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EGEMS

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https://www.readbyqxmd.com/read/27891528/preparing-nursing-home-data-from-multiple-sites-for-clinical-research-a-case-study-using-observational-health-data-sciences-and-informatics
#1
Richard D Boyce, Steven M Handler, Jordan F Karp, Subashan Perera, Charles F Reynolds
INTRODUCTION: A potential barrier to nursing home research is the limited availability of research quality data in electronic form. We describe a case study of converting electronic health data from five skilled nursing facilities to a research quality longitudinal dataset by means of open-source tools produced by the Observational Health Data Sciences and Informatics (OHDSI) collaborative. METHODS: The Long-Term Care Minimum Data Set (MDS), drug dispensing, and fall incident data from five SNFs were extracted, translated, and loaded into version 4 of the OHDSI common data model...
2016: EGEMS
https://www.readbyqxmd.com/read/27891527/the-multimorbidity-index-a-tool-for-assessing-the-prognosis-of-patients-from-their-history-of-illness
#2
Farrokh Alemi, Cari R Levy, Raya E Kheirbek
BACKGROUND: The Multimorbidity (MM) Index predicts the prognosis of patients from their diagnostic history. In contrast to existing approaches with broad diagnostic categories, it treats each diagnosis as a separate independent variable using individual International Classification of Disease, Revision 9 (ICD-9) codes. OBJECTIVE: This paper describes the MM Index, reviews the published data on its accuracy, and provides procedures for implementing the Index within electronic health record (EHR) systems...
2016: EGEMS
https://www.readbyqxmd.com/read/27891526/comparative-effectiveness-research-using-observational-data-active-comparators-to-emulate-target-trials-with-inactive-comparators
#3
Anders Huitfeldt, Miguel A Hernan, Mette Kalager, James M Robins
INTRODUCTION: Because a comparison of noninitiators and initiators of treatment may be hopelessly confounded, guidelines for the conduct of observational research often recommend using an "active" comparator group consisting of people who initiate a treatment other than the medication of interest. In this paper, we discuss the conditions under which this approach is valid if the goal is to emulate a trial with an inactive comparator. IDENTIFICATION OF EFFECTS: We provide conditions under which a target trial in a subpopulation can be validly emulated from observational data, using an active comparator that is known or believed to be inactive for the outcome of interest...
2016: EGEMS
https://www.readbyqxmd.com/read/27891525/a-validation-study-of-administrative-claims-data-to-measure-ovarian-cancer-recurrence-and-secondary-debulking-surgery
#4
Jennifer Livaudais-Toman, Natalia Egorova, Rebeca Franco, Monica Prasad-Hayes, Elizabeth A Howell, Juan Wisnivesky, Nina A Bickell
OBJECTIVE: Administrative claims data offer an alternative to chart abstraction to assess ovarian cancer recurrence, treatment and outcomes. Such analyses have been hindered by lack of valid recurrence and treatment algorithms. In this study, we sought to develop claims-based algorithms to identify ovarian cancer recurrence and secondary debulking surgery, and to validate them against the gold-standard of chart abstraction. METHODS: We conducted chart validation studies; 2 recurrence algorithms and 1 secondary surgery among 94 ovarian cancer patients treated at one hospital between 2003-2009...
2016: EGEMS
https://www.readbyqxmd.com/read/27713905/a-harmonized-data-quality-assessment-terminology-and-framework-for-the-secondary-use-of-electronic-health-record-data
#5
Michael G Kahn, Tiffany J Callahan, Juliana Barnard, Alan E Bauck, Jeff Brown, Bruce N Davidson, Hossein Estiri, Carsten Goerg, Erin Holve, Steven G Johnson, Siaw-Teng Liaw, Marianne Hamilton-Lopez, Daniella Meeker, Toan C Ong, Patrick Ryan, Ning Shang, Nicole G Weiskopf, Chunhua Weng, Meredith N Zozus, Lisa Schilling
OBJECTIVE: Harmonized data quality (DQ) assessment terms, methods, and reporting practices can establish a common understanding of the strengths and limitations of electronic health record (EHR) data for operational analytics, quality improvement, and research. Existing published DQ terms were harmonized to a comprehensive unified terminology with definitions and examples and organized into a conceptual framework to support a common approach to defining whether EHR data is 'fit' for specific uses...
2016: EGEMS
https://www.readbyqxmd.com/read/27713904/a-synthesis-of-current-surveillance-planning-methods-for-the-sequential-monitoring-of-drug-and-vaccine-adverse-effects-using-electronic-health-care-data
#6
Jennifer C Nelson, Robert Wellman, Onchee Yu, Andrea J Cook, Judith C Maro, Rita Ouellet-Hellstrom, Denise Boudreau, James S Floyd, Susan R Heckbert, Simone Pinheiro, Marsha Reichman, Azadeh Shoaibi
INTRODUCTION: The large-scale assembly of electronic health care data combined with the use of sequential monitoring has made proactive postmarket drug- and vaccine-safety surveillance possible. Although sequential designs have been used extensively in randomized trials, less attention has been given to methods for applying them in observational electronic health care database settings. EXISTING METHODS: We review current sequential-surveillance planning methods from randomized trials, and the Vaccine Safety Datalink (VSD) and Mini-Sentinel Pilot projects-two national observational electronic health care database safety monitoring programs...
2016: EGEMS
https://www.readbyqxmd.com/read/27683671/concordium-2015-strategic-uses-of-evidence-to-transform-delivery-systems
#7
Erin Holve, Samantha Weiss
In September 2015 the EDM Forum hosted AcademyHealth's newest national conference, Concordium. The 11 papers featured in the eGEMs "Concordium 2015" special issue successfully reflect the major themes and issues discussed at the meeting. Many of the papers address informatics or methodological approaches to natural language processing (NLP) or text analysis, which is indicative of the importance of analyzing text data to gain insights into care coordination and patient-centered outcomes. Perspectives on the tools and infrastructure requirements that are needed to build learning health systems were also recurrent themes...
2016: EGEMS
https://www.readbyqxmd.com/read/27683670/introduction-of-an-area-deprivation-index-measuring-patient-socioeconomic-status-in-an-integrated-health-system-implications-for-population-health
#8
Andrew J Knighton, Lucy Savitz, Tom Belnap, Brad Stephenson, James VanDerslice
INTRODUCTION: Intermountain Healthcare is a fully integrated delivery system based in Salt Lake City, Utah. As a learning healthcare system with a mission of performance excellence, it became apparent that population health management and our efforts to move towards shared accountability would require additional patient-centric metrics in order to provide the right care to the right patients at the right time. Several European countries have adopted social deprivation indices in measuring the impact that social determinants can have on health...
2016: EGEMS
https://www.readbyqxmd.com/read/27683669/using-a-patient-portal-to-transmit-patient-reported-health-information-into-the-electronic-record-workflow-implications-and-user-experience
#9
Barbara Sorondo, Amy Allen, Janet Bayleran, Stacy Doore, Samreen Fathima, Iyad Sabbagh, Lori Newcomb
INTRODUCTION: This project implemented an integrated patient self-reported screening tool in a patient portal and assessed clinical workflow and user experience in primary care practices. METHODS: An electronic health risk assessment based on the CMS Annual Wellness Visit (AWV) was developed to integrate self-reported health information into the patient's electronic health record (EHR). Patients enrolled in care coordination tested the implementation. The evaluation plan included quantitative and qualitative measures of patient adoption, provider adoption, workflow impact, financial impact, and technology impact...
2016: EGEMS
https://www.readbyqxmd.com/read/27683668/leadership-perspectives-on-operationalizing-the-learning-health-care-system-in-an-integrated-delivery-system
#10
Wayne Psek, F Daniel Davis, Gloria Gerrity, Rebecca Stametz, Lisa Bailey-Davis, Debra Henninger, Dorothy Sellers, Jonathan Darer
INTRODUCTION: Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders' perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders' perspectives on the LHS and learning activities in an integrated delivery system...
2016: EGEMS
https://www.readbyqxmd.com/read/27683667/v3nlp-framework-tools-to-build-applications-for-extracting-concepts-from-clinical-text
#11
Guy Divita, Marjorie E Carter, Le-Thuy Tran, Doug Redd, Qing T Zeng, Scott Duvall, Matthew H Samore, Adi V Gundlapalli
INTRODUCTION: Substantial amounts of clinically significant information are contained only within the narrative of the clinical notes in electronic medical records. The v3NLP Framework is a set of "best-of-breed" functionalities developed to transform this information into structured data for use in quality improvement, research, population health surveillance, and decision support. BACKGROUND: MetaMap, cTAKES and similar well-known natural language processing (NLP) tools do not have sufficient scalability out of the box...
2016: EGEMS
https://www.readbyqxmd.com/read/27683666/a-focus-group-exploration-of-automated-case-finders-to-identify-high-risk-heart-failure-patients-within-an-urban-safety-net-hospital
#12
Mark E Patterson, Derick Miranda, Greg Schuman, Christopher Eaton, Andrew Smith, Brad Silver
BACKGROUND: Leveraging "big data" as a means of informing cost-effective care holds potential in triaging high-risk heart failure (HF) patients for interventions within hospitals seeking to reduce 30-day readmissions. OBJECTIVE: Explore provider's beliefs and perceptions about using an electronic health record (EHR)-based tool that uses unstructured clinical notes to risk-stratify high-risk heart failure patients. METHODS: Six providers from an inpatient HF clinic within an urban safety net hospital were recruited to participate in a semistructured focus group...
2016: EGEMS
https://www.readbyqxmd.com/read/27683665/framework-for-deploying-a-virtualized-computing-environment-for-collaborative-and-secure-data-analytics
#13
Adrian Meyer, Laura Green, Ciearro Faulk, Stephen Galla, Anne-Marie Meyer
INTRODUCTION: Large amounts of health data generated by a wide range of health care applications across a variety of systems have the potential to offer valuable insight into populations and health care systems, but robust and secure computing and analytic systems are required to leverage this information. FRAMEWORK: We discuss our experiences deploying a Secure Data Analysis Platform (SeDAP), and provide a framework to plan, build and deploy a virtual desktop infrastructure (VDI) to enable innovation, collaboration and operate within academic funding structures...
2016: EGEMS
https://www.readbyqxmd.com/read/27683664/using-machine-learning-and-natural-language-processing-algorithms-to-automate-the-evaluation-of-clinical-decision-support-in-electronic-medical-record-systems
#14
Donald A Szlosek, Jonathan Ferrett
INTRODUCTION: As the number of clinical decision support systems (CDSSs) incorporated into electronic medical records (EMRs) increases, so does the need to evaluate their effectiveness. The use of medical record review and similar manual methods for evaluating decision rules is laborious and inefficient. The authors use machine learning and Natural Language Processing (NLP) algorithms to accurately evaluate a clinical decision support rule through an EMR system, and they compare it against manual evaluation...
2016: EGEMS
https://www.readbyqxmd.com/read/27683663/using-electronic-health-record-data-to-identify-prostate-cancer-patients-that-may-qualify-for-active-surveillance
#15
Andrew J Knighton, Tom Belnap, Kim Brunisholz, Kelly Huynh, Jay T Bishoff
INTRODUCTION: The introduction of the protein-specific antigen (PSA) test in care means that prostate cancer (PCa) is being detected earlier and more frequently. The result of increased screening using PSA, digital rectal examination and awareness of prostate was an increase in the number of men with low risk cancers. Active surveillance has become a viable alternative to immediate treatment with surgery, radiation and other forms of localized treatment. Evidence suggests that there is no significant difference in mortality rates between AS and surgery...
2016: EGEMS
https://www.readbyqxmd.com/read/27668266/an-automated-method-for-identifying-individuals-with-a-lung-nodule-can-be-feasibly-implemented-across-health-systems
#16
Farhood Farjah, Scott Halgrim, Diana S M Buist, Michael K Gould, Steven B Zeliadt, Elizabeth T Loggers, David S Carrell
INTRODUCTION: The incidence of incidentally detected lung nodules is rapidly rising, but little is known about their management or associated patient outcomes. One barrier to studying lung nodule care is the inability to efficiently and reliably identify the cohort of interest (i.e. cases). Investigators at Kaiser Permanente Southern California (KPSC) recently developed an automated method to identify individuals with an incidentally discovered lung nodule, but the feasibility of implementing this method across other health systems is unknown...
2016: EGEMS
https://www.readbyqxmd.com/read/27668265/a-general-framework-for-considering-selection-bias-in-ehr-based-studies-what-data-are-observed-and-why
#17
Sebastien Haneuse, Michael Daniels
Electronic health records (EHR) data are increasingly seen as a resource for cost-effective comparative effectiveness research (CER). Since EHR data are collected primarily for clinical and/or billing purposes, their use for CER requires consideration of numerous methodologic challenges including the potential for confounding bias, due to a lack of randomization, and for selection bias, due to missing data. In contrast to the recent literature on confounding bias in EHR-based CER, virtually no attention has been paid to selection bias possibly due to the belief that standard methods for missing data can be readily-applied...
2016: EGEMS
https://www.readbyqxmd.com/read/27563686/a-framework-to-support-the-sharing-and-reuse-of-computable-phenotype-definitions-across-health-care-delivery-and-clinical-research-applications
#18
Rachel L Richesson, Michelle M Smerek, C Blake Cameron
INTRODUCTION: The ability to reproducibly identify clinically equivalent patient populations is critical to the vision of learning health care systems that implement and evaluate evidence-based treatments. The use of common or semantically equivalent phenotype definitions across research and health care use cases will support this aim. Currently, there is no single consolidated repository for computable phenotype definitions, making it difficult to find all definitions that already exist, and also hindering the sharing of definitions between user groups...
2016: EGEMS
https://www.readbyqxmd.com/read/27563685/what-causes-care-coordination-problems-a-case-for-microanalysis
#19
Wayne Zachary, Russell Charles Maulitz, Drew A Zachary
INTRODUCTION: Care coordination (CC) is an important fulcrum for pursuing a range of health care goals. Current research and policy analyses have focused on aggregated data rather than on understanding what happens within individual cases. At the case level, CC emerges as a complex network of communications among providers over time, crossing and recrossing many organizational boundaries. Micro-level analysis is needed to understand where and how CC fails, as well as to identify best practices and root causes of problems...
2016: EGEMS
https://www.readbyqxmd.com/read/27563684/applying-sequential-analytic-methods-to-self-reported-information-to-anticipate-care-needs
#20
Elizabeth A Bayliss, J David Powers, Jennifer L Ellis, Jennifer C Barrow, MaryJo Strobel, Arne Beck
PURPOSE: Identifying care needs for newly enrolled or newly insured individuals is important under the Affordable Care Act. Systematically collected patient-reported information can potentially identify subgroups with specific care needs prior to service use. METHODS: We conducted a retrospective cohort investigation of 6,047 individuals who completed a 10-question needs assessment upon initial enrollment in Kaiser Permanente Colorado (KPCO), a not-for-profit integrated delivery system, through the Colorado State Individual Exchange...
2016: EGEMS
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