Objective
To evaluate the prevalence of seven social factors using physician notes as compared to claims and structured electronic health records (EHRs) data and the resulting association with 30‐day ...readmissions.
Study Setting
A multihospital academic health system in southeastern Massachusetts.
Study Design
An observational study of 49,319 patients with cardiovascular disease admitted from January 1, 2011, to December 31, 2013, using multivariable logistic regression to adjust for patient characteristics.
Data Collection/Extraction Methods
All‐payer claims, EHR data, and physician notes extracted from a centralized clinical registry.
Principal Findings
All seven social characteristics were identified at the highest rates in physician notes. For example, we identified 14,872 patient admissions with poor social support in physician notes, increasing the prevalence from 0.4 percent using ICD‐9 codes and structured EHR data to 16.0 percent. Compared to an 18.6 percent baseline readmission rate, risk‐adjusted analysis showed higher readmission risk for patients with housing instability (readmission rate 24.5 percent; p < .001), depression (20.6 percent; p < .001), drug abuse (20.2 percent; p = .01), and poor social support (20.0 percent; p = .01).
Conclusions
The seven social risk factors studied are substantially more prevalent than represented in administrative data. Automated methods for analyzing physician notes may enable better identification of patients with social needs.
Imperceptibility, security, capacity, and robustness are among many aspects of image watermarking design. An ideal watermarking system should embed a large amount of information perfectly securely, ...but with no visible degradation to the host image. Many researchers have geared efforts towards developing specific techniques for variant applications. In this paper, we propose an adjustable-purpose, reversible and fragile watermarking scheme for image watermarking by particle swarm optimization (PSO). In general, given any host image and watermark, our scheme can provide an optimal watermarking solution. First, the content of a host image is analyzed to extract significant regions of interest (ROIs) automatically. The remaining regions of non-interest (RONIs) are collated for embedding watermarks by different amounts of bits determined by PSO to achieve optimal watermarking. The parameters can be adjusted relying upon user’s watermarking purposes. Experimental results show that the proposed technique has accomplished higher capacity and higher PSNR (peak signal-to-noise ratio) watermarking.
IMPORTANCE: Realizing the benefits of cancer screening requires testing of eligible individuals and processes to ensure follow-up of abnormal results. OBJECTIVE: To test interventions to improve ...timely follow-up of overdue abnormal breast, cervical, colorectal, and lung cancer screening results. DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, cluster randomized clinical trial conducted at 44 primary care practices within 3 health networks in the US enrolling patients with at least 1 abnormal cancer screening test result not yet followed up between August 24, 2020, and December 13, 2021. INTERVENTION: Automated algorithms developed using data from electronic health records (EHRs) recommended follow-up actions and times for abnormal screening results. Primary care practices were randomized in a 1:1:1:1 ratio to (1) usual care, (2) EHR reminders, (3) EHR reminders and outreach (a patient letter was sent at week 2 and a phone call at week 4), or (4) EHR reminders, outreach, and navigation (a patient letter was sent at week 2 and a navigator outreach phone call at week 4). Patients, physicians, and practices were unblinded to treatment assignment. MAIN OUTCOMES AND MEASURES: The primary outcome was completion of recommended follow-up within 120 days of study enrollment. The secondary outcomes included completion of recommended follow-up within 240 days of enrollment and completion of recommended follow-up within 120 days and 240 days for specific cancer types and levels of risk. RESULTS: Among 11 980 patients (median age, 60 years IQR, 52-69 years; 64.8% were women; 83.3% were White; and 15.4% were insured through Medicaid) with an abnormal cancer screening test result for colorectal cancer (8245 patients 69%), cervical cancer (2596 patients 22%), breast cancer (1005 patients 8%), or lung cancer (134 patients 1%) and abnormal test results categorized as low risk (6082 patients 51%), medium risk (3712 patients 31%), or high risk (2186 patients 18%), the adjusted proportion who completed recommended follow-up within 120 days was 31.4% in the EHR reminders, outreach, and navigation group (n = 3455), 31.0% in the EHR reminders and outreach group (n = 2569), 22.7% in the EHR reminders group (n = 3254), and 22.9% in the usual care group (n = 2702) (adjusted absolute difference for comparison of EHR reminders, outreach, and navigation group vs usual care, 8.5% 95% CI, 4.8%-12.0%, P < .001). The secondary outcomes showed similar results for completion of recommended follow-up within 240 days and by subgroups for cancer type and level of risk for the abnormal screening result. CONCLUSIONS AND RELEVANCE: A multilevel primary care intervention that included EHR reminders and patient outreach with or without patient navigation improved timely follow-up of overdue abnormal cancer screening test results for breast, cervical, colorectal, and lung cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03979495
To develop a comprehensive value set for documenting and encoding adverse reactions in the allergy module of an electronic health record.
We analyzed 2 471 004 adverse reactions stored in Partners ...Healthcare's Enterprise-wide Allergy Repository (PEAR) of 2.7 million patients. Using the Medical Text Extraction, Reasoning, and Mapping System, we processed both structured and free-text reaction entries and mapped them to Systematized Nomenclature of Medicine - Clinical Terms. We calculated the frequencies of reaction concepts, including rare, severe, and hypersensitivity reactions. We compared PEAR concepts to a Federal Health Information Modeling and Standards value set and University of Nebraska Medical Center data, and then created an integrated value set.
We identified 787 reaction concepts in PEAR. Frequently reported reactions included: rash (14.0%), hives (8.2%), gastrointestinal irritation (5.5%), itching (3.2%), and anaphylaxis (2.5%). We identified an additional 320 concepts from Federal Health Information Modeling and Standards and the University of Nebraska Medical Center to resolve gaps due to missing and partial matches when comparing these external resources to PEAR. This yielded 1106 concepts in our final integrated value set. The presence of rare, severe, and hypersensitivity reactions was limited in both external datasets. Hypersensitivity reactions represented roughly 20% of the reactions within our data.
We developed a value set for encoding adverse reactions using a large dataset from one health system, enriched by reactions from 2 large external resources. This integrated value set includes clinically important severe and hypersensitivity reactions.
This work contributes a value set, harmonized with existing data, to improve the consistency and accuracy of reaction documentation in electronic health records, providing the necessary building blocks for more intelligent clinical decision support for allergies and adverse reactions.
The purpose of this study was to demonstrate nursing documentation variation based on electronic health record design and its relationship with different levels of care by reviewing how various ...flowsheet measures, within the same electronic health record across an integrated healthcare system, are documented in different types of medical facilities. Flowsheet data with information on patients who were admitted to academic medical centers, community hospitals, and rehabilitation centers were used to calculate the frequency of flowsheet entries documented. We then compared the distinct flowsheet measures documented in five flowsheet templates across the different facilities. We observed that each type of healthcare facility appeared to have distinct clinical care foci and flowsheet measures documented differed within the same template based on facility type. Designing flowsheets tailored to study settings can meet the needs of end users and increase documentation efficiency by reducing time spent on unrelated flowsheet measures. Furthermore, this process can save nurses time for direct patient care.
Food entries in a large allergy data repository Plasek, Joseph M; Goss, Foster R; Lai, Kenneth H ...
Journal of the American Medical Informatics Association : JAMIA,
04/2016, Letnik:
23, Številka:
e1
Journal Article
Recenzirano
Odprti dostop
Objective Accurate food adverse sensitivity documentation in electronic health records (EHRs) is crucial to patient safety. This study examined, encoded, and grouped foods that caused any adverse ...sensitivity in a large allergy repository using natural language processing and standard terminologies.
Methods Using the Medical Text Extraction, Reasoning, and Mapping System (MTERMS), we processed both structured and free-text entries stored in an enterprise-wide allergy repository (Partners’ Enterprise-wide Allergy Repository), normalized diverse food allergen terms into concepts, and encoded these concepts using the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) and Unique Ingredient Identifiers (UNII) terminologies. Concept coverage also was assessed for these two terminologies. We further categorized allergen concepts into groups and calculated the frequencies of these concepts by group. Finally, we conducted an external validation of MTERMS’s performance when identifying food allergen terms, using a randomized sample from a different institution.
Results We identified 158 552 food allergen records (2140 unique terms) in the Partners repository, corresponding to 672 food allergen concepts. High-frequency groups included shellfish (19.3%), fruits or vegetables (18.4%), dairy (9.0%), peanuts (8.5%), tree nuts (8.5%), eggs (6.0%), grains (5.1%), and additives (4.7%). Ambiguous, generic concepts such as “nuts” and “seafood” accounted for 8.8% of the records. SNOMED-CT covered more concepts than UNII in terms of exact (81.7% vs 68.0%) and partial (14.3% vs 9.7%) matches.
Discussion Adverse sensitivities to food are diverse, and existing standard terminologies have gaps in their coverage of the breadth of allergy concepts.
Conclusion New strategies are needed to represent and standardize food adverse sensitivity concepts, to improve documentation in EHRs.
Rationale Non-steroidal anti-inflammatory drugs (NSAIDs) are a common cause of adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs).
Maintaining continuity of care (CoC) in the inpatient setting is dependent on aligning goals and tasks with the plan of care (POC) during multidisciplinary rounds (MDRs). A number of locally ...developed rounding tools exist, yet there is a lack of standard content and functional specifications for electronic tools to support MDRs within and across settings.
To identify content and functional requirements for an MDR tool to support CoC.
We collected discrete clinical data elements (CDEs) discussed during rounds for 128 acute and critical care patients. To capture CDEs, we developed and validated an iPad-based observational tool based on informatics CoC standards. We observed 19 days of rounds and conducted eight group and individual interviews. Descriptive and bivariate statistics and network visualization were conducted to understand associations between CDEs discussed during rounds with a particular focus on the POC. Qualitative data were thematically analyzed. All analyses were triangulated.
We identified the need for universal and configurable MDR tool views across settings and users and the provision of messaging capability. Eleven empirically derived universal CDEs were identified, including four POC CDEs: problems, plan, goals, and short-term concerns. Configurable POC CDEs were: rationale, tasks/'to dos', pending results and procedures, discharge planning, patient preferences, need for urgent review, prognosis, and advice/guidance.
Some requirements differed between settings; yet, there was overlap between POC CDEs.
We recommend an initial list of 11 universal CDEs for continuity in MDRs across settings and 27 CDEs that can be configured to meet setting-specific needs.
Sexual and gender minority older adults receive less social support than does the general population, leading to reliance on long-term care services. On May 24, 2019, Taiwan became the first country ...in Asia to legalise same-sex marriage. Sexual and gender minority older adults are becoming more visible in Taiwanese society. However, healthcare providers' behaviour and intention to offer culturally competent care to sexual and gender minority older adults and factors affecting their behaviour and intention in Asian culture remain unclear.
This study determined factors associated with healthcare providers' behaviour and intention to offer culturally competent care to Taiwanese sexual and gender minority older adults and identified related training requirements.
A qualitative descriptive study was conducted.
This study recruited participants from 14 lesbian, gay, bisexual, and transgender organisations; long-term care facilities; and community healthcare centres. This study was approved by the Research Ethics Committee of National Taiwan University Hospital (Ref. 201811049RIND).
A total of 25 providers were interviewed: 12 nurses, 10 social workers, and 3 staff members from lesbian, gay, bisexual, and transgender organisations.
Semistructured interviews were conducted between May 2019 and September 2019. Interview data were analysed using the socio-ecological model and the constant comparative technique.
Factors associated with the providers' behaviour and intention to offer culturally competent care to sexual and gender minority older adults were categorised by the socio-ecological model level: 1) intrapersonal factors, namely providers' attitudes towards sexual and gender minority older adults, knowledge regarding sexual and gender minority populations, and experiences of providing care for sexual and gender minority older adults; 2) interpersonal factors, namely providers' concerns regarding interactions among staff, sexual and gender minority older adults, nonsexual and gender minority residents, and nonsexual and gender minority residents' families; 3) community factors, namely resources, training courses, and support from managers and organisations; and 4) societal factors, namely social environment and policies.
This study identified multilevel factors associated with the providers' cultural competence in caring for sexual and gender minority older adults in Taiwan. These factors may lead to disparities in quality of life and health for sexual and gender minority older adults. Recommendations to address multilevel barriers to reduce health disparities and improving quality of life in sexual and gender minority older adults have been provided.
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