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Tang W, Smith J, Dakkak J, Balasubramanian A, Seth B, Leotta C, Mathai SC, McCormack MC, Acharya S, Calypso A, Danoff SK. Decoding oxygen prescriptions: electronic health record documentation versus patient-reported use. BMC Pulm Med 2024; 24:491. [PMID: 39379926 PMCID: PMC11460145 DOI: 10.1186/s12890-024-03248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 08/28/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Long term oxygen therapy (LTOT) is prescribed for hypoxemia in pulmonary disease. Like other medical therapies, LTOT requires a prescription documenting the dosage (flow rate) and directions (at rest, with activity) which goes to a supplier. Communication with patients regarding oxygen prescription (flow rate, frequency, directions), monitoring (pulse oximetry) and dosage adjustment (oxygen titration) differs in comparison with medication prescriptions. We examined the communication of oxygen management plans in the electronic health record (EHR), and their consistency with patient-reported LTOT use. STUDY DESIGN AND METHODS A cross-sectional study was conducted in 71 adults with chronic lung disease on LTOT. Physician communication regarding oxygen management was obtained from the EHR. Participants were interviewed on their LTOT management plan. The information from each source was compared. RESULTS The study population was, on average, 64 years, two-thirds women, and most used oxygen for over 3 years. Only 45% of both at-rest and with-activity oxygen prescriptions were documented in the Electronic Health Record (EHR). Less than 20% of prescriptions were relayed to the patient in the after-visit summary. Of those with EHR-documented oxygen prescriptions, 44% of patients adhered to prescribed oxygen flow rates. Nearly all patients used a pulse oximeter (96%). INTERPRETATION We identified significant gaps in communication of oxygen management plans from provider to patient. Even when the oxygen prescription was clearly documented, there were differences in patient-reported oxygen management. Critical gaps in oxygen therapy result from the lack of consistent documentation of oxygen prescriptions in the EHR and patient-facing documents. Addressing these issues systematically may improve home oxygen management.
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Affiliation(s)
- Wilson Tang
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - J Smith
- The Johns Hopkins University, Baltimore, MD, USA
| | - J Dakkak
- The Johns Hopkins University, Baltimore, MD, USA
| | | | - B Seth
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Leotta
- The Johns Hopkins University, Baltimore, MD, USA
| | - S C Mathai
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M C McCormack
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Acharya
- The Johns Hopkins University, Baltimore, MD, USA
| | - A Calypso
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S K Danoff
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Zaeh SE, Case M, Au DH, DaSilva M, Deitemeyer K, DeLisa J, Feemster LC, Gerald LB, Krishnan JA, Sculley J, Woodruff A, Eakin MN. Clinical Practices Surrounding the Prescription of Home Oxygen in Patients With COPD and Desaturation. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:343-354. [PMID: 37433062 PMCID: PMC10699490 DOI: 10.15326/jcopdf.2023.0402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/13/2023]
Abstract
Purpose While home oxygen therapy increases survival in patients with chronic obstructive pulmonary disease (COPD) who have severe resting hypoxemia, recent evidence suggests that there is no survival benefit of home oxygen for patients with COPD who have isolated exertional desaturation. We aimed to understand clinician practice patterns surrounding the prescription of home oxygen for patients with COPD. Methods We conducted semi-structured qualitative interviews via videoconference with 15 physicians and 3 nurse practitioners who provide care for patients with COPD. Clinicians were recruited through the American Lung Association Airways Clinical Research Centers. Interview guides were created with the assistance of patient investigators and included questions regarding clinician practices surrounding the prescription of oxygen for patients with COPD and the use of clinical guidelines. Interviews were recorded, transcribed, and coded for themes. Results Of the 18 clinician interviewees, one-third were women, with most participants (n=11) being < 50 years old. Results of the semi-structured interviews suggested research evidence, clinical experience, and patient preferences contributed to clinician decision-making. Most clinicians described a shared decision-making process for prescribing home oxygen for patients, including discussion of risks and benefits, and developing an understanding of patient values and preferences. Clinicians did not use a structured tool to conduct these conversations. Conclusions Clinicians consider a number of patient and clinical factors when prescribing home oxygen therapy, often using a shared decision-making process. Tools to support shared decision-making about the use of home oxygen are needed.
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Affiliation(s)
- Sandra E. Zaeh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Meredith Case
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - David H. Au
- Veterans Affairs Puget Sound Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States
| | - Michele DaSilva
- Patient Advisory Board, American Lung Association, Chicago, Illinois, United States
| | - Karen Deitemeyer
- Patient Advisory Board, American Lung Association, Chicago, Illinois, United States
| | - Julie DeLisa
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
| | - Laura C. Feemster
- Veterans Affairs Puget Sound Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States
| | - Lynn B. Gerald
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
- Office of Population Health Sciences, University of Illinois-Chicago, Chicago, Illinois, United States
| | - Jerry A. Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
- Office of Population Health Sciences, University of Illinois-Chicago, Chicago, Illinois, United States
| | - Jennifer Sculley
- Office of Population Health Sciences, University of Illinois-Chicago, Chicago, Illinois, United States
| | - Annette Woodruff
- Patient Advisory Board, American Lung Association, Chicago, Illinois, United States
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
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Mador MJ. Identifying an Important Ingredient for Safe Discharge to Home Oxygen Therapy: The Respiratory Therapist and the RIsOTTO Study. Respir Care 2021; 66:347-348. [PMID: 33514661 PMCID: PMC9994234 DOI: 10.4187/respcare.08832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M Jeffery Mador
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of BuffaloBuffalo, New York
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Tan AYM, Vines DL, Krishnan JA, Prieto-Centurion V, Kallstrom TJ. Home Oxygen Evaluation by Respiratory Therapists in Patients Hospitalized for COPD Exacerbations: The RIsOTTO Study. Respir Care 2021; 66:183-190. [PMID: 32759371 PMCID: PMC9994231 DOI: 10.4187/respcare.07628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The majority of prescriptions for supplemental oxygen are written when patients are discharged to home from the hospital and the evaluation of these patients is inconsistent. Respiratory Therapists receive training in the evaluation and management of patients needing oxygen. The primary goal of the study was to estimate the frequency with which respiratory therapists (RTs) evaluate the need for home oxygen in patients hospitalized for COPD exacerbations before discharge. METHODS An online questionnaire was distributed to RTs in the United States by the American Association for Respiratory Care. RTs were asked to indicate how frequently they evaluate the need for home oxygen on an ordinal scale: Never, Rarely/occasionally, Sometimes, Most of the time, Almost every time, or Every time. Consistent evaluation for home oxygen was defined as performing an evaluation for home oxygen therapy Almost every time or Every time (ie, > 75% of the time). Bivariate and multivariable analyses were assessed using the Fisher exact test and logistic regression models. RESULTS Of 611 respondents, 490 were eligible for analysis. Fifty-eight percent of RTs reported consistently evaluating patients for home oxygen at rest, whereas 43% reported doing so during activity and 14% during sleep. Consistent evaluation for home oxygen requirements at rest was significantly associated with more years of practice (P = .03; highest among RTs with ≥ 30 y of practice at 40%), region of practice (P = .001; highest in the Midwest at 44%), and greater familiarity with criteria for home oxygen (P < .001; highest among RTs who selected Very familiar with guidelines from the Centers for Medicare and Medicaid Services at 58%). Practice in the Midwest and greater familiarity with criteria for home oxygen was associated with consistent evaluation for home oxygen during activity. Practice in the Midwest (vs Northeast; adjusted odds ratio 2.56, P < .001) and being very familiar with home oxygen criteria (vs not at all familiar; adjusted odds ratio 5.66, P < .001) were independently associated with a higher odds of evaluating for home oxygen at rest and with activity. Only 25% of RTs were involved in making decisions about home oxygen equipment. CONCLUSIONS RTs do not consistently evaluate patients hospitalized for COPD exacerbations for home oxygen prior to discharge, and only a minority of RTs are involved in selecting home oxygen equipment.
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Affiliation(s)
- Ai-Yui M Tan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, Illinois.
| | - David L Vines
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, Illinois
- Population Health Sciences Program, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Valentin Prieto-Centurion
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, Illinois
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Clustering datasets with demographics and diagnosis codes. J Biomed Inform 2020; 102:103360. [PMID: 31904428 DOI: 10.1016/j.jbi.2019.103360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/30/2019] [Accepted: 12/16/2019] [Indexed: 11/21/2022]
Abstract
Clustering data derived from Electronic Health Record (EHR) systems is important to discover relationships between the clinical profiles of patients and as a preprocessing step for analysis tasks, such as classification. However, the heterogeneity of these data makes the application of existing clustering methods difficult and calls for new clustering approaches. In this paper, we propose the first approach for clustering a dataset in which each record contains a patient's values in demographic attributes and their set of diagnosis codes. Our approach represents the dataset in a binary form in which the features are selected demographic values, as well as combinations (patterns) of frequent and correlated diagnosis codes. This representation enables measuring similarity between records using cosine similarity, an effective measure for binary-represented data, and finding compact, well-separated clusters through hierarchical clustering. Our experiments using two publicly available EHR datasets, comprised of over 26,000 and 52,000 records, demonstrate that our approach is able to construct clusters with correlated demographics and diagnosis codes, and that it is efficient and scalable.
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Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2019; 15:1369-1381. [PMID: 30499721 DOI: 10.1513/annalsats.201809-627ws] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
More than 1.5 million adults in the United States use supplemental oxygen for a variety of respiratory disorders to improve their quality of life and prolong survival. This document describes recommendations from a multidisciplinary workshop convened at the ATS International Conference in 2017 with the goal of optimizing home oxygen therapy for adults. Ideal supplemental oxygen therapy is patient-specific, provided by a qualified clinician, includes an individualized prescription and therapeutic education program, and offers oxygen systems that are safe, promote mobility, and treat hypoxemia. Recently, patients and clinicians report a growing number of problems with home oxygen in the United States. Oxygen users experience significant functional, mechanical, and financial problems and a lack of education related to their oxygen equipment-problems that impact their quality of life. Health care providers report a lack of readily accessible resources needed to prescribe oxygen systems correctly and efficiently. Patients with certain lung diseases are affected more than others because of physically unmanageable or inadequate portable systems. Analysis is needed to quantify the unintended impact that the Centers for Medicare and Medicaid Services Competitive Bidding Program has had on patients receiving supplemental oxygen from durable medical equipment providers. Studies using effectiveness and implementation research designs are needed to develop and evaluate new models for patient education, identify effective ways for stakeholders to interface, determine the economic benefit of having respiratory therapists perform in-home education and follow-up testing, and collaborate with technology companies to improve portable oxygen devices. Generation of additional evidence of the benefit of supplemental oxygen across the spectrum of advanced lung diseases and the development of clinical practice guidelines should both be prioritized.
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Lacasse Y, Tan AYM, Maltais F, Krishnan JA. Home Oxygen in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 197:1254-1264. [PMID: 29547003 DOI: 10.1164/rccm.201802-0382ci] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Two landmark trials conducted more than 35 years ago provided scientific evidence that, under very specific circumstances, long-term oxygen therapy (LTOT) may prolong life. These two trials enrolled 290 patients with chronic obstructive pulmonary disease and severe daytime hypoxemia documented by direct arterial blood gas measurement. From that time, LTOT became a standard of care, and the indications for oxygen therapy expanded to include nocturnal oxygen therapy for isolated nocturnal oxygen desaturation, ambulatory oxygen to correct exercise-induced desaturation, and short-burst oxygen to relieve dyspnea. In most cases, the rationale for broadening the indications for oxygen therapy is that, if hypoxemia exists, correcting it by increasing the FiO2 should help. However, with the exception of LTOT in severely hypoxemic patients with chronic obstructive pulmonary disease, randomized controlled trials of oxygen therapy have failed to demonstrate clinically significant benefits. Also, adherence to LTOT is usually suboptimal. Important areas for future research include improving understanding of the mechanisms of action of supplemental oxygen, the clinical and biochemical predictors of responsiveness to LTOT, the methods for measuring and enhancing adherence to LTOT, and the cost-effectiveness of oxygen therapy. A standardization of terminology to describe the use of supplemental oxygen at home is provided.
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Affiliation(s)
- Yves Lacasse
- 1 Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada; and
| | - Ai-Yui M Tan
- 2 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - François Maltais
- 1 Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada; and
| | - Jerry A Krishnan
- 2 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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