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Quality of the electronic medical record

Tiba Delespierre, Loic Josseran
BACKGROUND: New nursing homes (NH) data warehouses fed from residents' medical records allow monitoring the health of elderly population on a daily basis. Elsewhere, syndromic surveillance has already shown that professional data can be used for public health (PH) surveillance but not during a long-term follow-up of the same cohort. OBJECTIVE: This study aimed to build and assess a national ecological NH PH surveillance system (SS). METHODS: Using a national network of 126 NH, we built a residents' cohort, extracted medical and personal data from their electronic health records, and transmitted them through the internet to a national server almost in real time...
December 13, 2018: JMIR Public Health and Surveillance
Nicole R Fowler, Mara A Schonberg, Greg A Sachs, Peter H Schwartz, Sujuan Gao, Kathleen A Lane, Lev Inger, Alexia M Torke
BACKGROUND: Alzheimer's disease and related dementias (ADRD) impact a woman's life expectancy and her ability to participate in medical decision-making about breast cancer screening, necessitating the involvement of family caregivers. Making decisions about mammography screening for women with ADRD is stressful. There are no data that suggest that breast cancer screening helps women with ADRD live longer or better. Decision aids may improve the quality of decision-making about mammography for ADRD patients and may inform family caregivers about the risks, benefits, and need for decision-making around mammography screening...
December 12, 2018: Trials
Rachel Rosenblum, Ran Huo, Bethann Scarborough, Nathan Goldstein, Cardinale B Smith
PURPOSE: The Quality Oncology Practice Initiative (QOPI) is a quality measurement and improvement program designed to assess practice performance for various consensus-based and evidence-based measures. In this study, we evaluated differences in QOPI metrics met among patients with advanced solid cancer receiving routine oncologic care alone (routine care) compared with patients receiving integrated oncology and specialty-level palliative care (supportive care). METHODS: We conducted a retrospective chart review of 100 randomly selected patients treated between June 2013 and June 2015 from our supportive care group and matched these patients to 100 routine care group patients on the basis of tumor type and initial oncology visit date...
December 2018: Journal of Oncology Practice
Nader Najafi, Russ Cucina, Bruce Pierre, Raman Khanna
Importance: Physicians frequently use cardiac monitoring, or telemetry, beyond the duration recommended by published practice standards, resulting in "alarm fatigue" and excess cost. Prior studies have demonstrated an association between multicomponent quality improvement interventions and safe reduction of telemetry duration. Objective: To determine if a single-component intervention, a targeted electronic health record (EHR) alert, could achieve similar gains to multicomponent interventions and safely reduce unnecessary monitoring...
December 10, 2018: JAMA Internal Medicine
Daisy J M Ermers, Karin J H van Bussel, Marieke Perry, Yvonne Engels, Henk J Schers
Background: Advance care planning (ACP) is a crucial element of palliative care. It improves the quality of end-of-life care and reduces aggressive and needless life-prolonging medical interventions. However, little is known about its application in daily practice. This study aims to examine the application of ACP for patients with cancer in general practice. Methods: We performed a retrospective cohort study in 11 general practices in the Netherlands. Electronic patient records (EPRs) of deceased patients with colorectal or lung cancer were analysed...
December 10, 2018: Family Practice
Abby V Winterberg, Lili Ding, Lauren M Hill, Bobbie L Stubbeman, Anna M Varughese
BACKGROUND: Anxiety and distress behaviors during anesthesia induction are associated with negative postoperative outcomes for pediatric patients. Documenting behavioral responses to induction is useful to evaluate induction quality at hospitals and to optimize future anesthetics for returning patients, but we lack a simple tool for clinical documentation. The Induction Compliance Checklist is a tool for grading induction behaviors that is well validated for research purposes, but it is not practical for routine documentation in busy clinical practice settings...
December 7, 2018: Anesthesia and Analgesia
Jason K Wagner, Ellen Dillavou, Uttara Nag, Adham Abou Ali, Sandra Truong, Rabih Chaer, Eric Hager, Theodore Yuo, Michel Makaroun, Efthymios D Avgerinos
BACKGROUND: No independent comparisons, with midterm follow-up, of standard arteriovenous grafts (SAVGs) and immediate-access arteriovenous grafts (IAAVGs) exist. The goal of this study was to compare "real-world" performance of SAVGs and IAAVGs. METHODS: Consecutive patients who underwent placement of a hemodialysis graft between November 2014 and April 2016 were retrospectively identified from the electronic medical record and Vascular Quality Initiative database at two tertiary centers...
October 24, 2018: Journal of Vascular Surgery
Margaret L Halladay, Julie A Thompson, Charles A Vacchiano
PURPOSE: Anesthesia to postanesthesia care unit (PACU) handoffs are often incomplete, imprecise, and highly variable with respect to information transfer, and therefore can jeopardize patient safety. A standardized anesthesia to PACU electronic medical record (EMR)-based patient handoff checklist was implemented and evaluated for its effect on the information transfer. DESIGN: An observational preimplementation and postimplementation design was used. METHODS: Assessment of the completeness and accuracy of information transfer during the PACU handoff was performed for a convenience samples of 100 patients preimplementation, 3 weeks postimplementation, and 3 months postimplementation...
December 5, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Ashley N Marshall, Alison R Snyder Valier, Aubrey Yand, Kenneth C Lam
CONTEXT: There has been an increased interest in understanding how ankle injuries impact patient outcomes, however, it is unknown how the severity of a previous ankle injury influences health-related quality of life (HRQOL). OBJECTIVE: To determine the impact of a previous ankle injury on current HRQOL in collegiate athletes. DESIGN: Retrospective review of electronic medical records. SETTING: Athletic training clinics...
December 11, 2018: Journal of Sport Rehabilitation
Shrujal S Baxi, Ranjit Sukhu, Elizabeth Fortier, Kevin Oeffinger, Stacie Corcoran, Andrew Salner, Andrew J Vickers, Mary S McCabe, Talya Salz
PURPOSE: Although the provision of a treatment summary (TS) is a quality indicator in oncology, routine delivery of TSs remains challenging. Automatic TS generation could facilitate use, but data on accuracy are lacking in complex cancers such as head and neck cancer (HNC). We developed and evaluated an electronic platform to automate TS generation for HNC. METHODS: The algorithms autopopulated TSs using data from billing records and an institutional cancer registry...
December 3, 2018: Journal of Oncology Practice
Max T Wayne, Thomas S Valley, Colin R Cooke, Michael W Sjoding
BACKGROUND: The acute respiratory distress syndrome (ARDS) results in substantial mortality but remains underdiagnosed in clinical practice. Automated ARDS "sniffer" systems, tools that can automatically analyze electronic medical record data, have been developed to improve recognition of ARDS in clinical practice. OBJECTIVE: To perform a systematic review examining the evidence underlying automated sniffer systems for ARDS detection. DATA SOURCES: MEDLINE and Scopus databases through October 2018 to identify studies of tools using routinely available clinical data to detect patients with ARDS...
December 6, 2018: Annals of the American Thoracic Society
Louise Purtell, P Marcin Sowa, Ilse Berquier, Carla Scuderi, Carol Douglas, Bernadette Taylor, Katrina Kramer, Wendy Hoy, Helen Healy, Ann Bonner
OBJECTIVES: For many people with advanced kidney disease, their physical, psychological and emotional needs remain unmet. Kidney supportive care, fully integrating specialist kidney and palliative care teams, responds to the emotional and symptom distress in this cohort who may be on a non-dialysis care pathway or on dialysis and approaching end of life. We aimed to analyse and describe the operation and patient characteristics of a new kidney supportive care programme (KSCp). METHODS: A multidisciplinary KSCp was introduced through a tertiary hospital in Brisbane, Australia...
December 4, 2018: BMJ Supportive & Palliative Care
Andrée-Anne Paré-Plante, Antoine Boivin, Djamal Berbiche, Mylaine Breton, Maryse Guay
BACKGROUND: First-contact accessibility remains an important problem in Canada, with this indicator staying the worst of all Organization for Economic Co-operation and Development countries. In the province of Quebec, a number of primary healthcare (PHC) organizations have adopted measures to improve access (e.g. advance access scheduling, expanded nursing role, electronic medical record, financial incentives). The impact of those changes is unknown. The goal of this study is to assess which PHC organizations' characteristics are associated with improved first-contact accessibility...
December 3, 2018: BMC Family Practice
Devon K Check, Marilyn L Kwan, Neetu Chawla, Stacie B Dusetzina, Emily Valice, Isaac J Ergas, Janise M Roh, Tatjana Kolevska, Donald L Rosenstein, Lawrence H Kushi
CONTEXT: Patients with cancer commonly experience depression. If not addressed, depression can lead to reduced quality of life and survival. OBJECTIVE: Given the introduction of national initiatives to improve management of psychiatric symptoms among patients with cancer, we examined patterns of depression detection and treatment over time, and with respect to patient characteristics. METHODS: This cross-sectional study linked data from the Pathways Study, a prospective cohort study of women diagnosed with breast cancer at Kaiser Permanente Northern California (KPNC) between 2005-2013, with data from KPNC's electronic medical record...
November 30, 2018: Journal of Pain and Symptom Management
Daniel J Morgan, Sanket S Dhruva, Eric R Coon, Scott M Wright, Deborah Korenstein
Importance: Overuse of medical care is a well-recognized problem in health care, associated with patient harm and costs. We sought to identify and highlight original research articles published in 2017 that are most relevant to understanding medical overuse. Observations: A structured review of English-language articles published in 2017 was performed, coupled with examination of tables of contents of high-impact journals to identify articles related to medical overuse in adult care...
December 3, 2018: JAMA Internal Medicine
Jason P Van Batavia, Dana A Weiss, Christopher J Long, Julian Madison, Gus McCarthy, Natalie Plachter, Stephen A Zderic
PURPOSE: The era of the electronic health record (EHR) generates the ability to systematically collect and record innumerable data for complex procedures such as videourodynamic studies (VUDS). We developed a Structured Data Entry System (SDES) that would serve as a way to better standardize VUDS for both quality improvement and research capabilities. METHODS: A working group convened to design a SDES form for VUDS in a flow sheet format in our hospital's EHR, allowing for easy integration of the information into the clinical encounter note and for weekly export of data to clinicians in spreadsheet form...
November 19, 2018: Journal of Pediatric Rehabilitation Medicine
Erin Sarzynski, Mark Ensberg, Amy Parkinson, Laurie Fitzpatrick, Laura Houdeshell, Charles Given, Kevin Brooks
Despite patient safety initiatives to improve care transitions, prior research largely neglects to elicit feedback from home health nurses regarding health information exchange. The goal of this quality improvement study was to identify opportunities to facilitate information transfer during hospital-to-home-health-care transitions for older adults with heart failure. We conducted focus groups with 19 nurses employed by a single healthcare system using two commercially available electronic health record (EHR) vendors...
November 28, 2018: Geriatric Nursing
Angelina Prima Kurniati, Eric Rojas, David Hogg, Geoff Hall, Owen A Johnson
There is a growing body of literature on process mining in healthcare. Process mining of electronic health record systems could give benefit into better understanding of the actual processes happened in the patient treatment, from the event log of the hospital information system. Researchers report issues of data access approval, anonymisation constraints, and data quality. One solution to progress methodology development is to use a high-quality, freely available research dataset such as Medical Information Mart for Intensive Care III, a critical care database which contains the records of 46,520 intensive care unit patients over 12 years...
November 29, 2018: Health Informatics Journal
Phuong T Hoang, Dominic Hodgkin, John P Thomas, Grant Ritter, Jon Chilingerian
RATIONALE AND OBJECTIVE: To evaluate the relationship between receipt of annual physicals and the receipt of provider recommendation for preventive services, during a period when Medicare did not cover annual physicals (before 2011). METHODS: Electronic medical records of patients aged 65 years and older from a US health care system were extracted for the 2001 to 2007 period. A fixed-effects logistic model was used to assess the relationship between receipt of periodic health examination (PHE) and receipt of provider recommendation for mammogram screening for 6466 female Medicare beneficiaries...
November 29, 2018: Journal of Evaluation in Clinical Practice
DeAngelo McKinley, Pamela Moye-Dickerson, Shondria Davis, Ayman Akil
Heart failure (HF) is responsible for more 30-day readmissions than any other condition. Minorities, particularly African American males (AAM), are at much higher risk for readmission than the general population. In this study, demographic, social, and clinical data were collected from the electronic medical records of 132 AAM patients (control and intervention) admitted with a primary or secondary admission diagnosis of HF. Both groups received guideline-directed therapy for HF. Additionally the intervention group received a pharmacist-led intervention...
November 28, 2018: American Journal of Men's Health
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