window used to assess obstetric co-morbidities has on the completeness of ascertainment of those co-morbidities. METHODS We conducted a five-year analysis of inpatient hospitalisations of pregnant women from 2010-2014 using the Nationwide Readmissions Database. For each woman, using discharge diagnoses, we identified 24 conditions used to create the Obstetric Comorbidity Index. Using various assessment windows for capturing obstetric co-morbidities, including the delivery hospitalisation only and all weekly windows from 7 to 280 days, we calculated the frequency and rate of each co-morbidity and the degree of underascertainment of the co-morbidity. Under each scenario, and for each co-morbidity, we also calculated the all-cause, 30-day readmission rate. RESULTS There were over 3 million delivery hospitalisations from 2010 to 2014 included in this analysis. Compared with a full 280-day window, assessment of obstetric co-morbidities using only diagnoses made during the delivery hospitalisation would result in failing to identify over 35% of cases of chronic renal disease, 28.5% cases in which alcohol abuse was documented during pregnancy, and 23.1% of women with pulmonary hypertension. For seven other co-morbidities, at least 1 in 20 women with that condition would have been missed with exclusive reliance on the delivery hospitalisation for co-morbidity diagnoses. Not only would reliance on delivery hospitalisations have resulted in missed cases of co-morbidities, but for many conditions, estimates of readmission rates for women with obstetric co-morbidities would have been underestimated. CONCLUSIONS An increasing proportion of maternal and child health research is based on large administrative databases. This study provides data that facilitate the assessment of the degree to which important obstetric co-morbidities may be underascertained when using these databases.
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Affiliation(s)
- Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sanjukta Modak
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer L Matas
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - George J Germanos
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Syed Ahsan Raza
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Denny Fe G Agana
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Judette M Louis
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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19
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Oemrawsingh A, Swami N, Valderas JM, Hazelzet JA, Pusic AL, Gliklich RE, Bergmark RW. Patient-Reported Morbidity Instruments: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:791-811. [PMID: 32540238 DOI: 10.1016/j.jval.2020.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/27/2020] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Although comorbidities play an essential role in risk adjustment and outcomes measurement, there is little consensus regarding the best source of this data. The aim of this study was to identify general patient-reported morbidity instruments and their measurement properties. METHODS A systematic review was conducted using multiple electronic databases (Embase, Medline, Cochrane Central, and Web of Science) from inception to March 2018. Articles focusing primarily on the development or subsequent validation of a patient-reported morbidity instrument were included. After including relevant articles, the measurement properties of each morbidity instrument were extracted by 2 investigators for narrative synthesis. RESULTS A total of 1005 articles were screened, of which 34 eligible articles were ultimately included. The most widely assessed instruments were the Self-Reported Charlson Comorbidity Index (n = 7), the Self-Administered Comorbidity Questionnaire (n = 3), and the Disease Burden Morbidity Assessment (n = 3). The most commonly included conditions were diabetes, hypertension, and myocardial infarction. Studies demonstrated substantial variability in item-level reliability versus the gold standard medical record review (κ range 0.66-0.86), meaning that the accuracy of the self-reported comorbidity data is dependent on the selected morbidity. CONCLUSIONS The Self-Reported Charlson Comorbidity Index and the Self-Administered Comorbidity Questionnaire were the most frequently cited instruments. Significant variability was observed in reliability per comorbid condition of patient-reported morbidity questionnaires. Further research is needed to determine whether patient-reported morbidity data should be used to bolster medical records data or serve as a stand-alone entity when risk adjusting observational outcomes data.
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Affiliation(s)
- Arvind Oemrawsingh
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Nishwant Swami
- University of Massachusetts Medical School, Worcester, MA, USA
| | - José M Valderas
- International Society for Quality of Life Research, Health Services & Policy Research, University of Exeter Medical School, Exeter, England, UK
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Patient Reported Outcomes, Value, and Experience Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard E Gliklich
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Regan W Bergmark
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Patient Reported Outcomes, Value and Experience Center, Brigham and Women's Hospital, Boston, MA, USA
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Viuff JH, Vejborg I, Schwartz W, Bak M, Mikkelsen EM. Morbidity as a Predictor for Participation in the Danish National Mammography Screening Program: A Cross-Sectional Study. Clin Epidemiol 2020; 12:509-518. [PMID: 32547242 PMCID: PMC7259444 DOI: 10.2147/clep.s250418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose In this cross-sectional study, we evaluated the association between morbidity and participation in the prevalence round of the Danish national mammography screening program. Patients and Methods Morbidity was assessed by the Charlson Comorbidity Index (CCI) score (0, 1-2, and ≥3) and by 19 individual diagnoses. We retrieved data on participation from The Danish Quality Database of Mammography Screening and on diagnoses from The Danish National Patient Registry. We estimated prevalence proportion ratios (PR) with 95% confidence intervals (CI). Results In total, 519,009 (79.8%) women participated in the first national breast cancer screening round. Relative to women with a CCI score of 0, the adjusted PRs were 0.96 (95% CI: 0.95-0.96) for a CCI score of 1-2 and 0.80 (95% CI: 0.79-0.81) for a CCI score of ≥3. Compared with no disease, the PRs for a diagnosis of the most prevalent, but less severe diseases, chronic pulmonary disease, cerebrovascular disease, diabetes I and II were 0.93 (95% CI: 0.93-0.94), 0.96 (95% CI: 0.94-0.96), and 0.96 (95% CI: 0.95-0.97), respectively. Among women with low prevalent, but most severe diseases, the PRs were 0.69 (95% CI: 0.60-0.81) for AIDS and 0.73 (95% CI: 0.70-0.76) for metastatic solid tumor. Conclusion Women with a high CCI score or one severe chronic condition are less likely to participate in breast cancer screening compared to women without disease. However, these women account for a small proportion of all non-participating women. Thus, it might be most beneficial to maximize breast cancer screening participation in women with less severe although more common morbidities.
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Affiliation(s)
- Jakob H Viuff
- Department of Clinical Epidemiology, Aarhus University Hospital,Aarhus N 8200, Denmark
| | - Ilse Vejborg
- Department of Radiology, University Hospital of Copenhagen Rigshospitalet, Copenhagen 2100, Denmark
| | - Walter Schwartz
- Department of Radiology, Odense University Hospital, Odense C 5000, Denmark
| | - Martin Bak
- Department of Pathology, Sydvestjysk Sygehus, Esbjerg 6700, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital,Aarhus N 8200, Denmark
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Zhang J, Xu L, Li J, Sun L, Qin W. Association between obesity-related anthropometric indices and multimorbidity among older adults in Shandong, China: a cross-sectional study. BMJ Open 2020; 10:e036664. [PMID: 32430453 PMCID: PMC7239539 DOI: 10.1136/bmjopen-2019-036664] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Whether the association between obesity-related anthropometric indices and multimorbidity differs by age among Chinese older adults (aged 65+) is unclear. We aimed to investigate the association between body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with multimorbidity among the young-old (aged 65-79) and old-old (aged 80+) adults. DESIGN Cross-sectional population-based study. SETTING Shandong province on the eastern coast of China. PARTICIPANTS 5493 subjects aged 65 years or above. MEASUREMENTS Details on sociodemographics, lifestyle characteristics and chronic conditions were collected using a structured questionnaire. The respondents were assessed with anthropometric measurements including height, weight, WC, hip circumference. RESULTS The overall prevalence of multimorbidity in older adults (aged 65+) was 35.2%. The BMI-obesity, WC-obesity and WHR-obesity rates were 7.4%, 57.5% and 80.4%, respectively. In the young-old adults (aged 65-79), the likelihood of multimorbidity was more than two times higher among the BMI-obese than the BMI-normal population (OR 2.08, 95% CI 1.66 to 2.60). Similar but less strong associations were found for the WC-obese and WHR-obese young-old population (OR 1.60, 95% CI 1.42 to 1.81; OR 1.31, 95% CI 1.10 to 1.56, respectively). For the old-old group (aged 80+), the BMI-obese, WC-obese and WHR-obese had a higher likelihood of having multimorbidity compared with the normal weight category (OR 2.10, 95% CI 0.96 to 4.57; OR 1.75, 95% CI 1.21 to 2.54; OR 2.15, 95% CI 1.18 to 3.93, respectively). CONCLUSION BMI-obesity, WC-obesity and WHR-obesity were associated with a greater risk of multimorbidity, and the associations were different between the young-old and the old-old adults. These age differences need to be considered in assessing healthy body weight in old age. These findings may be vital for public health surveillance, prevention and management strategies for multimorbidity in older adults.
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Affiliation(s)
- Jiao Zhang
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center for Health Economics Experiment and Public Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lingzhong Xu
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center for Health Economics Experiment and Public Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiajia Li
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center for Health Economics Experiment and Public Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Long Sun
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenzhe Qin
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center for Health Economics Experiment and Public Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
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Pacheco-Brousseau L, Poitras S, Savard J, Varin D, Moreau G, Matar WY, Beaulé P. Development of the French-Canadian Version of the Self-Administered Comorbidities Questionnaire (SCQ) in a hospital population undergoing hip or knee arthroplasty. Orthop Traumatol Surg Res 2020; 106:557-561. [PMID: 32265177 DOI: 10.1016/j.otsr.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED The Self-Administered Comorbidity Questionnaire (SCQ) is a tool used by hospitalized patients to self-report their comorbidities. It can help to explain the effectiveness of hip or knee arthroplasty, its complications, the length of hospital stay and perioperative resource utilization. HYPOTHESIS The French-Canadian version of the SCQ will be suitable for use in a Canadian hospital population. OBJECTIVES (1) translate and evaluate the transcultural validity of the SCQ in a French Canadian population undergoing hip or knee arthroplasty; (2) determine the standard error of measurement (SEM) in the French Canadian version. MATERIALS AND METHODS The translation and transcultural adaptation process consisted of four steps: (1) initial translation; (2) back translation; (3) assessment of questionnaire clarity with patients; (4) assessment of the translation's transcultural validity. The SEM was also calculated. RESULTS Twenty participants were recruited for step 3 and 83 participants for step 4. The original English version of the SCQ and the translated French-Canadian version (SCQ-FC) were similar with intra-class correlation coefficients for the intra-language and inter-language agreement between 0.71 and 0.97. The SEM was 1.92. CONCLUSION The SCQ-FC is comparable to the original English language version. Using this questionnaire allows us to document the comorbidities present in patients undergoing hip and knee arthroplasty in a French-Canadian population, and the impact of these comorbidities on the patients' health. LEVEL OF EVIDENCE V, Prospective study.
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Affiliation(s)
- Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, University of Ottawa, 451, chemin Smyth, K1H 8M5 Ottawa, ON, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, 451, chemin Smyth, K1H 8M5 Ottawa, ON, Canada.
| | - Jacinthe Savard
- School of Rehabilitation Sciences, University of Ottawa, 451, chemin Smyth, K1H 8M5 Ottawa, ON, Canada
| | - Daniel Varin
- Centre intégré de santé et des services sociaux de l'Outaouais (CISSSO), 116, boulevard Lionel-Émond, J8Y 1W7 Gatineau, QC, Canada
| | - Guy Moreau
- Hôpital Montfort, 713, Montreal Rd, K1K 0T2 Ottawa, ON, Canada
| | - Wadih Y Matar
- Centre intégré de santé et des services sociaux de l'Outaouais (CISSSO), 116, boulevard Lionel-Émond, J8Y 1W7 Gatineau, QC, Canada
| | - Paul Beaulé
- The Ottawa Hospital, 501, chemin Smyth, K1H 8L6 Ottawa, ON, Canada
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Morón-Duarte LS, Ramirez Varela A, Bassani DG, Bertoldi AD, Domingues MR, Wehrmeister FC, Silveira MF. Agreement of antenatal care indicators from self-reported questionnaire and the antenatal care card of women in the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil. BMC Pregnancy Childbirth 2019; 19:410. [PMID: 31703634 PMCID: PMC6839160 DOI: 10.1186/s12884-019-2573-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Studies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data. The reliability of self-reported information is often questioned as administrative data or medical records, such as antenatal care cards, are usually preferred. In this study, we measured the agreement of antenatal care indicators from self-reported information and antenatal care cards of pregnant women in the 2015 Pelotas Birth Cohort, Brazil. METHODS In a sample of 3923 mothers, indicator agreement strengths were estimated from Kappa and prevalence-and-bias-adjusted Kappa (PABAK) coefficients. Maternal characteristics associated with indicator agreements were assessed with heterogeneity chi-squared tests. RESULTS The self-reported questionnaire and the antenatal care card showed a moderate to high agreement in 10 of 21 (48%) antenatal care indicators that assessed care service use, clinical examination and diseases during pregnancy. Counseling indicators performed poorly. Self-reported information presented a higher frequency data and a higher sensitivity but slightly lower specificity when compared to the antenatal card. Factors associated with higher agreement between both data sources included lower maternal age, higher level of education, primiparous status, and being a recipient of health care in the public sector. CONCLUSIONS Self-reported questionnaire and antenatal care cards provided substantially different information on indicator performance. Reliance on only one source of data to assess antenatal care quality may be questionable for some indicators. From a public health perspective, it is recommended that antenatal care programs use multiple data sources to estimate quality and effectiveness of health promotion and disease prevention in pregnant women and their offspring.
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Affiliation(s)
- Lina Sofia Morón-Duarte
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul 96020-220 Brazil
| | - Andrea Ramirez Varela
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul 96020-220 Brazil
| | - Diego G. Bassani
- Center for Global Child Health, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Andrea Dâmaso Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul 96020-220 Brazil
| | - Marlos R. Domingues
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul 96020-220 Brazil
| | - Fernando C. Wehrmeister
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul 96020-220 Brazil
| | - Mariangela Freitas Silveira
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul 96020-220 Brazil
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Khanji C, Schnitzer ME, Bareil C, Perreault S, Lalonde L. Concordance of care processes between medical records and patient self-administered questionnaires. BMC FAMILY PRACTICE 2019; 20:92. [PMID: 31269902 PMCID: PMC6607524 DOI: 10.1186/s12875-019-0979-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 06/13/2019] [Indexed: 11/10/2022]
Abstract
Background Despite the increasing use of medical records to measure quality of care, studies have shown that their validity is suboptimal. The objective of this study is to assess the concordance of cardiovascular care processes evaluated through medical record review and patient self-administered questionnaires (SAQs) using ten quality indicators (TRANSIT indicators). These indicators were developed as part of a participatory research program (TRANSIT study) dedicated to TRANSforming InTerprofessional clinical practices to improve cardiovascular disease (CVD) prevention in primary care. Methods For every patient participating in the TRANSIT study, the compliance to each indicator (individual scores) as well as the mean compliance to all indicators of a category (subscale scores) and to the complete set of ten indicators (overall scale score) were established. Concordance between results obtained using medical records and patient SAQs was assessed by prevalence-adjusted bias-adjusted kappa (PABAK) coefficients as well as intraclass correlation coefficients (ICCs) and 95% confidence intervals (95% CI). Generalized linear mixed models (GLMM) were used to identify patients’ sociodemographic and clinical characteristics associated with agreement between the two data sources. Results The TRANSIT study was conducted in a primary care setting among patients (n = 759) with multimorbidity, at moderate (16%) and high risk (83%) of cardiovascular diseases. Quality of care, as measured by the TRANSIT indicators, varied substantially between medical records and patient SAQ. Concordance between the two data sources, as measured by ICCs (95% CI), was poor for the subscale (0.18 [0.08–0.27] to 0.46 [0.40–0.52]) and overall (0.46 [0.40–0.53]) compliance scale scores. GLMM showed that agreement was not affected by patients’ characteristics. Conclusions In quality improvement strategies, researchers must acknowledge that care processes may not be consistently recorded in medical records. They must also be aware that the evaluation of the quality of care may vary depending on the source of information, the clinician responsible of documenting the interventions, and the domain of care. Electronic supplementary material The online version of this article (10.1186/s12875-019-0979-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cynthia Khanji
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada
| | - Mireille E Schnitzer
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada
| | - Céline Bareil
- HEC Montréal, University of Montreal, 3000 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T2A7, Canada
| | - Sylvie Perreault
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada.,Sanofi Aventis Endowment Chair in Drug Utilization, Montreal, Canada
| | - Lyne Lalonde
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada. .,Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Montreal, Canada.
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Agreement between patient reported outcomes and clinical reports after radical prostatectomy - a prospective longitudinal study. BMC Urol 2019; 19:35. [PMID: 31068176 PMCID: PMC6505270 DOI: 10.1186/s12894-019-0467-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/25/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In clinical research information can be retrieved through various sources. The aim is to evaluate the agreement between answers in patient questionnaires and clinical reports in a study of patients after radical prostatectomy and patient characteristics associated with agreement between these two data sources. METHODS In the prospective non-randomized longitudinal trial LAParoscopic Prostatectomy Robot Open (LAPPRO) 4003 patients undergoing radical prostatectomy at 14 centers in Sweden were followed. Analysis of agreement is made using a variety of methods, including the recently proposed Gwet's AC1, which enables us to handle the limitations of Cohen's Kappa where agreement depends on the underlying prevalence. RESULTS The incidence of postoperative events was consistently reported higher by the patient compared with the clinical reports for all outcomes. Agreement regarding the absence of events (negative agreement) was consistently higher than agreement regarding events (positive agreement) for all outcome variables. Overall impression of agreement depends on which measure used for the assessment. The previously reported desirable properties of Gwet's AC1 as well as the patient characteristics associated with agreement were confirmed. CONCLUSION The differences in incidence and agreement across the different variables and time points highlight the importance of carefully assessing which source of information to use in clinical research. TRIAL REGISTRATION ISRCTN06393679 ( www.isrctn.com ). Date of registration: 07/02/2008. Retrospectively registered.
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Johnson HM, Sullivan-Vedder L, Kim K, McBride PE, Smith MA, LaMantia JN, Fink JT, Knutson Sinaise MR, Zeller LM, Lauver DR. Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial. Contemp Clin Trials 2019; 78:88-100. [PMID: 30677485 PMCID: PMC6387836 DOI: 10.1016/j.cct.2019.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 12/25/2022]
Abstract
Young adults (18-39 year-olds) with hypertension have a higher lifetime risk for cardiovascular disease. However, less than 50% of young adults achieve hypertension control in the United States. Hypertension self-management programs are recommended to improve control, but have been targeted to middle-aged and older populations. Young adults need hypertension self-management programs (i.e., home blood pressure monitoring and lifestyle modifications) tailored to their unique needs to lower blood pressure and reduce the risks and medication burden they may face over a lifetime. To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension. MyHEART is a patient-centered program, based upon the Self-Determination Theory, that uses evidence-based health behavior approaches to lower blood pressure. Therefore, the objective of this study is to evaluate MyHEART's impact on changes in systolic and diastolic blood pressure compared to usual care after 6 and 12 months in 310 geographically and racially/ethnically diverse young adults with uncontrolled hypertension. Secondary outcomes include MyHEART's impact on behavioral outcomes at 6 and 12 months, compared to usual clinical care (increased physical activity, decreased sodium intake) and to examine whether MyHEART's effects on self-management behavior are mediated through variables of perceived competence, autonomy, motivation, and activation (mediation outcomes). MyHEART is one of the first multicenter, randomized controlled hypertension trials tailored to young adults with primary care. The design and methodology will maximize the generalizability of this study. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03158051.
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Affiliation(s)
- Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Lisa Sullivan-Vedder
- Aurora Health Care Department of Family Medicine, Family Care Center, 1020 N 12(th) Street, Milwaukee, WI 53233, USA.
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, K6/420 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792-4675, USA.
| | - Patrick E McBride
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA.
| | - Maureen A Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut Street, 707 WARF Building, Madison, WI 53726, USA; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI 53715-1896, USA.
| | - Jamie N LaMantia
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Jennifer T Fink
- Department of Health Informatics and Administration, University of Wisconsin-Milwaukee College of Health Sciences, NWQ Building B, Suite #6455, 2025 E. Newport Avenue, Milwaukee, WI 53211-2906, USA.
| | - Megan R Knutson Sinaise
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Laura M Zeller
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Diane R Lauver
- School of Nursing, University of Wisconsin, Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI 53705, USA.
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Merzenich H, Blettner M, Niehoff D, Schwentner L, Schmidt M, Schmitt M, Wollschläger D. Cardiac late events in German breast cancer patients: a validation study on the agreement between patient self-reports and information from physicians. BMC Cardiovasc Disord 2018; 18:218. [PMID: 30497402 PMCID: PMC6267788 DOI: 10.1186/s12872-018-0961-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-administered health-status questionnaires are important tools in epidemiology. The objective of the presented validation study is to measure the agreement between breast cancer patients' self-reports and their physicians' information on late cardiac events, and to investigate determinants of agreement. To estimate possible misclassification is an important requirement for observational studies on cardiovascular endpoints. METHODS A retrospective, multi-center cohort study included 11,982 women diagnosed with breast cancer in Germany in 1998-2008. In 2014, a questionnaire survey assessed cardiovascular risk factors and incident cardiac events after therapy. A validation study was conducted, based on a sample of 3091 breast cancer patients from two university hospitals. Among them, 2261 women (73%) sent back the questionnaire on cardiovascular events, and 1316 women gave consent to request medical records from their general practitioners. A total of 1212/1316 (92.1%) medical records could be obtained for validation. Cohen's kappa coefficient was calculated, and multivariate regression was applied to study the influence of patient characteristics on agreement between both data sources. RESULTS Overall agreement for the composite endpoint of any cardiac event was 84.5% (kappa 0.35). Of 1055 breast cancer patients reporting no cardiac event, 950 (90%) had no such diagnosis in physicians' medical records. A total of 157 breast cancer survivors indicated a cardiac event, and the same diagnosis was confirmed by GPs for 74 (47%) women. For specific diagnoses, moderate to substantial agreement of self-reports was found for myocardial infarction (kappa 0.54) and stroke (kappa 0.61). Poor to fair agreement was present for angina pectoris, valvular heart disease, arrhythmia, and congestive heart failure. Younger age, higher education and a more recent cancer diagnosis were found to be associated with greater total agreement. CONCLUSIONS For the composite endpoint, survivors of breast cancer report the absence of cardiac disease accurately. However, for specific diagnoses, self-reported morbidity data from breast cancer patients may not fully agree with information from physicians. The agreement is moderate for acute events like myocardial infarction and stroke, but poor to fair for chronic diseases.
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Affiliation(s)
- Hiltrud Merzenich
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
| | - Dorothea Niehoff
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075 Ulm, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55101 Mainz, Germany
| | - Margit Schmitt
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075 Ulm, Germany
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
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Hoffmann J, Haastert B, Brüne M, Kaltheuner M, Begun A, Chernyak N, Icks A. How do patients with diabetes report their comorbidities? Comparison with administrative data. Clin Epidemiol 2018; 10:499-509. [PMID: 29750054 PMCID: PMC5933335 DOI: 10.2147/clep.s135872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
AIMS Patients with diabetes are probably often unaware of their comorbidities. We estimated agreement between self-reported comorbidities and administrative data. METHODS In a random sample of 464 diabetes patients, data from a questionnaire asking about the presence of 14 comorbidities closely related to diabetes were individually linked with statutory health insurance data. RESULTS Specificities were >97%, except cardiac insufficiency (94.5%), eye diseases (93.8%), peripheral arterial disease (92.6%), hypertension (90.9%), and peripheral neuropathy (85.8%). Sensitivities were <60%, except amputation (100%), hypertension (83.1%), and myocardial infarction (67.2%). A few positive predictive values were >90% (hypertension, myocardial infarction, and eye disease), and six were below 70%. Six negative predictive values were >90%, and two <70% (hypertension and eye disease). Total agreement was between 42.7% (eye disease) and 100% (dialysis and amputation). Overall, substantial agreement was observed for three morbidities (kappa 0.61-0.80: hypertension, myocardial infarction, and amputation). Moderate agreement (kappa 0.41-0.60) was estimated for angina pectoris, heart failure, stroke, peripheral neuropathy, and kidney disease. Factors associated with agreement were the number of comorbidities, diabetes duration, age, sex, and education. CONCLUSIONS Myocardial infarction and amputation were well reported by patients as comorbidities; eye diseases and foot ulceration rather poorly, particularly in older, male, or less educated patients. Patient information needs improving.
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Affiliation(s)
- Jonas Hoffmann
- Institute of Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
| | | | - Manuela Brüne
- Institute of Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
| | | | - Alexander Begun
- Institute of Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
| | - Nadja Chernyak
- Faculty of Medicine, Centre for Health and Society, Institute of Health Services Research and Health Economics, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
- Faculty of Medicine, Centre for Health and Society, Institute of Health Services Research and Health Economics, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Ingolstädter Neuherberg, Germany
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Individual Data Linkage of Survey Data with Claims Data in Germany-An Overview Based on a Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121543. [PMID: 29232834 PMCID: PMC5750961 DOI: 10.3390/ijerph14121543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/16/2022]
Abstract
Research based on health insurance data has a long tradition in Germany. By contrast, data linkage of survey data with such claims data is a relatively new field of research with high potential. Data linkage opens up new opportunities for analyses in the field of health services research and public health. Germany has comprehensive rules and regulations of data protection that have to be followed. Therefore, a written informed consent is needed for individual data linkage. Additionally, the health system is characterized by heterogeneity of health insurance. The lidA-living at work-study is a cohort study on work, age and health, which linked survey data with claims data of a large number of statutory health insurance data. All health insurance funds were contacted, of whom a written consent was given. This paper will give an overview of individual data linkage of survey data with German claims data on the example of the lidA-study results. The challenges and limitations of data linkage will be presented. Despite heterogeneity, such kind of studies is possible with a negligibly small influence of bias. The experience we gain in lidA will be shown and provide important insights for other studies focusing on data linkage.
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Mollon L, Bhattacharjee S. Health related quality of life among myocardial infarction survivors in the United States: a propensity score matched analysis. Health Qual Life Outcomes 2017; 15:235. [PMID: 29202758 PMCID: PMC5716338 DOI: 10.1186/s12955-017-0809-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/23/2017] [Indexed: 12/30/2022] Open
Abstract
Background Little is known regarding the health-related quality of life among myocardial infarction (MI) survivors in the United States. The purpose of this population-based study was to identify differences in health-related quality of life domains between MI survivors and propensity score matched controls. Methods This retrospective, cross-sectional matched case-control study examined differences in health-related quality of life (HRQoL) among MI survivors of myocardial infarction compared to propensity score matched controls using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. Propensity scores were generated via logistic regression for MI survivors and controls based on gender, race/ethnicity, age, body mass index (BMI), smoking status, and comorbidities. Chi-square tests were used to compare differences between MI survivors to controls for demographic variables. A multivariate analysis of HRQoL domains estimated odds ratios. Life satisfaction, sleep quality, and activity limitations were estimated using binary logistic regression. Social support, perceived general health, perceived physical health, and perceived mental health were estimated using multinomial logistic regression. Significance was set at p < 0.05. Results The final sample consisted of 16,729 MI survivors matched to 50,187 controls (n = 66,916). Survivors were approximately 2.7 times more likely to report fair/poor general health compared to control (AOR = 2.72, 95% CI: 2.43–3.05) and 1.5 times more likely to report limitations to daily activities (AOR = 1.46, 95% CI: 1.34–1.59). Survivors were more likely to report poor physical health >15 days in the month (AOR = 1.63, 95% CI: 1.46–1.83) and poor mental health >15 days in the month (AOR = 1.25, 95% CI: 1.07–1.46) compared to matched controls. There was no difference in survivors compared to controls in level of emotional support (rarely/never: AOR = 0.75, 95% CI: 0.48–1.18; sometimes: AOR = 0.73, 95% CI: 0.41–1.28), hours of recommended sleep (AOR = 1.14, 95% CI: 0.94–1.38), or life satisfaction (AOR = 1.62, 95% CI: 0.99–2.63). Conclusion MI survivors experienced lower HRQoL on domains of general health, physical health, daily activity, and mental health compared to the general population.
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Affiliation(s)
- Lea Mollon
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 North Martin Avenue, Tucson, AZ, 85721, USA
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 North Martin Avenue, Tucson, AZ, 85721, USA.
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Stephan BCM, Minett T, Muniz-Terrera G, Harrison SL, Matthews FE, Brayne C. Neuropsychological profiles of vascular disease and risk of dementia: implications for defining vascular cognitive impairment no dementia (VCI-ND). Age Ageing 2017; 46:755-760. [PMID: 28203692 DOI: 10.1093/ageing/afx016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Indexed: 11/13/2022] Open
Abstract
Background vascular cognitive impairment no dementia (VCI-ND) defines a preclinical phase of cognitive decline associated with vascular disorders. The neuropsychological profile of VCI-ND may vary according to different vascular conditions. Objective to determine the neuropsychological profile of individuals with no dementia and vascular disorders, including hypertension, peripheral vascular disease (PVD), coronary heart disease (CHD), diabetes and stroke. Risk of 2-year incident dementia in individuals with disease and cognitive impairment was also tested. Methods participants were from the Cognitive Function and Ageing Study. At baseline, 13,004 individuals aged ≥65 years were enrolled into the study. Individuals were grouped by baseline disorder status (present, absent) for each condition. Cognitive performance was assessed using the Mini Mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAMCOG). Dementia was assessed at 2 years. Results in the cross-sectional analysis, hypertension, PVD and CHD were not associated with cognitive impairment. Stroke was associated with impaired global (MMSE) and CAMCOG sub-scale (including memory and non-memory) scores. Diabetes was associated with impairments in global cognitive function (MMSE) and abstract thinking. In the longitudinal analysis, cognitive impairments were associated with incident dementia in all groups. Conclusion the neuropsychological profile in individuals with vascular disorders depends on the specific condition investigated. In all conditions cognitive impairment is a risk factor for dementia. A better understanding of which cognitive domains are affected in different disease groups could help improve operationalisation of the neuropsychological criteria for VCI-ND and could also aid with the development of dementia risk prediction models in persons with vascular disease.
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Affiliation(s)
- Blossom Christa Maree Stephan
- Newcastle University – Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle upon Tyne, Tyne and Wear, UK
| | - Thais Minett
- University of Cambridge – Institute of Public Health, Cambridge, UK
| | | | - Stephanie L Harrison
- Newcastle University – Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle upon Tyne, Tyne and Wear, UK
| | - Fiona E Matthews
- MRC Biostatistics Unit – University of Cambridge, Cambridge CB2 2SR, UK
| | - Carol Brayne
- University of Cambridge – Institute of Public Health, Cambridge, UK
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Diaz A, Kang J, Moore SP, Baade P, Langbecker D, Condon JR, Valery PC. Association between comorbidity and participation in breast and cervical cancer screening: A systematic review and meta-analysis. Cancer Epidemiol 2017; 47:7-19. [DOI: 10.1016/j.canep.2016.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/11/2016] [Accepted: 12/22/2016] [Indexed: 01/08/2023]
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Valikodath NG, Newman-Casey PA, Lee PP, Musch DC, Niziol LM, Woodward MA. Agreement of Ocular Symptom Reporting Between Patient-Reported Outcomes and Medical Records. JAMA Ophthalmol 2017; 135:225-231. [PMID: 28125754 PMCID: PMC5404734 DOI: 10.1001/jamaophthalmol.2016.5551] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Accurate documentation of patient symptoms in the electronic medical record (EMR) is important for high-quality patient care. OBJECTIVE To explore inconsistencies between patient self-report on an Eye Symptom Questionnaire (ESQ) and documentation in the EMR. DESIGN, SETTING, AND PARTICIPANTS This investigation was an observational study in comprehensive ophthalmology and cornea clinics at an academic institution among a convenience sample of 192 consecutive eligible patients, of whom 30 declined participation. Patients were recruited at the Kellogg Eye Center from October 1, 2015, to January 31, 2016. Patients were eligible to be included in the study if they were 18 years or older. MAIN OUTCOMES AND MEASURES Concordance of symptoms reported on an ESQ with data recorded in the EMR. Agreement of symptom report was analyzed using κ statistics and McNemar tests. Disagreement was defined as a negative symptom report or no mention of a symptom in the EMR for patients who reported moderate to severe symptoms on the ESQ. Logistic regression was used to investigate if patient factors, physician characteristics, or diagnoses were associated with the probability of disagreement for symptoms of blurry vision, pain or discomfort, and redness. RESULTS A total of 162 patients (324 eyes) were included. The mean (SD) age of participants was 56.6 (19.4) years, 62.3% (101 of 162) were female, and 84.9% (135 of 159) were white. At the participant level, 33.8% (54 of 160) had discordant reporting of blurry vision between the ESQ and EMR. Likewise, documentation was discordant for reporting glare (48.1% [78 of 162]), pain or discomfort (26.5% [43 of 162]), and redness (24.7% [40 of 162]), with poor to fair agreement (κ range, -0.02 to 0.42). Discordance of symptom reporting was more frequently characterized by positive reporting on the ESQ and lack of documentation in the EMR (Holm-adjusted McNemar P < .03 for 7 of 8 symptoms except for blurry vision [P = .59]). Return visits at which the patient reported blurry vision on the ESQ had increased odds of not reporting the symptom in the EMR compared with new visits (odds ratio, 5.25; 95% CI, 1.69-16.30; Holm-adjusted P = .045). CONCLUSIONS AND RELEVANCE Symptom reporting was inconsistent between patient self-report on an ESQ and documentation in the EMR, with symptoms more frequently recorded on a questionnaire. These results suggest that documentation of symptoms based on EMR data may not provide a comprehensive resource for clinical practice or "big data" research.
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Affiliation(s)
- Nita G. Valikodath
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - Paul P. Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
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Kelly AM, Smith B, Luo Z, Given B, Wehrwein T, Master I, Farley JE. Discordance between patient and clinician reports of adverse reactions to MDR-TB treatment. Int J Tuberc Lung Dis 2017; 20:442-7. [PMID: 26970151 DOI: 10.5588/ijtld.15.0318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING An urban out-patient clinic in Durban, South Africa, providing community-based treatment for drug-resistant tuberculosis (TB). OBJECTIVE To describe concordance between patient report and clinician documentation of adverse drug reactions (ADRs) to treatment for multidrug-resistant TB (MDR-TB). DESIGN ADRs were documented by interview using an 18-item symptom checklist and medical record data abstraction during a cross-sectional parent study with 121 MDR-TB patients, 75% of whom were co-infected with the human immunodeficiency virus. Concordance was analyzed using Cohen's κ statistic, Gwet's agreement coefficient (AC) 1, and McNemar's test. RESULTS ADRs were reported much more frequently in patient interviews (μ = 8.6) than in medical records (μ = 1.4). Insomnia was most common (67% vs. 2%), followed by peripheral neuropathy (65% vs. 18%), and confusion (61 vs. 4%). κ scores were very low, with the highest degree of concordance found in hearing loss (κ = 0.23), which was the only ADR not found to be significantly different between the two data sources (P = 0.34). CONCLUSIONS Our study showed a lack of concordance between patient report and clinician documentation of ADRs. These findings indicate the need for improved documentation of ADRs to better reflect patients' experiences during MDR-TB treatment. These data have important implications for country-level pharmacovigilance programs that rely on clinician documentation of ADRs for MDR-TB policy formation.
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Affiliation(s)
- A M Kelly
- Columbia University School of Nursing, New York, New York, USA
| | - B Smith
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Z Luo
- Michigan State University Department of Epidemiology and Biostatistics, East Lansing, Michigan, USA
| | - B Given
- Michigan State University College of NursingEast Lansing, Michigan, USA
| | - T Wehrwein
- Michigan State University College of NursingEast Lansing, Michigan, USA
| | - I Master
- King Dinuzulu Hospital Complex, Durban, South Africa
| | - J E Farley
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Impacts of structuring the electronic health record: Results of a systematic literature review from the perspective of secondary use of patient data. Int J Med Inform 2017; 97:293-303. [DOI: 10.1016/j.ijmedinf.2016.10.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 06/17/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022]
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Hernandez-Romieu AC, Garg S, Rosenberg ES, Thompson-Paul AM, Skarbinski J. Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009-2010. BMJ Open Diabetes Res Care 2017; 5:e000304. [PMID: 28191320 PMCID: PMC5293823 DOI: 10.1136/bmjdrc-2016-000304] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/18/2016] [Accepted: 11/23/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Nationally representative estimates of diabetes mellitus (DM) prevalence among HIV-infected adults in the USA are lacking, and whether HIV-infected adults are at increased risk of DM compared with the general adult population remains controversial. METHODS We used nationally representative survey (2009-2010) data from the Medical Monitoring Project (n=8610 HIV-infected adults) and the National Health and Nutrition Examination Survey (n=5604 general population adults) and fit logistic regression models to determine and compare weighted prevalences of DM between the two populations, and examine factors associated with DM among HIV-infected adults. RESULTS DM prevalence among HIV-infected adults was 10.3% (95% CI 9.2% to 11.5%). DM prevalence was 3.8% (CI 1.8% to 5.8%) higher in HIV-infected adults compared with general population adults. HIV-infected subgroups, including women (prevalence difference 5.0%, CI 2.3% to 7.7%), individuals aged 20-44 (4.1%, CI 2.7% to 5.5%), and non-obese individuals (3.5%, CI 1.4% to 5.6%), had increased DM prevalence compared with general population adults. Factors associated with DM among HIV-infected adults included age, duration of HIV infection, geometric mean CD4 cell count, and obesity. CONCLUSIONS 1 in 10 HIV-infected adults receiving medical care had DM. Although obesity contributes to DM risk among HIV-infected adults, comparisons to the general adult population suggest that DM among HIV-infected persons may develop at earlier ages and in the absence of obesity.
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Affiliation(s)
| | - Shikha Garg
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Angela M Thompson-Paul
- Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lucke T, Herrera R, Wacker M, Holle R, Biertz F, Nowak D, Huber RM, Söhler S, Vogelmeier C, Ficker JH, Mückter H, Jörres RA. Systematic Analysis of Self-Reported Comorbidities in Large Cohort Studies - A Novel Stepwise Approach by Evaluation of Medication. PLoS One 2016; 11:e0163408. [PMID: 27792735 PMCID: PMC5085029 DOI: 10.1371/journal.pone.0163408] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 09/08/2016] [Indexed: 01/22/2023] Open
Abstract
Objective In large cohort studies comorbidities are usually self-reported by the patients. This way to collect health information only represents conditions known, memorized and openly reported by the patients. Several studies addressed the relationship between self-reported comorbidities and medical records or pharmacy data, but none of them provided a structured, documented method of evaluation. We thus developed a detailed procedure to compare self-reported comorbidities with information on comorbidities derived from medication inspection. This was applied to the data of the German COPD cohort COSYCONET. Methods Approach I was based solely on ICD10-Codes for the diseases and the indications of medications. To overcome the limitations due to potential non-specificity of medications, Approach II was developed using more detailed information, such as ATC-Codes specific for one disease. The relationship between reported comorbidities and medication was expressed by a four-level concordance score. Results Approaches I and II demonstrated that the patterns of concordance scores markedly differed between comorbidities in the COSYCONET data. On average, Approach I resulted in more than 50% concordance of all reported diseases to at least one medication. The more specific Approach II showed larger differences in the matching with medications, due to large differences in the disease-specificity of drugs. The highest concordance was achieved for diabetes and three combined cardiovascular disorders, while it was substantial for dyslipidemia and hyperuricemia, and low for asthma. Conclusion Both approaches represent feasible strategies to confirm self-reported diagnoses via medication. Approach I covers a broad spectrum of diseases and medications but is limited regarding disease-specificity. Approach II uses the information from medications specific for a single disease and therefore can reach higher concordance scores. The strategies described in a detailed and reproducible manner are generally applicable in large studies and might be useful to extract as much information as possible from the available data.
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Affiliation(s)
- Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
- * E-mail:
| | - Ronald Herrera
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Center for International Health, Ludwig-Maximilian University Munich, München, Germany
| | - Margarethe Wacker
- German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Rolf Holle
- German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
| | - Rudolf M. Huber
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
- Thoracic Oncology Center Munich (TOM), University Hospital LMU Munich, München, Germany
| | - Sandra Söhler
- Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany
| | - Claus Vogelmeier
- Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany
| | - Joachim H. Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuremberg, Nürnberg, Germany
- Paracelsus Medical University Nuremberg, Nürnberg, Germany
| | - Harald Mückter
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian University Munich, München, Germany
| | - Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
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Eichler GS, Cochin E, Han J, Hu S, Vaughan TE, Wicks P, Barr C, Devenport J. Exploring Concordance of Patient-Reported Information on PatientsLikeMe and Medical Claims Data at the Patient Level. J Med Internet Res 2016; 18:e110. [PMID: 27174602 PMCID: PMC4882413 DOI: 10.2196/jmir.5130] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/25/2015] [Accepted: 02/21/2016] [Indexed: 11/16/2022] Open
Abstract
Background With the emergence of data generated by patient-powered research networks, it is informative to characterize their correspondence with health care system-generated data. Objectives This study explored the linking of 2 disparate sources of real-world data: patient-reported data from a patient-powered research network (PatientsLikeMe) and insurance claims. Methods Active patients within the PatientsLikeMe community, residing in the United States, aged 18 years or older, with a self-reported diagnosis of multiple sclerosis or Parkinson’s disease (PD) were invited to participate during a 2-week period in December 2014. Patient-reported data were anonymously matched and compared to IMS Health medical and pharmacy claims data with dates of service between December 2009 and December 2014. Patient-level match (identity), diagnosis, and usage of disease-modifying therapies (DMTs) were compared between data sources. Results Among 603 consenting patients, 94% had at least 1 record in the IMS Health dataset; of these, there was 93% agreement rate for multiple sclerosis diagnosis. Concordance on the use of any treatment was 59%, and agreement on reports of specific treatment usage (within an imputed 5-year period) ranged from 73.5% to 100%. Conclusions It is possible to match patient identities between the 2 data sources, and the high concordance at multiple levels suggests that the matching process was accurate. Likewise, the high degree of concordance suggests that these patients were able to accurately self-report their diagnosis and, to a lesser degree, their treatment usage. Further studies of linked data types are warranted to evaluate the use of enriched datasets to generate novel insights.
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Vigen C, Kwan ML, John EM, Gomez SL, Keegan THM, Lu Y, Shariff-Marco S, Monroe KR, Kurian AW, Cheng I, Caan BJ, Lee VS, Roh JM, Bernstein L, Sposto R, Wu AH. Validation of self-reported comorbidity status of breast cancer patients with medical records: the California Breast Cancer Survivorship Consortium (CBCSC). Cancer Causes Control 2016; 27:391-401. [PMID: 26797455 PMCID: PMC5792190 DOI: 10.1007/s10552-016-0715-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/08/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare information from self-report and electronic medical records for four common comorbidities (diabetes, hypertension, myocardial infarction, and other heart diseases). METHODS We pooled data from two multiethnic studies (one case-control and one survivor cohort) enrolling 1,936 women diagnosed with breast cancer, who were members of Kaiser Permanente Northern California. RESULTS Concordance varied by comorbidity; kappa values ranged from 0.50 for other heart diseases to 0.87 for diabetes. Sensitivities for comorbidities from self-report versus medical record were similar for racial/ethnic minorities and non-Hispanic Whites, and did not vary by age, neighborhood socioeconomic status, or education. Women with a longer history of comorbidity or who took medications for the comorbidity were more likely to report the condition. Hazard ratios for all-cause mortality were not consistently affected by source of comorbidity information; the hazard ratio was lower for diabetes, but higher for the other comorbidities when medical record versus self-report was used. Model fit was better when the medical record versus self-reported data were used. CONCLUSIONS Comorbidities are increasingly recognized to influence the survival of patients with breast or other cancers. Potential effects of misclassification of comorbidity status should be considered in the interpretation of research results.
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Affiliation(s)
- Cheryl Vigen
- University of Southern California, 1540 Alcazar St. CHP-133, Los Angeles, CA, 90089-9003, USA.
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Esther M John
- Cancer Prevention Institute of California, 2201 Walnut Ave #300, Fremont, CA, 94538, USA
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, 2201 Walnut Ave #300, Fremont, CA, 94538, USA
| | - Theresa H M Keegan
- Cancer Prevention Institute of California, 2201 Walnut Ave #300, Fremont, CA, 94538, USA
| | - Yani Lu
- Beckman Research Institute of the City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, 2201 Walnut Ave #300, Fremont, CA, 94538, USA
| | - Kristine R Monroe
- University of Southern California, 1540 Alcazar St. CHP-133, Los Angeles, CA, 90089-9003, USA
| | - Allison W Kurian
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Iona Cheng
- Cancer Prevention Institute of California, 2201 Walnut Ave #300, Fremont, CA, 94538, USA
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Leslie Bernstein
- Beckman Research Institute of the City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Richard Sposto
- University of Southern California, Health Sciences Campus, 4650 Sunset Blvd, SRT 600A, MS#54, Los Angeles, CA, 90027-6016, USA
| | - Anna H Wu
- University of Southern California, Health Sciences Campus, NOR 4443, Mail Code:9175, Los Angeles, CA, 90089-9175, USA
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Ahn GY, Cho SK, Kim D, Choi CB, Lee EB, Bae SC, Sung YK. Agreement of Major Diagnosis and Comorbidity between Self-reported Questionnaire and Medical Record Review in Patients with Rheumatic Disease. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.6.348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ga Young Ahn
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Dam Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Chan-Bum Choi
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Eun Bong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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Adriaanse MC, Drewes HW, van der Heide I, Struijs JN, Baan CA. The impact of comorbid chronic conditions on quality of life in type 2 diabetes patients. Qual Life Res 2015; 25:175-82. [PMID: 26267523 PMCID: PMC4706581 DOI: 10.1007/s11136-015-1061-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 12/13/2022]
Abstract
Objective To study the prevalence, impact and dose–response relationship of comorbid chronic conditions on quality of life of type 2 diabetes patients. Research design and methods Cross-sectional data of 1676 type 2 diabetes patients, aged 31–96 years, and treated in primary care, were analyzed. Quality of life (QoL) was measured using the mental component summary (MCS) and the physical component summary (PCS) scores of the Short Form-12. Diagnosis of type 2 diabetes was obtained from medical records and comorbidities from self-reports. Results Only 361 (21.5 %) of the patients reported no comorbidities. Diabetes patients with comorbidities showed significantly lower mean difference in PCS [−8.5; 95 % confidence interval (CI) −9.8 to −7.3] and MCS scores (−1.9; 95 % CI −3.0 to −0.9), compared to diabetes patients without. Additional adjustments did not substantially change these associations. Both MCS and PCS scores decrease significantly with the number of comorbid conditions, yet most pronounced regarding physical QoL. Comorbidities that reduced physical QoL most significantly were retinopathy, heart diseases, atherosclerosis in abdomen or legs, lung diseases, incontinence, back, neck and shoulder disorder, osteoarthritis and chronic rheumatoid arthritis, using the backwards stepwise regression procedure. Conclusion Comorbidities are highly prevalent among type 2 diabetes patients and have a negative impact on the patient’s QoL. A strong dose–response relationship between comorbidities and physical QoL was found. Reduced physical QoL is mainly determined by musculoskeletal and cardiovascular disorders.
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Affiliation(s)
- Marcel C Adriaanse
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - Hanneke W Drewes
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Iris van der Heide
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jeroen N Struijs
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Caroline A Baan
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Gresham E, Forder P, Chojenta CL, Byles JE, Loxton DJ, Hure AJ. Agreement between self-reported perinatal outcomes and administrative data in New South Wales, Australia. BMC Pregnancy Childbirth 2015; 15:161. [PMID: 26238999 PMCID: PMC4524430 DOI: 10.1186/s12884-015-0597-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 07/21/2015] [Indexed: 12/04/2022] Open
Abstract
Background Many epidemiological studies that focus on pregnancy rely on maternal self-report of perinatal outcomes. The aim of this study was to evaluate the agreement between self-reported perinatal outcomes (gestational hypertension with or without proteinuria, gestational diabetes, premature birth and low birth weight) in a longitudinal study and linked to administrative data (medical records). Methods Self-reported survey data from the Australian Longitudinal Study on Women’s Health was linked with the New South Wales Perinatal Data Collection. Agreement between the two sources was evaluated using percentage agreement and kappa statistics. Analyses were conducted at two levels by: i) the mother and ii) each individual child. Results Women reliably self-report their perinatal outcomes (≥87 % agreement). Gestational hypertension with or without proteinuria had the lowest level of agreement. Mothers’ reports of perinatal outcomes were more reliable when evaluated by child. Restricting the analysis to complete and consistent reporting further strengthened the reliability of the child-specific data, increasing the agreement from >92 to >95 % for all outcomes. Conclusions The present study offers a high degree of confidence in the use of maternal self-reports of the perinatal outcomes gestational hypertension, gestational diabetes, preterm birth and low birth weight in epidemiological research, particularly when reported on a per child basis. Furthermore self-report offers a cost-effective and convenient method for gathering detailed maternal perinatal histories.
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Affiliation(s)
- Ellie Gresham
- Research Centre for Gender, Health and Ageing, School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia.
| | - Peta Forder
- Research Centre for Gender, Health and Ageing, School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia.
| | - Catherine L Chojenta
- Research Centre for Gender, Health and Ageing, School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia.
| | - Julie E Byles
- Research Centre for Gender, Health and Ageing, School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia.
| | - Deborah J Loxton
- Research Centre for Gender, Health and Ageing, School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia.
| | - Alexis J Hure
- Research Centre for Gender, Health and Ageing, School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia.
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Ng X, Low AHL, Thumboo J. Comparison of the Charlson Comorbidity Index derived from self-report and medical record review in Asian patients with rheumatic diseases. Rheumatol Int 2015; 35:2005-11. [PMID: 26059942 DOI: 10.1007/s00296-015-3296-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/18/2015] [Indexed: 12/19/2022]
Abstract
The aim of the study was to compare the agreement between self-report Charlson Comorbidity Index (SR-CCI) and the medical record-based CCI (MR-CCI) and to examine the impact of both instruments on health-related quality of life (HRQoL) amongst Asian patients with rheumatic diseases. This cross-sectional study surveyed a convenience sample of patients seen at rheumatology specialty outpatient clinics. Patients completed the SR-CCI and Short Form 36, while two research assistants completed the MR-CCI. Item-level agreement between the SR-CCI and MR-CCI was evaluated using kappa coefficients. Adjusted linear regression models evaluated the independent effect of the SR-CCI/MR-CCI on HRQoL. The study included 301 patients (median age 51, range 21-79, 61.5 % female, 68.8 % Chinese, 17.6 % Indian, 6.0 % Malay). Kappa statistics for cerebrovascular disease (0.433), chronic pulmonary disease (0.509), connective tissue disease/rheumatoid arthritis (0.506), ulcer disease (0.461), and tumour (0.541) reflected moderate agreement between the SR-CCI and MR-CCI (all p < 0.0001). There was substantial agreement in the reporting of diabetes (0.764, p < 0.0001) but poor/fair agreement for that of myocardial infarction (0.359, p < 0.0001) and diabetes with end-organ damage (0.189, p = 0.0002). Increases in SR-CCI were associated with significant reductions in both physical (β coefficient -2.56, p < 0.0001) and mental HRQoL (β coefficient -1.24, p = 0.044). However, such associations were not observed with the MR-CCI. The SR-CCI demonstrated moderate concordance with the MR-CCI, and the SR-CCI but not MR-CCI scores were associated with lower HRQoL. Assessment of comorbidities amongst rheumatology patients remains complex, and more efficient methods of quantifying these conditions are needed for clinical and research purposes.
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Affiliation(s)
- Xinyi Ng
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology, Singapore General Hospital, The Academia, 20 College Road, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, The Academia, 20 College Road, Singapore, Singapore.
- Duke-NUS Graduate Medical School, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Hansen H, Pohontsch N, van den Bussche H, Scherer M, Schäfer I. Reasons for disagreement regarding illnesses between older patients with multimorbidity and their GPs - a qualitative study. BMC FAMILY PRACTICE 2015; 16:68. [PMID: 26032949 PMCID: PMC4450605 DOI: 10.1186/s12875-015-0286-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/22/2015] [Indexed: 11/16/2022]
Abstract
Background Chronic conditions are the most common themes in doctor-patient communication, especially for older patients with multimorbidity and their GPs. Former quantitative studies identified a variety of socio-demographic and health-related factors which were associated with the (dis-)agreement between medical records and patient self-reported diseases. The aim of this qualitative study was to identify reasons for disagreement regarding illnesses between patients and their GPs. Methods We conducted three focus groups with GPs (n = 15) and three focus groups with multimorbid patients aged 65 to 85 (n = 21). The participants were recruited from the MultiCare Cohort Study. Focus groups were audiotaped and transcribed verbatim. The transcripts of the focus groups were analysed using the qualitative content analysis according to Mayring. Categories were determined deductively and inductively. Results The analysis revealed seven themes concerning reasons for disagreement regarding illnesses between patients and their GPs: problems with communication and cooperation between health care professionals, disease management by the GP and the patient, the documentation behaviour of the GP, communication challenges between GP and patient, differences in the understanding of a disease between GP and patient, the prioritization and rating of diseases by GP and patient and obliviousness, repression and avoidance by the patient. Conclusions For older patients with multimorbidity, our study demonstrated that there is a need to enhance the cooperation between GPs, specialists and outpatient care, a demand to improve doctor-patient communication and a need for interventions to increase patients’ knowledge of diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0286-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heike Hansen
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Nadine Pohontsch
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Hendrik van den Bussche
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Martin Scherer
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Ingmar Schäfer
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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De-loyde KJ, Harrison JD, Durcinoska I, Shepherd HL, Solomon MJ, Young JM. Which information source is best? Concordance between patient report, clinician report and medical records of patient co-morbidity and adjuvant therapy health information. J Eval Clin Pract 2015; 21:339-46. [PMID: 25645368 DOI: 10.1111/jep.12327] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIM AND OBJECTIVES Previous studies investigating agreement between data sources for co-morbidity and adjuvant therapy information have suggested agreement varies depending on how the information is collected. The aim of this study was to compare agreement among three data sources: patient report, clinician report and medical record. METHOD Data were collected as part of a nurse-delivered telephone intervention (the CONNECT programme). Patient report was collected using a self-administered questionnaire. Clinician report was collected from the patient's treating surgeon. Medical record information was extracted by a member of the research team. The proportion of specific agreement [positive (PA) and negative agreement (NA)] and Kappa statistics were calculated. RESULTS The study sample comprised 756 surgical patients with colorectal cancer. For the majority of co-morbidities the lowest level of agreement was found between the patient and clinician (PA 0.29-0.64, Kappa values ranged from 0.22 to 0.58). The highest agreement and Kappa values for co-morbidities were generally found between the patient report and medical record (PA 0.36-0.80 and NA 0.92-0.99; Kappa 0.34-0.77). There was good agreement between patient and clinician reports for receipt adjuvant therapy {Kappa 0.78 [confidence interval (CI) 0.72-0.84] and 0.84 [CI 0.80-0.88], respectively; PA 0.87 and 0.92, respectively}. No consistent pattern in the predictors of non-agreement was found. CONCLUSION Given there was higher agreement between patient report and medical record review, the use of patient self-report questionnaires to ascertain co-morbid conditions remains a valid method for health services research.
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Affiliation(s)
- Katie J De-loyde
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Stephan BCM, Minett T, Terrera GM, Matthews FE, Brayne C. Dementia prediction for people with stroke in populations: is mild cognitive impairment a useful concept? Age Ageing 2015; 44:78-83. [PMID: 25002454 DOI: 10.1093/ageing/afu085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND criteria for mild cognitive impairment (MCI) capture an intermediate cognitive state between normal ageing and dementia, associated with increased dementia risk. Whether criteria for MCI are applicable in the context of stroke and can be used to predict dementia in stroke cases is not known. OBJECTIVES to determine the prevalence of MCI in individuals with stroke and identify predictors of 2-year incident dementia in stroke cases. METHODS individuals were from the Medical Research Council Cognitive Function and Ageing Study. MCI prevalence in individuals with stroke was determined. Logistic regression, with receiver operating characteristic curve analysis, was used to identify variables associated with risk of dementia in stroke cases including MCI criteria, demographic, health and lifestyle variables. FINDINGS of 2,640 individuals seen at the first assessment, 199 reported stroke with no dementia. In individuals with stroke, criteria for MCI are not appropriate, with less than 1% of stroke cases being classified as having MCI. However, in individuals with stroke two components of the MCI definition, subjective memory complaint and cognitive function (memory and praxis scores) predicted 2-year incident dementia (area under the curve = 0.85, 95% CI: 0.77-0.94, n = 113). CONCLUSION criteria for MCI do not appear to capture risk of dementia in the context of stroke in the population. In stroke cases, subjective and objective cognitive performance predicts dementia and these variables could possibly be incorporated into dementia risk models for stroke cases. Identifying individuals with stroke at greatest risk of dementia has important implications for treatment and intervention.
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Affiliation(s)
- Blossom C M Stephan
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road Newcastle upon Tyne, NE2 4AX, UK
| | - Thais Minett
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge University, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | | | - Fiona E Matthews
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge University, Cambridge CB2 0SR, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge University, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
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Authors' reply to Hennessy and Leonard's comment on "Desideratum for evidence-based epidemiology". Drug Saf 2014; 38:105-7. [PMID: 25511912 DOI: 10.1007/s40264-014-0254-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pulford J, Siba PM, Mueller I, Hetzel MW. The exit interview as a proxy measure of malaria case management practice: sensitivity and specificity relative to direct observation. BMC Health Serv Res 2014; 14:628. [PMID: 25465383 PMCID: PMC4259085 DOI: 10.1186/s12913-014-0628-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper aims to assess the sensitivity and specificity of exit interviews as a measure of malaria case management practice as compared to direct observation. METHODS The malaria case management of 1654 febrile patients attending 110 health facilities from across Papua New Guinea was directly observed by a trained research officer as part of a repeat cross sectional survey. Patient recall of 5 forms of clinical advice and 5 forms of clinical action were then assessed at service exit and statistical analyses on matched observation/exit interview data conducted. RESULTS The sensitivity of exit interviews with respect to clinical advice ranged from 36.2% to 96.4% and specificity from 53.5% to 98.6%. With respect to clinical actions, sensitivity of the exit interviews ranged from 83.9% to 98.3% and specificity from 70.6% to 98.1%. CONCLUSION The exit interview appears to be a valid measure of objective malaria case management practices such as the completion of a diagnostic test or the provision of antimalarial medication, but may be a less valid measure of low frequency, subjective practices such as the provision of malaria prevention advice.
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Affiliation(s)
- Justin Pulford
- Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea. .,School of Population Health, The University of Queensland, Herston, Qld 4006, Australia.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea.
| | - Ivo Mueller
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain. .,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
| | - Manuel W Hetzel
- Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea. .,Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
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Hu X, Huang J, Lv Y, Li G, Peng X. Status of prevalence study on multimorbidity of chronic disease in China: systematic review. Geriatr Gerontol Int 2014; 15:1-10. [PMID: 25163532 DOI: 10.1111/ggi.12340] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 12/21/2022]
Abstract
It is imperative to provide a more uniform method to improve the validity of prevalence studies on multimorbidity. However, the status of prevalence studies on multimorbidity of chronic disease is still yet to be confirmed in China. The objective of the present systematic review was to evaluate the variance across prevalence studies and to explore possible explanations for variations in China. Published literature was obtained from four databases. The studies that described the prevalence of multimorbidity on chronic disease based on the general population were considered. We assessed the risk of bias by a preplanned checklist referring to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). The heterogeneity among eligible studies was estimated by I(2) statistic and P-value using MetaAnalyst software. Nine studies were eligible for this systematic review. The prevalence of multimorbidity among the population aged 60 years or more ranged from 6.4% (95% CI 5.1-8.0) to 76.5% (95%CI 73.6-79.2). However, just two of nine studies could be judged as having a low risk of bias. It was shown that key items introducing the risk of bias included inconsistent sampling method, lacking of uniform measure indices and data source based on self-report. Heterogeneity test showed I(2) = 50% (P < 0.001), which showed there was substantial variation among individual studies. Therefore, only a narrative summary rather than meta-analysis was carried out. Marked methodology heterogeneity exists among prevalence studies on multimorbidity. Suggested methodological aspects that should be considered in future studies include sampling method, measure indices of multimorbidity and data source.
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Affiliation(s)
- Xiaolan Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
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Koller KR, Wilson AS, Asay ED, Metzger JS, Neal DE. Agreement Between Self-Report and Medical Record Prevalence of 16 Chronic Conditions in the Alaska EARTH Study. J Prim Care Community Health 2014; 5:160-5. [PMID: 24399443 DOI: 10.1177/2150131913517902] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
The gold standard for health information is the health record. Hospitalization and outpatient diagnoses provide health systems with data on which to project health costs and plan programmatic changes. Although health record information may be reliable and perceived as accurate, it may not include population-specific information and may exclude care provided outside a specific health care facility. Sole reliance on medical record information may lead to underutilization of health care services and inadequate assessment of population health status. In this study, we analyzed agreement, without assuming a gold standard, between self-reported and recorded chronic conditions in an American Indian/Alaska Native cohort. Self-reported health history was collected from 3821 adult participants of the Alaska EARTH study during 2004-2006. Participant medical records were electronically accessed and reviewed. Self-reported chronic conditions were underreported in relation to the medical record and both information sources reported the absence more reliably than the presence of conditions (across conditions, median positive predictive value = 64%, median negative predictive value = 94%). Agreement was affected by age, gender, and education. Differences between participant- and provider-based prevalence of chronic conditions demonstrate why health care administrators and policy makers should not rely exclusively on medical record-based administrative data for a comprehensive evaluation of population health.
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Affiliation(s)
| | - Amy S Wilson
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Elvin D Asay
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
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