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Senthinathan A, Thompson W, Gomes Z, Kiflen M, Bonilla AO, Stephenson E, Butt D, O’Neill B, Udell JA, Tu K. Assessing Primary Care Blood Pressure Documentation for Hypertension Management During the COVID-19 Pandemic by Patient and Provider Groups. CJC Open 2023; 5:916-924. [PMID: 38204848 PMCID: PMC10774078 DOI: 10.1016/j.cjco.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/10/2023] [Indexed: 01/12/2024] Open
Abstract
Background Primary care electronic medical record (EMR) data can be used to identify, manage, and screen hypertension cases. However, this approach relies on completeness and accessibility of documented blood pressure (BP) values. With the large switch to virtual care due to the COVID-19 pandemic, we assessed BP documentation in primary care EMRs during the pandemic, across patient and physician groups. Methods Hypertension-related visits were identified during the pre-pandemic (January 2017 to February 2020) and pandemic (March 2020 to December 2021) periods from a primary care EMR database in Ontario, Canada. Clustered logistic regression models were used to analyze the relationship of physician and patient characteristics with an outcome variable of documented BP. A chart review of 3200 hypertension visits without a BP recorded in structured data fields was conducted to determine if BP was recorded in progress notes. Results Pre-pandemic, 75.7% of hypertension-related visits (113,966 of 150,511) had a BP recorded in structured documentation, but this significantly decreased to 36.4% (26,660 of 73,239) during the pandemic (odds ratio [OR] = 0.18, 95% confidence interval [CI]: 0.18-0.19). For virtual visits, 14.3% (6357 of 44,572) had a documented BP, vs 74.0% (20,056 of 27,089) for in-person visits. Chart review found that 55.9% of hypertension visits had no associated BP in structured documentation, but did have a BP recorded in the progress note. Male providers, compared to female providers, were less likely to record BPs pre-pandemic (OR = 0.45, 95% CI: 0.32-0.63) and during the pandemic, for both virtual visits (OR = 0.48, 95% CI: 0.32-0.71) and in-person visits (OR = 0.46, 95% CI: 0.33-0.64). Conclusions BP documented in primary care EMRs declined during the pandemic, most likely due to high rates of virtual visits impacting hypertension detection and management.
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Affiliation(s)
- Arrani Senthinathan
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wade Thompson
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Women’s College Hospital, Toronto, Ontario, Canada
| | - Zoya Gomes
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michel Kiflen
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela Ortigoza Bonilla
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ellen Stephenson
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Debra Butt
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Scarborough Health Network, Toronto, Ontario, Canada
| | - Braden O’Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jacob A. Udell
- Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada
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Ezeoke OM, Brooks G, Postow MA, Baxi S, Young Kim S, Narang B, Diamond LC. Associations Between Race/Ethnicity, Language, and Enrollment on Cancer Research Studies. Oncologist 2022; 28:131-138. [PMID: 36321912 PMCID: PMC9907053 DOI: 10.1093/oncolo/oyac218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The objective of this study was to determine whether differences in patients' race/ethnicity, preferred language, and other factors were associated with patient enrollment in oncology research studies. PATIENTS AND METHODS We conducted a retrospective cross-sectional analysis of all adults (>18 and ≤90) seen at a large, metropolitan cancer center from 2005 to 2015, examining if enrollment to a research study, varied by race/ethnicity, preferred language, comorbidities, gender, and age. RESULTS A total of 233 604 patients were available for initial analysis. Of these, 93 278 (39.9%) were enrolled in a research protocol (therapeutic and non-therapeutic studies). Patients who self-reported their race/ethnicity as Native, Other, Unknown, or Refuse to Answer were less likely to be enrolled on a study. Patients with one or more comorbidities, and those whose preferred language was English, were more likely to be enrolled on a research study. A logistic regression model showed that, although Non-Hispanic Black patients were more likely to have one or more comorbidities and had a higher proportion of their subset selecting English as their preferred language, they were less likely to be enrolled on a study, than our largest population, Non-Hispanic/White patients. CONCLUSIONS We identified differences in research study enrollment based on preferred language, and within race/ethnicity categories including Native-Populations, Other, Unknown or Refuse to Answer compared to Non-Hispanic/White patients. We also highlighted the lower odds of enrollment among Non-Hispanic/Black patients, in the setting of factors such as comorbidities and English language preference, which were otherwise found to be positive predictors of enrollment. Further investigation is needed to design targeted interventions to reduce disparities in oncology research study enrollment, with particular focus on language diversity.
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Affiliation(s)
- Ogochukwu M Ezeoke
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital, Chicago, IL, USA,College of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary Brooks
- College of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Michael A Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Shrujal Baxi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Soo Young Kim
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bharat Narang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lisa C Diamond
- Corresponding author: Lisa C. Diamond, MD, MPH, Assistant Attending Physician, Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Fl, New York, NY 10017, USA. Tel: +1 646 888 4246;
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Jose A, Zhou C, Baker R, Walker J, Kurek N, O'Donnell RE, Elwing JM, Gerson M. Predictive value of incidental right ventricular abnormalities identified on SPECT for mortality and pulmonary hypertension. J Nucl Cardiol 2022; 29:1903-1914. [PMID: 33851355 PMCID: PMC8043660 DOI: 10.1007/s12350-021-02612-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical significance of incidentally found RV abnormalities on low-risk SPECT studies is not well-defined. The objective of this study was to determine the predictive value of incidental right ventricular (RV) abnormalities identified on single photon emission computed tomography (SPECT) scans for mortality and pulmonary hypertension (PH). METHODS We retrospectively analyzed all low-risk SPECT studies in patients without known coronary artery or pulmonary vascular disease, performed at our institution, from 2007-2020. Adjusted Cox proportional hazards models were used to evaluate the association between incidental RV abnormalities on low-risk SPECT studies and outcomes. RESULTS Of the 4761 patients included in the analysis, mortality events were present in 494, and echocardiographic PH was present in 619. Incidental RV abnormalities on low-risk SPECT studies were significantly and independently associated with all-cause mortality (HR = 1.41, CI [1.07-1.86], P = 0.0152) and echocardiographic PH (HR = 2.06, CI [1.64-2.60], P < 0.0001). CONCLUSIONS These data suggest incidental RV abnormalities found on low-risk SPECT imaging studies are significantly and independently associated with increased mortality and risk of developing echocardiographic PH, and could identify high-risk patients for closer monitoring and additional diagnostic testing.
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Affiliation(s)
- Arun Jose
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, 6352-A, Medical Sciences Building, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
| | - Christine Zhou
- Division of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rachel Baker
- Undergraduate Studies, University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA
| | - Jackson Walker
- Division of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nicholas Kurek
- Division of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert E O'Donnell
- Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean M Elwing
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, 6352-A, Medical Sciences Building, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Myron Gerson
- Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Moon JS, Cannesson M. A Century of Technology in Anesthesia & Analgesia. Anesth Analg 2022; 135:S48-S61. [PMID: 35839833 PMCID: PMC9298489 DOI: 10.1213/ane.0000000000006027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Technological innovation has been closely intertwined with the growth of modern anesthesiology as a medical and scientific discipline. Anesthesia & Analgesia, the longest-running physician anesthesiology journal in the world, has documented key technological developments in the specialty over the past 100 years. What began as a focus on the fundamental tools needed for effective anesthetic delivery has evolved over the century into an increasing emphasis on automation, portability, and machine intelligence to improve the quality, safety, and efficiency of patient care.
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Affiliation(s)
- Jane S Moon
- From the Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
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Li R, Niu Y, Scott SR, Zhou C, Lan L, Liang Z, Li J. Using Electronic Medical Record Data for Research in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 Hospital in Beijing: Cross-sectional Study. JMIR Med Inform 2021; 9:e24405. [PMID: 34342589 PMCID: PMC8371484 DOI: 10.2196/24405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/01/2020] [Accepted: 06/07/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND With the proliferation of electronic medical record (EMR) systems, there is an increasing interest in utilizing EMR data for medical research; yet, there is no quantitative research on EMR data utilization for medical research purposes in China. OBJECTIVE This study aimed to understand how and to what extent EMR data are utilized for medical research purposes in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 hospital in Beijing, China. Obstacles and issues in the utilization of EMR data were also explored to provide a foundation for the improved utilization of such data. METHODS For this descriptive cross-sectional study, cluster sampling from Xuanwu Hospital, one of two Stage 7 hospitals in Beijing, was conducted from 2016 to 2019. The utilization of EMR data was described as the number of requests, the proportion of requesters, and the frequency of requests per capita. Comparisons by year, professional title, and age were conducted by double-sided chi-square tests. RESULTS From 2016 to 2019, EMR data utilization was poor, as the proportion of requesters was 5.8% and the frequency was 0.1 times per person per year. The frequency per capita gradually slowed and older senior-level staff more frequently used EMR data compared with younger staff. CONCLUSIONS The value of using EMR data for research purposes is not well studied in China. More research is needed to quantify to what extent EMR data are utilized across all hospitals in Beijing and how these systems can enhance future studies. The results of this study also suggest that young doctors may be less exposed or have less reason to access such research methods.
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Affiliation(s)
- Rui Li
- Information Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yue Niu
- Statistical Procedure Department, Blueballon (Beijing) Medical Research Co, Ltd, Beijing, China
| | - Sarah Robbins Scott
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chu Zhou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lan Lan
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Beijing, China
| | - Zhigang Liang
- Information Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia Li
- Information Center, Xuanwu Hospital, Capital Medical University, Beijing, China
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Challenges Frequently Encountered in the Secondary Use of Electronic Medical Record Data for Research. Comput Inform Nurs 2020; 38:338-348. [PMID: 32149742 DOI: 10.1097/cin.0000000000000609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The wide adoption of electronic medical records and subsequent availability of large amounts of clinical data provide a rich resource for researchers. However, the secondary use of clinical data for research purposes is not without limitations. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review to identify current issues related to secondary use of electronic medical record data via MEDLINE and CINAHL databases. All articles published until June 2018 were included. Sixty articles remained after title and abstract review, and four domains of potential limitations were identified: (1) data quality issues, present in 91.7% of the articles reviewed; (2) data preprocessing challenges (53.3%); (3) privacy concerns (18.3%); and (4) potential for limited generalizability (21.7%). Researchers must be aware of the limitations inherent to the use of electronic medical record data for research and consider the potential effects of these limitations throughout the entire study process, from initial conceptualization to the identification of adequate sources that can provide data appropriate for answering the research questions, analysis, and reporting study results. Consideration should also be given to using existing data quality assessment frameworks to facilitate use of standardized data quality definitions and further efforts of standard data quality reporting in publications.
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Joseph NT, Worrell NH, Collins J, Schmidt M, Sobers G, Hutchins K, Chahine EB, Faya C, Lewis L, Green VL, Castellano PZ, Lindsay MK. Implementation of a Postpartum Hemorrhage Safety Bundle at an Urban Safety-Net Hospital. AJP Rep 2020; 10:e255-e261. [PMID: 33094014 PMCID: PMC7571554 DOI: 10.1055/s-0040-1714713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/21/2020] [Indexed: 11/05/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is a leading cause of preventable maternal morbidity and mortality. Standardized response to obstetric hemorrhage is associated with significant improvement in maternal outcomes, yet implementation can be challenging. Objective The primary objective is to describe the methodology for program implementation of the Alliance for Innovation on Maternal Health Safety Bundle on PPH at an urban safety-net hospital. Methods Over an 18-month period, interventions geared toward (1) risk assessment and stratification, (2) hemorrhage identification and management, (3) team communication and simulation, and (4) debriefs and case review were implemented. Hemorrhage risk assessment stratification rates were tracked overtime as an early measure of bundle compliance. Results Hemorrhage risk assessment stratification rates improved to >90% during bundle implementation. Conclusion Keys to implementation included multidisciplinary stakeholder commitment, stepwise and iterative approach, and parallel systems for monitoring and evaluation Implementation of a PPH safety bundle is feasible in a resource-constrained setting.
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Affiliation(s)
- Naima T. Joseph
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Janice Collins
- Department of Obstetrics and Gynecology, Morehouse University School of Medicine, Atlanta, Georgia
| | - Melanie Schmidt
- Department of Pharmacy, Grady Health System, Atlanta, Georgia
| | - Grace Sobers
- Department of Nursing, Grady Health System, Atlanta, Georgia
| | | | - E. Britton Chahine
- Division of General Obstetrics and Gynecology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Christine Faya
- Department of Anesthesia, Emory University School of Medicine, Atlanta, Georgia
| | - Luanne Lewis
- Health Information Management, Grady Health System, Atlanta, Georgia
| | - Victoria L. Green
- Division of General Obstetrics and Gynecology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Penny Z. Castellano
- Division of General Obstetrics and Gynecology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Michael K. Lindsay
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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Weiner MG. POINT: Is ICD-10 Diagnosis Coding Important in the Era of Big Data? Yes. Chest 2018; 153:1093-1095. [PMID: 29410203 DOI: 10.1016/j.chest.2018.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/17/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
- Mark G Weiner
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
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