EGEMS

Background: There is scant guidance for defining what denominator to use when estimating disease prevalence via electronic health record (EHR) data. Objectives: Describe the intervals between medical encounters to inform the selection of denominators for population-level disease rates, and evaluate the impact of different denominators on the prevalence of chronic conditions. Methods: We analyzed the EHRs of three practices in Massachusetts using the Electronic medical record Support for Public Health (ESP) system...

Background: Electronic health record (EHR) data can measure cardiovascular health (CVH) of patient populations, but have limited generalizability when derived from one health care system. Objective: We used The Guideline Advantage™ (TGA) data repository, comprising EHR data of patients from 8 diverse health care systems, to describe CVH of adult patients and progress towards the American Heart Association's (AHA's) 2020 Impact Goals. Methods: Our analysis included 203,488 patients with 677,733 encounters recorded in TGA from 2012 to 2015...

Clinical registries are increasingly used as national performance measurement platforms. In 2018, nearly 70 percent of the more than 50 specialty society registries in the United States were used by the Centers for Medicare & Medicaid Services (CMS) to measure the quality of clinical care. Private payers and evaluating organizations also use or desire to use registry information to inform quality improvement programs and value-based payment models. The requirements for an entity to become a CMS Qualified Clinical Data Registry (QCDR) constitute a minimum set of standards for the purpose of reporting to the CMS Quality Payment Program...

Introduction: Faced with growing populations of older, medically complex patients, health systems are now incentivized to deliver cost-effective, high-value care. We evaluated a new method that builds upon existing Medicare spending concentration studies to further segment these expenditures, revealing use patterns to inform care redesign. Methods: We obtained monthly Medicare expenditure data and derived baseline comparison data using typical methods for identifying a yearly high-cost subpopulation...

Purpose: Little is known about how disease risk score (DRS) development should proceed under different pharmacoepidemiologic follow-up strategies. In an analysis of dabigatran vs. warfarin and risk of major bleeding, we compared the results of DRS adjustment when models were developed under "intention-to-treat" (ITT) and "as-treated" (AT) approaches. Methods: We assessed DRS model discrimination, calibration, and ability to induce prognostic balance via the "dry run analysis"...

Context: Integrating electronic health records (EHR) with other sources of administrative data is key to identifying factors affecting the long-term health of traditionally underserved populations, such as individuals involved in the justice system. Linking existing administrative data from multiple sources overcomes many of the limitations of traditional prospective studies of population health, but the linking process assumes high levels of data quality and consistency within administrative data...

Introduction: The symptom burden faced by long-term head and neck cancer survivors is not well understood. In addition, the accuracy of clinical data sources for symptom ascertainment is not clear. Objective: To 1) describe the prevalence of symptoms in 5-year survivors of head and neck cancer, and 2) to evaluate agreement between symptoms obtained via self-report and symptoms obtained from clinical data sources. Methods: We recruited 5-year survivors of head and neck cancer enrolled at Kaiser Permanente Washington (n = 54)...

Background: Since the inception of Accountable Care Organizations (ACOs), many have acknowledged the potential synergy between ACOs and health information technology (IT) in meeting quality and cost goals. Objective: We conducted a systematic review of the literature in order to describe what research has been conducted at the intersection of health IT and ACOs and identify directions for future research. Methods: We identified empirical studies discussing the use of health IT via PubMed search with subsequent snowball reference review...

Background: The goal of this study was to compare the performance of several database algorithms designed to identify red blood cell (RBC) Transfusion Related hospital Admissions (TRAs) in Veterans with end stage renal disease (ESRD). Methods: Hospitalizations in Veterans with ESRD and evidence of dialysis between 01/01/2008 and 12/31/2013 were screened for TRAs using a clinical algorithm (CA) and four variations of claims-based algorithms (CBA 1-4). Criteria were implemented to exclude patients with non-ESRD-related anemia (e...

eGEMs , in close partnership with our key sponsor and publisher, AcademyHealth, has provided a window to the transformational impact of electronic health data (EHD) on how we pursue health and deliver healthcare. This commentary traces key milestones in that journey and announces the next chapter for this community and the critical work it produces.

Objective: To identify factors contributing to changes on quality, productivity, and safety outcomes during a large commercial electronic health record (EHR) implementation and to guide future research. Methods: We conducted a mixed-methods study assessing the impact of a commercial EHR implementation. The method consisted of a quantitative longitudinal evaluation followed by qualitative semi-structured, in-depth interviews with clinical employees from the same implementation...

Introduction: Like most patient-centered medical home (PCMH) models, Oregon's program, the Patient-Centered Primary Care Home (PCPCH), aims to improve care while reducing costs; however, previous work shows that PCMH models do not uniformly achieve desired outcomes. Our objective was to describe a process for refining PCMH models to identify high value elements (HVEs) that reduce cost and utilization. Methods: We performed a targeted literature review of each PCPCH core attribute...

Even though it is well known that quality, safety, and patient-centeredness of health care can be improved, leveraging the organizational apparatus of a care delivery environment to render improvement in a consistent and comprehensive manner has proven difficult. The Health Care Systems Research Network (HCSRN), which began as the HMO Research Network, emerged from a desire to improve health and study problems in health care in a systematic and collaborative way, spurring the delivery of true evidence-informed medicine...

Cancer patients interact with clinicians who are distributed across locations and organizations. This makes it difficult to coordinate care and adds to the burden of cancer care delivery. Failures in care coordination can harm patients. The rapid growth in the number of cancer survivors and the increasing complexity of cancer care has kindled an interest in new care delivery models. Information technology (IT) is an important component of care delivery. While IT can potentially enhance collaborative work among people distributed across locations, organizations and time, the current design and implementation of health IT adds to the human burden and often makes it a part of the problem instead of the solution...

Introduction: In aggregate, existing data quality (DQ) checks are currently represented in heterogeneous formats, making it difficult to compare, categorize, and index checks. This study contributes a data element-function conceptual model to facilitate the categorization and indexing of DQ checks and explores the feasibility of leveraging natural language processing (NLP) for scalable acquisition of knowledge of common data elements and functions from DQ checks narratives. Methods: The model defines a "data element", the primary focus of the check, and a "function", the qualitative or quantitative measure over a data element...

Objective: This study examines the impact of the transition from ICD-9-CM to ICD-10-CM diagnosis coding on the recording of mental health disorders in electronic health records (EHRs) and claims data in ten large health systems. We present rates of these diagnoses across two years spanning the October 2015 transition. Methods: Mental health diagnoses were identified from claims and EHR data at ten health care systems in the Mental Health Research Network (MHRN)...

Background: Tailored care management requires effectively segmenting heterogeneous populations into actionable subgroups. Using patient reported data may help identify groups with care needs not revealed in traditional clinical data. Methods: We conducted retrospective segmentation analyses of 9,617 Kaiser Permanente Colorado members age 65 or older at risk for high utilization due to advanced illness and geriatric issues who had completed a Medicare Health Risk Assessment (HRA) between 2014 and 2017...

BACKGROUND: Appendicitis is a common surgical emergency in children, yet diagnosis can be challenging. An electronic health record (EHR) based, clinical decision support (CDS) system called Appy CDS was designed to help guide management of pediatric patients with acute abdominal pain within the Health Care Systems Research Network (HCSRN). OBJECTIVES: To describe the development and implementation of a clinical decision support tool (Appy CDS) built independently but synergistically at two large HCSRN affiliated health systems using well-established platforms, and to assess the tool's Triage component, aiming to identify pediatric patients at increased risk for appendicitis...

Suicide is a preventable public health problem. Zero Suicide (ZS) is a suicide prevention framework currently being evaluated by Mental Health Research Network investigators embedded in six Health Care Systems Research Network (HCSRN) member health systems implementing ZS. This paper describes ongoing collaboration to develop population-based process improvement metrics for use in, and comparison across, these and other health systems. Robust process improvement metrics are sorely needed by the hundreds of health systems across the country preparing to implement their own best practices in suicide care...

Researchers often use prescribing data from electronic health records (EHR) or dispensing data from medication or medical claims to determine medication utilization. However, neither source has complete information on medication use. We compared antibiotic prescribing and dispensing records for 200,395 patients in the National Patient-Centered Clinical Research Network (PCORnet) Antibiotics and Childhood Growth Study. We stratified analyses by delivery system type [closed integrated (cIDS) and non-cIDS]; 90...