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Rath KA, Tucker KL, Lewis A. Fluctuating Code Status: Strategies to Minimize End-of-Life Conflict in the Neurocritical Care Setting. Am J Hosp Palliat Care 2021; 39:79-85. [PMID: 34002621 DOI: 10.1177/10499091211017872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are multiple factors that may cause end-of-life conflict in the critical care setting. These include severe illness, family distress, lack of awareness about a patient's wishes, prognostic uncertainty, and the participation of multiple providers in goals-of-care discussions. METHODS Case report and discussion of the associated ethical issues. RESULTS We present a case of a patient with a pontine stroke, in which the family struggled with decision-making about goals-of-care, leading to fluctuation in code status from Full Code to Do Not Resuscitate-Comfort Care, then back to Full Code, and finally to Do Not Resuscitate-Do Not Intubate. We discuss factors that contributed to this situation and methods to avoid conflict. Additionally, we review the effects of discord at the end-of-life on patients, families, and the healthcare team. CONCLUSION It is imperative that healthcare teams proactively collaborate with families to minimize end-of-life conflict by emphasizing decision-making that prioritizes the best interest and autonomy of the patient.
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Affiliation(s)
- Kelly A Rath
- Department of Neurocritical Care, Gardner Neuroscience Institute, University of Cincinnati, OH, USA
| | - Kristi L Tucker
- Section on Neurocritical Care, Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA.,Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
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Lemon C, De Ridder M, Khadra M. Do Electronic Medical Records Improve Advance Directive Documentation? A Systematic Review. Am J Hosp Palliat Care 2018; 36:255-263. [PMID: 30165755 DOI: 10.1177/1049909118796191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Documentation rates of advance directives (ADs) remain low. Using electronic medical records (EMRs) could help, but a synthesis of evidence is currently lacking. OBJECTIVES To evaluate the evidence for using EMRs in documenting ADs and its implications for overcoming challenges associated with their use. DESIGN Systematic review of articles in English, published from inception of databases to December 2017. DATA SOURCES PubMed, PsycINFO, EMBASE, and CINAHL. METHODS/MEASUREMENTS Four databases were searched from inception to December 2017. Randomized and nonrandomized quantitative studies examining the effects of EMRs on creation, storage, or use of ADs were included. All featured an advance care planning process. Evidence was evaluated using the Cochrane Collaboration's risk assessment tool. RESULTS Fifteen studies were included: 1 randomized controlled trial, 1 randomized pilot, 4 pre-post studies, 4 cross-sectional studies, 1 retrospective cohort study, 1 historical control study, 1 retrospective observational study, 1 retrospective review, and 1 evaluation of an EMR feature. Seven studies showed that EMR-based reminders, AD templates, and decision aids can improve AD documentation rates. Three demonstrated that EMR search functions, decision aids, and automatic identification software can help identify patients who have or need ADs according to certain criteria. Five showed EMRs can create documentation challenges, including locating ADs, and making some patients more likely than others to have an AD. Most studies had an unclear or high risk of bias. CONCLUSIONS Limited evidence suggests EMRs could be used to help address AD documentation challenges but may also create additional problems. Stronger evidence is needed to more conclusively determine how EMR may assist in population approaches to improving AD documentation.
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Affiliation(s)
- Christopher Lemon
- University of Notre Dame Australia, Sydney, School of Medicine, Sydney, NSW, Australia
| | - Michael De Ridder
- Institute of Biomedical Engineering and Technology (BMET), The University of Sydney, Australia.,Nepean Telehealth Technology Centre, Sydney Medical School Nepean, The University of Sydney, Australia
| | - Mohamed Khadra
- Nepean Telehealth Technology Centre, Sydney Medical School Nepean, The University of Sydney, Australia.,Discipline of Surgery, Sydney Medical School Nepean, The University of Sydney, Australia
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3
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An Integrated Review of Research Using Clinical Decision Support to Improve Advance Directive Documentation. J Hosp Palliat Nurs 2017. [DOI: 10.1097/njh.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bose-Brill S, Kretovics M, Ballenger T, Modan G, Lai A, Belanger L, Koesters S, Pressler-Vydra T, Wills C. Development of a tethered personal health record framework for early end-of-life discussions. THE AMERICAN JOURNAL OF MANAGED CARE 2016; 22:412-418. [PMID: 27355808 PMCID: PMC5219928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES End-of-life planning, known as advance care planning (ACP), is associated with numerous positive outcomes, such as improved patient satisfaction with care and improved patient quality of life in terminal illness. However, patient-provider ACP conversations are rarely performed or documented due to a number of barriers, including time required, perceived lack of skill, and a limited number of resources. Use of tethered personal health records (PHRs) may help streamline ACP conversations and documentations for outpatient workflows. Our objective was to develop an ACP-PHR framework that would be for use in a primary care, outpatient setting. STUDY DESIGN Qualitative content analysis of focus groups and cognitive interviews (participatory design). METHODS A novel PHR-ACP tool was developed and tested using data and feedback collected from 4 patient focus groups (n = 13), 1 provider focus group (n = 4), and cognitive interviews (n = 22). RESULTS Patient focus groups helped develop a focused, 4-question PHR communication tool. Cognitive interviews revealed that, while patients felt framework content and workflow were generally intuitive, minor changes to content and workflow would optimize the framework. CONCLUSIONS A focused framework for electronic ACP communication using a patient portal tethered to the PHR was developed. This framework may provide an efficient way to have ACP conversations in busy outpatient settings.
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Affiliation(s)
- Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, Ohio State University, 895 Yard St, Columbus, OH 43212. E-mail:
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Lakin JR, Isaacs E, Sullivan E, Harris HA, McMahan RD, Sudore RL. Emergency Physicians' Experience with Advance Care Planning Documentation in the Electronic Medical Record: Useful, Needed, and Elusive. J Palliat Med 2016; 19:632-8. [PMID: 27203483 DOI: 10.1089/jpm.2015.0486] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE For patients' preferences to be honored, emergency department (ED) physicians must be able to find and use advance care planning (ACP) information in the electronic medical record (EMR). ED physicians' experiences with ACP EMR documentation and their documentation needs are unknown. METHODS We surveyed 70 ED physicians (81% response rate) from a tertiary and county ED. Our primary outcome was confidence finding and using ACP EMR documentation (percentage reporting very/extremely on a five-point Likert scale). Secondary outcomes included frequency of use and perceived usefulness of types of ACP documentation. Suggestions for improvement were analyzed using thematic content analysis. RESULTS Participants' mean age was 36 years (± 9) and 54% were women. Thirty-one percent reported being very/extremely confident they could find ACP EMR documentation, and 55% felt very/extremely confident they could use it to care for patients. Yet 74% needed it ≥1 time/week and 43% ≥5 times/week. Participants reported code status orders (90%), Physician Orders for Life Sustaining Treatment (POLST) (86%), and durable power of attorney for health care (78%) as very/extremely useful, followed by values statements (31%), oral directives (34%), and living wills (37%). ED physicians wanted highly visible ACP information, "on the main screen." CONCLUSIONS EMR systems are not optimized to provide critical ACP information to ED physicians who lack confidence finding or using ACP EMR documentation to care for patients. Dedicated ACP information on the EMR home screen and tailored training may be needed to help ED providers find, use, and discuss ACP documentation to provide care aligned with patients' goals.
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Affiliation(s)
- Joshua R Lakin
- 1 Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.,2 Center for Palliative Care , Harvard Medical School, Boston, Massachusetts
| | - Eric Isaacs
- 3 Department of Emergency Medicine, University of California , San Francisco, California
| | - Erin Sullivan
- 3 Department of Emergency Medicine, University of California , San Francisco, California
| | - Heather A Harris
- 4 Supportive and Palliative Care Service, Division of Hospital Medicine, San Francisco General Hospital , San Francisco, California.,5 Department of Medicine, University of California , San Francisco, California
| | - Ryan D McMahan
- 6 Division of Geriatrics, University of California , San Francisco, California.,7 San Francisco VA Medical Center , San Francisco, California
| | - Rebecca L Sudore
- 6 Division of Geriatrics, University of California , San Francisco, California.,7 San Francisco VA Medical Center , San Francisco, California
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7
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Brown SM, Jones JP, Aronsky D, Jones BE, Lanspa MJ, Dean NC. Relationships among initial hospital triage, disease progression and mortality in community-acquired pneumonia. Respirology 2013; 17:1207-13. [PMID: 22805170 DOI: 10.1111/j.1440-1843.2012.02225.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Appropriate triage of patients with community-acquired pneumonia (CAP) may improve morbidity, mortality and use of hospital resources. Worse outcomes from delayed intensive care unit (ICU) admission have long been suspected but have not been verified. METHODS In a retrospective study of consecutive patients with CAP admitted from 1996-2006 to the ICUs of a tertiary care hospital, we measured serial severity scores, intensive therapies received, ICU-free days, and 30-day mortality. Primary outcome was mortality. We developed a regression model of mortality with ward triage (and subsequent ICU transfer within 72 h) as the predictor, controlled by propensity for ward triage and radiographic progression. RESULTS Of 1059 hospital-admitted patients, 269 (25%) were admitted to the ICU during hospitalization. Of those, 167 were directly admitted to the ICU without current requirement for life support, while 61 (23%) were initially admitted to the hospital ward, 50 of those undergoing ICU transfer within 72 h. Ward triage was associated with increased mortality (OR 2.6, P = 0.056) after propensity adjustment. The effect was less (OR 2.2, P = 0.12) after controlling for radiographic progression. The effect probably increased (OR 4.1, P = 0.07) among patients with ≥ 3 severity predictors at admission. CONCLUSIONS Initial ward triage among patients transferred to the ICU is associated with twofold higher 30-day mortality. This effect is most apparent among patients with ≥ 3 severity predictors at admission and is attenuated by controlling for radiographic progression. Intensive monitoring of ward-admitted patients with CAP seems warranted. Further research is needed to optimize triage in CAP.
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Affiliation(s)
- Samuel M Brown
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
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8
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Oshitani Y, Nagai H, Matsui H. Rationale for physicians to propose do-not-resuscitate orders in elderly community-acquired pneumonia cases. Geriatr Gerontol Int 2013; 14:54-61. [DOI: 10.1111/ggi.12054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Yohei Oshitani
- Center for Pulmonary Diseases; National Hospital Organization Tokyo National Hospital; Tokyo Japan
| | - Hideaki Nagai
- Center for Pulmonary Diseases; National Hospital Organization Tokyo National Hospital; Tokyo Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases; National Hospital Organization Tokyo National Hospital; Tokyo Japan
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Temel JS, Greer JA, Gallagher ER, Jackson VA, Lennes IT, Muzikansky A, Park ER, Pirl WF. Electronic Prompt to Improve Outpatient Code Status Documentation for Patients With Advanced Lung Cancer. J Clin Oncol 2013; 31:710-5. [DOI: 10.1200/jco.2012.43.2203] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Rates of documentation of end-of-life care preferences in the medical record remain low, even among patients with incurable malignancies. We therefore conducted a two-phase study to develop and assess the effect of electronic prompts to encourage oncology clinicians to document code status in the outpatient electronic health record (EHR) of patients with advanced lung cancers. Patients and Methods To determine the optimal delivery, content, and timing of the electronic prompt, we first facilitated focus groups with oncology clinicians at an affiliated medical center. Given this feedback, we developed e-mail reminders timed to the start of each new chemotherapy regimen. Between July 2009 and January 2011, 102 eligible patients with incurable lung cancer were approached, and 100 agreed to participate. We compared e-mail prompt participants (EPPs) with a cohort of 100 consecutive historical controls who began therapy for incurable lung cancer at least 1 year before the start of this study. The primary outcome measure was clinician documentation of code status in the EHR. Results EPPs were similar to historical controls, with no significant differences in demographic or clinical characteristics. At 1-year follow-up, 33.7% (n = 33/98) of EPPs had a code status documented in the outpatient EHR compared with 14.5% (n = 12/83) of historical controls (P = .003). Mean time to code status documentation was significantly shorter in EPPs (8.6 months [95% CI, 7.6 to 9.5]) compared with controls (10.5 months [95% CI, 9.8 to 11.3]; P = .004). Conclusion e-mail prompts may improve the rate and timing of code status documentation in the EHR and warrant further investigation.
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Affiliation(s)
| | | | | | | | - Inga T. Lennes
- All authors: the Massachusetts General Hospital, Boston, MA
| | | | - Elyse R. Park
- All authors: the Massachusetts General Hospital, Boston, MA
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Friedlin J, Overhage M. An evaluation of the UMLS in representing corpus derived clinical concepts. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2011; 2011:435-444. [PMID: 22195097 PMCID: PMC3243131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We performed an evaluation of the Unified Medical Language System (UMLS) in representing concepts derived from medical narrative documents from three domains: chest x-ray reports, discharge summaries and admission notes. We detected concepts in these documents by identifying noun phrases (NPs) and N-grams, including unigrams (single words), bigrams (word pairs) and trigrams (word triples). After removing NPs and N-grams that did not represent discrete clinical concepts, we processed the remaining with the UMLS MetaMap program. We manually reviewed the results of MetaMap processing to determine whether MetaMap found full, partial or no representation of the concept. For full representations, we determined whether post-coordination was required. Our results showed that a large portion of concepts found in clinical narrative documents are either unrepresented or poorly represented in the current version of the UMLS Metathesaurus and that post-coordination was often required in order to fully represent a concept.
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Affiliation(s)
- Jeff Friedlin
- Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, IN, USA
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12
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Dean NC, Jones JP, Aronsky D, Brown S, Vines CG, Jones BE, Allen T. Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department. Ann Emerg Med 2011; 59:35-41. [PMID: 21907451 DOI: 10.1016/j.annemergmed.2011.07.032] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 07/11/2011] [Accepted: 07/25/2011] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE We examine variability among emergency physicians in rate of hospitalization for patients with pneumonia and the effect of variability on clinical outcomes. METHODS We studied 2,069 LDS Hospital emergency department (ED) patients with community-acquired pneumonia who were aged 18 years or older during 1996 to 2006, identified by International Classification of Diseases, Ninth Revision coding and compatible chest radiographs. We extracted vital signs, laboratory and radiographic results, hospitalization, and outcomes from the electronic medical record. We defined "low severity" as PaO(2)/FiO(2) ratio greater than or equal to 280 mm Hg, predicted mortality less than 5% by an electronic version of CURB-65 that uses continuous and weighted elements (eCURB), and less than 3 Infectious Disease Society of America-American Thoracic Society 2007 severe pneumonia minor criteria. We adjusted hospitalization decisions and outcomes for illness severity and patient demographics. RESULTS Initial hospitalization rate was 58%; 10.7% of patients initially treated as outpatients were secondarily hospitalized within 7 days. Median age of admitted patients was 63 years; median eCURB predicted mortality was 2.65% (mean 6.8%) versus 46 years and 0.93% for outpatients. The 18 emergency physicians (average age 44.9 [standard deviation 7.6] years; years in practice 8.4 [standard deviation 6.9]) objectively calculated and documented illness severity in 2.7% of patients. Observed 30-day mortality for inpatients was 6.8% (outpatient mortality 0.34%) and decreased over time. Individual physician admission rates ranged from 38% to 79%, with variability not explained by illness severity, time of day, day of week, resident care in conjunction with an attending physician, or patient or physician demographics. Higher hospitalization rates were not associated with reduced mortality or fewer secondary hospital admissions. CONCLUSION We observed a 2-fold difference in pneumonia hospitalization rates among emergency physicians, unexplained by objective data.
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Affiliation(s)
- Nathan C Dean
- Pulmonary and Critical Care Medicine Division at Intermountain Medical Center and the University of Utah, Salt Lake City, UT, USA.
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Yoon HM, Choi YS, Hyun JJ. Current Situation on Signing Advance Medical Directives and Actual Life-sustaining Treatment Given at a University Hospital. ACTA ACUST UNITED AC 2011. [DOI: 10.14475/kjhpc.2011.14.2.91] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ho Min Yoon
- Department of Family Medicine, Korea University Guro Hospital, Seoul,
| | - Youn Seon Choi
- Department of Family Medicine, Korea University Guro Hospital, Seoul,
| | - Jong Jin Hyun
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
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Code status documentation in the outpatient electronic medical records of patients with metastatic cancer. J Gen Intern Med 2010; 25:150-3. [PMID: 19894078 PMCID: PMC2837502 DOI: 10.1007/s11606-009-1161-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/12/2009] [Accepted: 10/13/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Advanced care planning (ACP) is considered an essential component of medical care in the United States, especially in patients with incurable diseases. However, little is known about clinical practices in outpatient oncology settings related to discussing end-of-life care and documenting code status preferences in ambulatory medical records. OBJECTIVE To assess the rate of documentation of code status in the electronic longitudinal medical records (LMR) of patients with metastatic cancer. DESIGN Retrospective review of 2,498 patients with metastatic solid tumors at an academic cancer center. An electronic patient database and the LMR were queried to identify demographic information, cancer type, number of clinic visits, and documentation of code status. PARTICIPANTS The sample consisted of adult patients with metastatic prostate, breast, ovarian, bladder kidney, colorectal, non-colorectal gastrointestinal (GI), and lung cancers. MEASUREMENTS Primary outcome was the percentage of documented code status in the LMR. MAIN RESULTS Among the 2,498 patients, 20.3% had a documented code status. Code status was designated most frequently in patients with non-colorectal GI (193/609, 31.7%) and lung (179/583, 30.7%) cancers and least frequently in patients with genitourinary malignancies [bladder/kidney (4/89, 4.5%), ovarian (4/93, 4.3%), and prostate (7/365, 1.9%) cancers]. Independent predictors of having documented code status included religious affiliation, cancer type, and a greater number of visits to the cancer center. Younger patients and black patients were less likely to be designated as DNR/DNI. CONCLUSIONS Despite the incurable nature of metastatic cancer, only a minority of patients had a code status documented in the electronic medical record.
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Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia. Crit Care Med 2009; 37:3010-6. [PMID: 19789456 DOI: 10.1097/ccm.0b013e3181b030d9] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Validate the Infectious Disease Society of America/American Thoracic Society 2007 (IDSA/ATS 2007) criteria for predicting severe community-acquired pneumonia (SCAP) and evaluate a health-services definition for SCAP. DESIGN Retrospective cohort study. SETTING LDS Hospital, an academic tertiary care facility in the western United States. PATIENTS Consecutive patients with International Classification of Diseases, Ninth Edition, codes and chest radiographs consistent with community-acquired pneumonia from 1996 to 2006 seen at LDS Hospital. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We utilized the electronic medical record to examine intensive care unit admission, intensive therapies received, and predictors of severity, as well as 30-day mortality. We also developed logistic regression models of mortality and disease severity. We calculated the IDSA/ATS 2007 criteria as well as three other pneumonia severity scores. We defined SCAP as receipt of intensive therapy in the intensive care unit. In 2413 episodes of pneumonia, 1540 were admitted to the hospital, while 379 were admitted to the intensive care unit. Overall 30-day mortality was 3.7% but was 16% among intensive care patients. The IDSA/ATS 2007 minor criteria predicted SCAP with an area under the curve of 0.88 (95% confidence interval 0.85-0.90), which improved to 0.90 (95% confidence interval 0.88-0.92) with weighting. Competing models had area under the curve of 0.76 to 0.83. Using four rather than three minor criteria improved the positive predictive value from 54% to 81%, with a stable negative predictive value of 94% to 92%. CONCLUSIONS The IDSA/ATS 2007 criteria predicted pneumonia severity better than other models. Using four rather than three minor criteria may be a superior cutoff, although this will depend on institutional characteristics.
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Roth CP, Lim YW, Pevnick JM, Asch SM, McGlynn EA. The challenge of measuring quality of care from the electronic health record. Am J Med Qual 2009; 24:385-94. [PMID: 19482968 DOI: 10.1177/1062860609336627] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The electronic health record (EHR) is seen by many as an ideal vehicle for measuring quality of health care and monitoring ongoing provider performance. It is anticipated that the availability of EHR-extracted data will allow quality assessment without the expensive and time-consuming process of medical record abstraction. A review of the data requirements for the indicators in the Quality Assessment Tools system suggests that only about a third of the indicators would be readily accessible from EHR data. Other factors involving complexity of required data elements, provider documentation habits, and EHR variability make the task of quality measurement more difficult than may be appreciated. Accurately identifying eligible cases for quality assessment and validly scoring those cases with EHR-extracted data will pose significant challenges but could potentially plummet the cost and therefore expand the use of quality assessment.
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Affiliation(s)
- Carol P Roth
- RAND Health, Santa Monica, California 90407-2138, USA.
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Turchin A, Kolatkar NS, Grant RW, Makhni EC, Pendergrass ML, Einbinder JS. Using regular expressions to abstract blood pressure and treatment intensification information from the text of physician notes. J Am Med Inform Assoc 2006; 13:691-5. [PMID: 16929043 PMCID: PMC1656954 DOI: 10.1197/jamia.m2078] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This case study examined the utility of regular expressions to identify clinical data relevant to the epidemiology of treatment of hypertension. We designed a software tool that employed regular expressions to identify and extract instances of documented blood pressure values and anti-hypertensive treatment intensification from the text of physician notes. We determined sensitivity, specificity and precision of identification of blood pressure values and anti-hypertensive treatment intensification using a gold standard of manual abstraction of 600 notes by two independent reviewers. The software processed 370 Mb of text per hour, and identified elevated blood pressure documented in free text physician notes with sensitivity and specificity of 98%, and precision of 93.2%. Anti-hypertensive treatment intensification was identified with sensitivity 83.8%, specificity of 95.0%, and precision of 85.9%. Regular expressions can be an effective method for focused information extraction tasks related to high-priority disease areas such as hypertension.
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Affiliation(s)
- Alexander Turchin
- Clinical Informatics Research and Development, Partners HealthCare System, 93 Worcester Street, Suite 201, Wellesley, MA 02481, USA.
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