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Casal-Guisande M, Comesaña-Campos A, Núñez-Fernández M, Torres-Durán M, Fernández-Villar A. Proposal and Definition of an Intelligent Clinical Decision Support System Applied to the Prediction of Dyspnea after 12 Months of an Acute Episode of COVID-19. Biomedicines 2024; 12:854. [PMID: 38672208 PMCID: PMC11047904 DOI: 10.3390/biomedicines12040854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Long COVID is a condition that affects a significant proportion of patients who have had COVID-19. It is characterised by the persistence of associated symptoms after the acute phase of the illness has subsided. Although several studies have investigated the risk factors associated with long COVID, identifying which patients will experience long-term symptoms remains a complex task. Among the various symptoms, dyspnea is one of the most prominent due to its close association with the respiratory nature of COVID-19 and its disabling consequences. This work proposes a new intelligent clinical decision support system to predict dyspnea 12 months after a severe episode of COVID-19 based on the SeguiCovid database from the Álvaro Cunqueiro Hospital in Vigo (Galicia, Spain). The database is initially processed using a CART-type decision tree to identify the variables with the highest predictive power. Based on these variables, a cascade of expert systems has been defined with Mamdani-type fuzzy-inference engines. The rules for each system were generated using the Wang-Mendel automatic rule generation algorithm. At the output of the cascade, a risk indicator is obtained, which allows for the categorisation of patients into two groups: those with dyspnea and those without dyspnea at 12 months. This simplifies follow-up and the performance of studies aimed at those patients at risk. The system has produced satisfactory results in initial tests, supported by an AUC of 0.75, demonstrating the potential and usefulness of this tool in clinical practice.
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Affiliation(s)
- Manuel Casal-Guisande
- Fundación Pública Galega de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain;
| | - Alberto Comesaña-Campos
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain;
- Design, Expert Systems and Artificial Intelligent Solutions Group (DESAINS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
| | - Marta Núñez-Fernández
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
| | - María Torres-Durán
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
| | - Alberto Fernández-Villar
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
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Morikawa T, Sakuma M, Nakamura T, Sonoyama T, Matsumoto C, Takeuchi J, Ohta Y, Kosaka S, Morimoto T. Effectiveness of a computerized clinical decision support system for prevention of glucocorticoid-induced osteoporosis. Sci Rep 2022; 12:14967. [PMID: 36056121 PMCID: PMC9440130 DOI: 10.1038/s41598-022-19079-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/24/2022] [Indexed: 11/09/2022] Open
Abstract
Glucocorticoids are widely used for a variety of diseases, but the prevention of glucocorticoid-induced osteoporosis is sometimes neglected. Therefore, the effectiveness of a computerized clinical decision support system (CDSS) to improve the performance rate of preventive care for glucocorticoid-induced osteoporosis was evaluated. We conducted a prospective cohort study of outpatients who used glucocorticoids for three months or longer and who met the indication for preventive care based on a guideline. The CDSS recommended bisphosphonate (BP) prescription and bone mineral density (BMD) testing based on the risk of osteoporosis. The observation period was one year (phase 1: October 2017-September 2018) before implementation and the following one year (phase 2: October 2018-September 2019) after implementation of the CDSS. Potential alerts were collected without displaying them during phase 1, and the alerts were displayed during phase 2. We measured BP prescriptions and BMD testing for long-term prescription of glucocorticoids. A total of 938 patients (phase 1, 457 patients; phase 2, 481 patients) were included, and the baseline characteristics were similar between the phases. The median age was 71 years, and men accounted for 51%. The primary disease for prescription of glucocorticoids was rheumatic disease (28%), followed by hematologic diseases (18%). The prevalence of patients who needed an alert for BP prescription (67% vs. 63%, P = 0.24) and the acceptance rate of BP prescription (16% vs. 19%, P = 0.33) were similar between the phases. The number of patients who had orders for BMD testing was significantly increased (4% vs. 24%, P < 0.001) after CDSS implementation. The number of patients who needed an alert for BMD testing was significantly decreased from 93% in phase 1 to 87% in phase 2 (P = 0.004). In conclusion, the CDSS significantly increased BMD testing in patients with a higher risk of glucocorticoid-induced osteoporosis, but did not increase BP prescription.
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Affiliation(s)
- Toru Morikawa
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
- Department of General Medicine, Nara City Hospital, Nara, Japan
| | - Mio Sakuma
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tsukasa Nakamura
- Department of Infectious Diseases, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Tomohiro Sonoyama
- Department of Pharmacy, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Chisa Matsumoto
- Center for Health Surveillance and Preventive Medicine, Tokyo Medical University, Tokyo, Japan
| | - Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshinori Ohta
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
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Abstract
OBJECTIVE To understand the impact of clinical decision support systems (CDSSs) on improving HIV testing and diagnosis. DESIGN An original global systematic review (PROSPERO Number: CRD42020175576) of peer-reviewed articles reporting on electronic CDSSs that generate triggers encouraging healthcare providers to perform an HIV test. METHODS Medline, Embase, Cochrane CENTRAL and CINAHL EBSCOhost were searched up to 17 November 2020 and reference lists of included articles were checked. Qualitative and quantitative syntheses (using meta-analyses) of identified studies were performed. RESULTS The search identified 1424 records. Twenty-two articles met inclusion criteria (19 of 22 non-HIV endemic settings); 18 clinical and four laboratory-driven reminders. Reminders promoted 'universal' HIV testing for all patients without a known HIV infection and no recent documented HIV test, or 'targeted' HIV testing in patients with clinical risk-factors or specific diagnostic tests. CDSSs increased HIV testing in hospital and nonhospital setting, with the pooled risk-ratio amongst studies reporting comparable outcome measures in hospital settings (n = 3) of 2.57 [95% confidence interval (CI) 1.53-4.33, random-effect model] and in nonhospital settings (n = 4) of 2.13 (95% CI 1.78-4.14, random effect model). Results of the clinical impact of CDSSs on HIV diagnosis were mixed. CONCLUSION CDSSs improve HIV testing and may, potentially, improve diagnosis. The data support the broader study of CDSSs in low- and high prevalent HIV settings to determine their precise impact on UNAIDS goals to reach universal HIV testing and treatment coverage.
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Vallée A, Sveltlane D, Trichereau J, Neveu S, Fourn E, Majerholc C, Lesprit P, Mazaux L, Henintsoa SH, Matejczuk G, Vasse M, Zucman D. Electronic medical record alert increases HIV screening rates: the Foch hospital pilot POP-up project. BMC Health Serv Res 2022; 22:784. [PMID: 35710554 PMCID: PMC9202097 DOI: 10.1186/s12913-022-08176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 06/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Despite significant national human immunodeficiency virus (HIV) screening activity, there are persistent delays in screening, and many missed diagnostic opportunities. To facilitate targeted screening, an electronic medical record (EMR) alert reminder was applied in the Foch hospital. Screening rates after implementation were reported. Methods A prospective cohort analysis was performed in Foch Hospital between 24 April 2018 and 4 October 2019 among hospitalized patients born in high HIV prevalence countries and/or having social vulnerability criteria (universal health coverage). From the admissions software, when specific low health coverage was provided and/or high-prevalence country of birth was registered, an electronic alert (EMR alert) appeared on the ward where the patient was hospitalized. The EMR alert database was examined for HIV screening and activity responses from each service of the Hospital. Results Eight thousand one hundred eighty-one alerts were recovered during the period for 1448 patients. 27 services used the EMR alert. Most of the alerts were directly closed (74.4%), 14.5% of the alerts were closed due to doctors declaring that they did not have time to respond. 297 (3.6%) of the 8181 alerts resulted in a prescription of HIV serology corresponding for 20.5% of the patients. Conclusion EMR alert can help to increase the rate of HIV screening in hospital care practice. Through this EMR alert system, HIV screening can be implemented as a common practice like any other medical alternative. Future research should examine the factors influencing physicians’ attitudes to this alert system to improve the HIV screening rate.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France.
| | - Dimi Sveltlane
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Julie Trichereau
- Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France
| | - Stéphane Neveu
- Département d'Informatique, Hôpital Foch, Suresnes, France
| | - Erwan Fourn
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Catherine Majerholc
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Philippe Lesprit
- Department of Hygiene and Infectious Disease, Foch Hospital, Suresnes, France
| | - Laurence Mazaux
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - Seheno Harijaona Henintsoa
- Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France
| | | | - Marc Vasse
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - David Zucman
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
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Agustí C, Cunillera O, Almeda J, Mascort J, Carrillo R, Olmos C, Montoliu A, Alberny M, Molina I, Cayuelas L, Casabona J. Efficacy of an electronic reminder for HIV screening in primary healthcare based on indicator conditions in Catalonia (Spain). HIV Med 2022; 23:868-879. [DOI: 10.1111/hiv.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Cristina Agustí
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalunya (CEEISCAT) Department of Health Generalitat of Catalunya Badalona Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
| | - Oriol Cunillera
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol) Barcelona Spain
| | - Jesús Almeda
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol) Barcelona Spain
- Research Support Unit Primary Health General Directorate of Costa de Ponent Catalan Institute of Health (ICS) Cornellà de Llobregat Spain
| | - Juanjo Mascort
- Catalan Society of Family and Community Medicine (CAMFiC) Barcelona Spain
- Spanish Society of Family and Community Medicine (semFYC) Barcelona Spain
- Department of Clinical Sciences Faculty of Medicine University of Barcelona (UB) Barcelona Spain
| | - Ricard Carrillo
- Catalan Society of Family and Community Medicine (CAMFiC) Barcelona Spain
- Spanish Society of Family and Community Medicine (semFYC) Barcelona Spain
| | - Carmen Olmos
- Health Department Catalan Government Barcelona Spain
| | - Alexandra Montoliu
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
- Unit of Infections and Cancer ‐ Information and Interventions (UNIC ‐ I&I) Cancer Epidemiology Research Program (CERP) Hospitalet de Llobregat Barcelona Spain
| | - Mireia Alberny
- Medical Management of Primary Care Servicies STI/HIV Area Catalan Institute of Health (ICS) Barcelona Spain
| | - Izarbe Molina
- Association of Family and Community Nursing of Catalonia (AIFiCC) Barcelona Spain
| | - Laia Cayuelas
- Centro de Atención Primaria Casanova Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Barcelona Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalunya (CEEISCAT) Department of Health Generalitat of Catalunya Badalona Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine Universitat Autónoma de Barcelona Badalona Spain
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Benes G, David J, Synowicz M, Betech A, Dasa V, Krause PC, Jones D, Hall L, Leslie L, Chapple AG. Race and Age Impact Osteoporosis Screening Rates in Women Prior to Hip Fracture. Arch Osteoporos 2022; 17:34. [PMID: 35150320 DOI: 10.1007/s11657-022-01076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/08/2022] [Indexed: 02/03/2023]
Abstract
Bone mineral density screening and clinical risk factors are important to stratify individuals for increased risk of fracture. In a population with no history of fractures or baseline bone density measurement, black women were less likely to be screened than white counterparts prior to hip fracture. PURPOSE To evaluate overall BMD (bone mineral density) screening rates within two years of hip fracture and to identify any disparities for osteoporosis screening or treatment in a female cohort who were eligible for screening under insurance and national recommendations. METHODS Data were obtained from 1,109 female patients listed in the Research Action for Health Network (REACHnet) database, which consists of multiple health partner systems in Louisiana and Texas. Patients < 65 years old or with a history of hip fracture or osteoporosis diagnosis, screening or treatment more than 2 years before hip fracture were removed. RESULTS Only 223 (20.1%) females were screened within the two years prior to hip fracture. Additionally, only 23 (10%) of the screened patients received treatment, despite 187 (86.6%) patients being diagnosed with osteoporosis or osteopenia. Screening rates reached a maximum of 27.9% in the 75-80 age group, while the 90 + age group had the lowest screening rates of 12%. We found a quadratic relationship between age and screening rates, indicating that the screening rate increases in age until age 72 and then decreases starkly. After adjusting for potential confounders, we found that black patients had significantly decreased screening rates compared to white patients (adjusted OR = .454, 95% CI = .227-.908, p value = .026) which held in general and for patient ages 65-97. CONCLUSION Despite national recommendations, overall BMD screening rates among women prior to hip fracture are low. If individuals are not initially screened when eligible, they are less likely to ever be screened prior to fracture. Clinicians should address racial disparities by recommending more screening to otherwise healthy black patients above the age of 65. Lastly, treatment rates need to increase among those diagnosed with osteoporosis since all patients went on to hip fracture.
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Affiliation(s)
- Gregory Benes
- Louisiana State University Health Sciences Center School of Medicine, 1901 Perdido St, New Orleans, LA, 70112, USA.
| | - Justin David
- Louisiana State University Health Sciences Center School of Medicine, 1901 Perdido St, New Orleans, LA, 70112, USA
| | - Molly Synowicz
- University of Toledo General Surgery Residency Program, Toledo, OH, USA
| | - Alex Betech
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
| | - Vinod Dasa
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
| | - Peter C Krause
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
| | - Deryk Jones
- Ochsner Sports Medicine Institute, Jefferson, LA, USA
| | - Lauren Hall
- Baylor Scott & White Health Research Institute, Dallas, TX, USA
| | - Lauren Leslie
- Ochsner Sports Medicine Institute, Jefferson, LA, USA
| | - Andrew G Chapple
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA.,Biostatistics Program, School of Public Health, LSU Health Sciences Center, New Orleans, LA, USA
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Casal-Guisande M, Comesaña-Campos A, Dutra I, Cerqueiro-Pequeño J, Bouza-Rodríguez JB. Design and Development of an Intelligent Clinical Decision Support System Applied to the Evaluation of Breast Cancer Risk. J Pers Med 2022; 12:jpm12020169. [PMID: 35207657 PMCID: PMC8880667 DOI: 10.3390/jpm12020169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is currently one of the main causes of death and tumoral diseases in women. Even if early diagnosis processes have evolved in the last years thanks to the popularization of mammogram tests, nowadays, it is still a challenge to have available reliable diagnosis systems that are exempt of variability in their interpretation. To this end, in this work, the design and development of an intelligent clinical decision support system to be used in the preventive diagnosis of breast cancer is presented, aiming both to improve the accuracy in the evaluation and to reduce its uncertainty. Through the integration of expert systems (based on Mamdani-type fuzzy-logic inference engines) deployed in cascade, exploratory factorial analysis, data augmentation approaches, and classification algorithms such as k-neighbors and bagged trees, the system is able to learn and to interpret the patient’s medical-healthcare data, generating an alert level associated to the danger she has of suffering from cancer. For the system’s initial performance tests, a software implementation of it has been built that was used in the diagnosis of a series of patients contained into a 130-cases database provided by the School of Medicine and Public Health of the University of Wisconsin-Madison, which has been also used to create the knowledge base. The obtained results, characterized as areas under the ROC curves of 0.95–0.97 and high success rates, highlight the huge diagnosis and preventive potential of the developed system, and they allow forecasting, even when a detailed and contrasted validation is still pending, its relevance and applicability within the clinical field.
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Affiliation(s)
- Manuel Casal-Guisande
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain; (J.C.-P.); (J.-B.B.-R.)
- Department of Computer Sciences, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal;
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Correspondence: (M.C.-G.); (A.C.-C.)
| | - Alberto Comesaña-Campos
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain; (J.C.-P.); (J.-B.B.-R.)
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Correspondence: (M.C.-G.); (A.C.-C.)
| | - Inês Dutra
- Department of Computer Sciences, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal;
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Jorge Cerqueiro-Pequeño
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain; (J.C.-P.); (J.-B.B.-R.)
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - José-Benito Bouza-Rodríguez
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain; (J.C.-P.); (J.-B.B.-R.)
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
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Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168435. [PMID: 34444182 PMCID: PMC8391274 DOI: 10.3390/ijerph18168435] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
Diagnosis is one of the crucial tasks performed by primary care physicians; however, primary care is at high risk of diagnostic errors due to the characteristics and uncertainties associated with the field. Prevention of diagnostic errors in primary care requires urgent action, and one of the possible methods is the use of health information technology. Its modes such as clinical decision support systems (CDSS) have been demonstrated to improve the quality of care in a variety of medical settings, including hospitals and primary care centers, though its usefulness in the diagnostic domain is still unknown. We conducted a scoping review to confirm the usefulness of the CDSS in the diagnostic domain in primary care and to identify areas that need to be explored. Search terms were chosen to cover the three dimensions of interest: decision support systems, diagnosis, and primary care. A total of 26 studies were included in the review. As a result, we found that the CDSS and reminder tools have significant effects on screening for common chronic diseases; however, the CDSS has not yet been fully validated for the diagnosis of acute and uncommon chronic diseases. Moreover, there were few studies involving non-physicians.
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Gogineni VSM, Manfrini D, Aroda SH, Zhang Y, Nelson DS, Egerman R, Park K. Variations in Awareness of Association Between Adverse Pregnancy Outcomes and Cardiovascular Risk by Specialty. Cardiol Ther 2021; 10:577-592. [PMID: 34043209 PMCID: PMC8555062 DOI: 10.1007/s40119-021-00220-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) remains the leading cause of death among women. Adverse pregnancy outcomes (APOs), including pre-eclampsia (PE), gestational diabetes mellitus (GDM) and pre-term birth (PTB) are associated with future maternal CVD risk. However, data on awareness of the association between APOs and long-term CVD risk among physicians in different specialties are lacking. This study assessed awareness of this association and whether this knowledge varies by specialty. Methods An anonymous web-based voluntary survey was sent to physicians in internal medicine (IM), family medicine (FM), obstetrics-gynecology (Ob-Gyn) and cardiology. The questions aimed to assess a physician’s knowledge regarding identification of APOs and their association with future CVD risk and knowledge of CVD risk factor screening in women with APOs and future CVD risk. Results The survey was completed by 53 physicians, of whom 21% were in IM, 26% in FM, 23% in Ob-Gyn and 30% in cardiology. Based on the responses, cardiologists screened most frequently for APOs, with 56% always screening a female patient and 31% often screening. Only half of the IM and FM physicians acknowledged awareness of the association between APOs and CVD risk. Respondents in all specialties recognized PE and GDM as APOs linked to long-term maternal CVD risk, but failed to associate PTB as an APO. The majority of physicians in IM, FM and cardiology also lacked the knowledge of how often to appropriately screen for CVD risk factors associated with APOs. Conclusion Awareness of the association between APO and future maternal CVD risk varies by specialty. A significant percentage of the physicians who responded to the survey did not routinely ask about APOs when assessing CVD risk and failed to identify PTB as a risk factor for APOs. Education on this topic and targeted efforts to improve screening for APOs are needed within all specialties to help reduce CVD morbidity and mortality.
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Affiliation(s)
| | - Denise Manfrini
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Sharon H Aroda
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Yahan Zhang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Danielle S Nelson
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
| | - Robert Egerman
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
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Lapane KL, Shridharmurthy D, Khan S, Lindstrom D, Beccia A, Yi E, Kay J, Dube C, Liu SH. Primary care physician perspectives on screening for axial spondyloarthritis: A qualitative study. PLoS One 2021; 16:e0252018. [PMID: 34029339 PMCID: PMC8143395 DOI: 10.1371/journal.pone.0252018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Many patients with axial spondylarthritis (axSpA) experience lengthy diagnostic delays upwards of 14 years. (5-14 years). Screening tools for axSpA have been proposed for use in primary care settings, but whether this approach could be implemented into busy primary care settings remains unknown. OBJECTIVE To solicit feedback from primary care physicians regarding questions from the Inflammatory Back Pain Assessment: the Assessment of Spondyloarthritis International Society (ASAS) Expert Criteria and gain insight about barriers and facilitators for implementing axSpA screening in primary care. METHODS Guided by Consolidated Criteria for reporting Qualitative Research (COREQ-criteria), we recorded, transcribed, and analyzed in-depth interviews with eight family medicine physicians and ten internists (purposeful sampling) using immersion/crystallization techniques. RESULTS Few physicians reported awareness of existing classification criteria for axSpA, and many reported a lack of confidence in their ability to distinguish between inflammatory and mechanical back pain. From three domains, 10 subthemes emerged: 1) typical work-up of axSpA patients in primary care, with subthemes including the clues involved in work-up and role of clinical examinations for axSpA; 2) feedback on questions from the Inflammatory Back Pain Assessment: ASAS Expert Criteria, with subthemes to evaluate contents/questions of a potential screening tool for axSpA; and 3) implementation of the screening tool in primary care settings, with subthemes of perceived barriers including awareness, time, other conditions to screen, rare disease, and lack of structured questionnaire for back pain and perceived facilitators including workflow issues and awareness. CONCLUSIONS Primary care physicians believed that an improved screening instrument and a strong evidence-base to support the need for screening for axSpA are required. The implementation of axSpA screening into a busy primary care practice requires integration into the practice workflow, with use of technology suggested as a possible way to improve efficiency.
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Affiliation(s)
- Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Divya Shridharmurthy
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Sara Khan
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Daniel Lindstrom
- Graduate Medical Education, Internal Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Ariel Beccia
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States of America
| | - Jonathan Kay
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
- Division of Rheumatology, UMass Memorial Medical Center, Worcester, MA, United States of America
| | - Catherine Dube
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
- * E-mail:
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Papaioannou A, McCloskey E, Bell A, Ngui D, Mehan U, Tan M, Goldin L, Langer A. Use of an electronic medical record dashboard to identify gaps in osteoporosis care. Arch Osteoporos 2021; 16:76. [PMID: 33893868 PMCID: PMC8068625 DOI: 10.1007/s11657-021-00919-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/17/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Using an electronic medical record (EMR)-based dashboard, this study explored osteoporosis care gaps in primary care. Eighty-four physicians shared their practice activities related to bone mineral density testing, 10-year fracture risk calculation and treatment for those at high risk. Significant gaps in fracture risk calculation and osteoporosis management were identified. PURPOSE To identify care gaps in osteoporosis management focusing on Canadian clinical practice guidelines (CPG) related to bone mineral density (BMD) testing, 10-year fracture risk calculation and treatment for those at high risk. METHODS The ADVANTAGE OP EMR tool consists of an interactive algorithm to facilitate assessment and management of fracture risk using CPG. The FRAX® and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools were embedded to facilitate 10-year fracture risk calculation. Physicians managed patients as clinically indicated but with EMR reminders of guideline recommendations; participants shared practice level data on management activities after 18-month use of the tool. RESULTS Eighty-four physicians (54%) of 154 who agreed to participate in this study shared their aggregate practice activities. Across all practices, there were 171,310 adult patients, 40 years of age and older, of whom 17,214 (10%) were at elevated risk for fracture. Sixty-two percent of patients potentially at elevated risk for fractures did not have BMD testing completed; most common reasons for this were intention to order BMD later (48%), physician belief that BMD was not required (15%) and patient refusal (20%). For patients with BMD completed, fracture risk was calculated in 29%; 19% were at high risk, of whom 37% were not treated with osteoporosis medications as recommended by CPG. CONCLUSION Despite access to CPG and fracture risk calculators through the ADVANTAGE OP EMR tool, significant gaps remain in fracture risk calculation and osteoporosis management. Additional strategies are needed to address this clinical inertia among family physicians.
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Affiliation(s)
- A. Papaioannou
- McMaster University, Hamilton, Ontario Canada ,GERAS Centre for Aging Research, St. Peter’s Hospital, Hamilton Health Sciences, 88 Maplewood Ave, Hamilton, Ontario L8M 1W9 Canada
| | - E. McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - A. Bell
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - D. Ngui
- University of British Columbia, Vancouver, British Columbia Canada
| | - U. Mehan
- McMaster University, Hamilton, Ontario Canada ,Centre for Family Medicine Family Health Team, Kitchener, Ontario Canada
| | - M. Tan
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| | - L. Goldin
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| | - A. Langer
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
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Tazzeo C, Pritchard JM, Papaioannou A, Adachi JD. Promoting Osteoporosis Best Practices: A New Electronic Medical Record Tool. J Am Med Dir Assoc 2020; 21:1349-1352. [PMID: 32739281 DOI: 10.1016/j.jamda.2020.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
Despite the high prevalence and devastating outcomes associated with osteoporotic fractures, they are not well investigated or treated. We developed an electronic Osteoporosis and Falls Assessment Form for integration within electronic medical records (EMR) with the aim to improve osteoporosis-related care in family practice. We examined usage and collected usability feedback from 37 physicians. A medical record review was used to assess tool usage over a 6-month period after which all participants completed a survey to assess their perceptions of the tool. The tool was used at least once by 22 (59%) physicians with 119 patients. Most users reported that it enhanced their practice (64%) and they intended to use it in the future (71%). Time constraints, complexity, and requirements to manually enter sections were identified as barriers to use. Lessons learned will inform improvements, which, given the perceived value of this tool, will likely improve uptake.
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Affiliation(s)
- Clare Tazzeo
- GERAS Centre for Aging Research, Hamilton, ON, Canada
| | - Janet M Pritchard
- GERAS Centre for Aging Research, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - Alexandra Papaioannou
- GERAS Centre for Aging Research, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada.
| | - Jonathan D Adachi
- GERAS Centre for Aging Research, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
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13
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Matulis JC, Schilling JJ, North F. Primary Care Provider Continuity Is Associated With Improved Preventive Service Ordering During Brief Visits for Acute Symptoms. Health Serv Res Manag Epidemiol 2019; 6:2333392819826262. [PMID: 30793012 PMCID: PMC6376498 DOI: 10.1177/2333392819826262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 01/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background: If a patient presents for an acute care visit and sees their assigned primary care provider (PCP), they may be more likely to receive preventive and other services than a patient not seeing their assigned PCP. Methods: After exclusion of 2 visits with insufficient information, we reviewed 98 consecutive, outpatient internal medicine 15-minute acute care visits comparing patients seeing their assigned PCP with those seeing a non-PCP provider. The primary outcome, preventive service ordering, was measured in 2 ways: percentage of patient visits with any preventive service ordered and the total number of preventive services ordered as a proportion of all preventive service items due for each entire cohort. The secondary outcome of other work completed was assessed by comparing tests and consults ordered, and by counting the number of physical examination elements and discrete medical diagnoses documented. Results: The PCPs were significantly more likely than non-PCPs to order any preventive service 45% versus 17% (P = .005; odds ratio [OR]: 4.16, 95% confidence interval [CI]: 1.45-12.0). The PCP cohort ordered a higher proportion of the total number of preventive services due compared with the non-PCP cohort (30% vs 11%; P = .002; OR: 3.4, CI: 1.5-7.7). The PCPs also addressed more medical diagnoses (2.3 vs 1.4; P = .008) and more frequently ordered tests outside the reason for that visit (40% vs 13%; P = .003; OR: 4.27, CI: 1.5-11.8). Conclusion: Patients seeing their assigned PCP in brief, acute visits have higher rates of preventive and other service ordering compared to those not seeing their assigned PCP.
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Affiliation(s)
- John C Matulis
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Frederick North
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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14
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The Impact of Multifaceted Osteoporosis Group Education on Patients' Decision-Making regarding Treatment Options and Lifestyle Changes. J Osteoporos 2018; 2018:9703602. [PMID: 29785259 PMCID: PMC5892217 DOI: 10.1155/2018/9703602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 02/20/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Patients with chronic diseases like osteoporosis constantly have to make decisions related to their disease. Multifaceted osteoporosis group education (GE) may support patients' decision-making. This study investigated multifaceted osteoporosis GE focusing on the impact of GE on patients' decision-making related to treatment options and lifestyle. MATERIAL AND METHODS An interpretive description design using ethnographic methods was utilized with 14 women and three men diagnosed with osteoporosis who attended multifaceted GE. Data consisted of participant observation during GE and individual interviews. RESULTS Attending GE had an impact on the patients' decision-making in all educational themes. Patients decided on new ways to manage osteoporosis and made decisions regarding bone health and how to implement a lifestyle ensuring bone health. During GE, teachers and patients shared evidence-based knowledge and personal experiences and preferences, respectively, leading to a two-way exchange of information and deliberation about recommendations. Though teachers and patients explored the implications of the decisions and shared their preferences, teachers stressed that the patients ultimately had to make the decision. Teachers therefore refrained from participating in the final step of the decision-making process. CONCLUSION Attending GE has an impact on the patients' decision-making as it can initiate patient reflection and support decision-making.
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15
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Kershaw C, Taylor JL, Horowitz G, Brockmeyer D, Libman H, Kriegel G, Ngo L. Use of an electronic medical record reminder improves HIV screening. BMC Health Serv Res 2018; 18:14. [PMID: 29316919 PMCID: PMC5761195 DOI: 10.1186/s12913-017-2824-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 12/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background More than 1 in 7 patients with human immunodeficiency virus (HIV) infection in the United States are unaware of their serostatus despite recommendations of US agencies that all adults through age 65 be screened for HIV at least once. To facilitate universal screening, an electronic medical record (EMR) reminder was created for our primary care practice. Screening rates before and after implementation were assessed to determine the impact of the reminder on screening rates. Methods A retrospective cohort analysis was performed for patients age 18–65 with visits between January 1, 2012-October 30, 2014. EMR databases were examined for HIV testing and selected patient characteristics. We evaluated the probability of HIV screening in unscreened patients before and after the reminder and used a multivariable generalized linear model to test the association between likelihood of HIV testing and specific patient characteristics. Results Prior to the reminder, the probability of receiving an HIV test for previously unscreened patients was 15.3%. This increased to 30.7% after the reminder (RR 2.02, CI 1.95–2.09, p < 0.0001). The impact was most significant in patients age 45–65. White race, English as primary language, and higher median household income were associated with lower likelihoods of screening both before and after implementation (RR 0.68, CI 0.65–0.72; RR 0.74, CI 0.67–0.82; RR 0.84, CI 0.80–0.88, respectively). Conclusions The EMR reminder increased rates of HIV screening twofold in our practice. It was most effective in increasing screening rates in older patients. Patients who were white, English-speaking, and had higher incomes were less likely to be screened for HIV both before and after the reminder.
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Affiliation(s)
- Colleen Kershaw
- Department of Medicine, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA, 02215, USA.
| | - Jessica L Taylor
- Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2, Boston, MA, 02118, USA
| | - Gary Horowitz
- Department of Pathology, Tufts Medical Center, Biewend Building 3, 800 Washington St, Boston, MA, 02111, USA
| | - Diane Brockmeyer
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Howard Libman
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Gila Kriegel
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
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16
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Dagan N, Cohen-Stavi C, Leventer-Roberts M, Balicer RD. External validation and comparison of three prediction tools for risk of osteoporotic fractures using data from population based electronic health records: retrospective cohort study. BMJ 2017; 356:i6755. [PMID: 28104610 PMCID: PMC5244817 DOI: 10.1136/bmj.i6755] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To directly compare the performance and externally validate the three most studied prediction tools for osteoporotic fractures-QFracture, FRAX, and Garvan-using data from electronic health records. DESIGN Retrospective cohort study. SETTING Payer provider healthcare organisation in Israel. PARTICIPANTS 1 054 815 members aged 50 to 90 years for comparison between tools and cohorts of different age ranges, corresponding to those in each tools' development study, for tool specific external validation. MAIN OUTCOME MEASURE First diagnosis of a major osteoporotic fracture (for QFracture and FRAX tools) and hip fractures (for all three tools) recorded in electronic health records from 2010 to 2014. Observed fracture rates were compared to probabilities predicted retrospectively as of 2010. RESULTS The observed five year hip fracture rate was 2.7% and the rate for major osteoporotic fractures was 7.7%. The areas under the receiver operating curve (AUC) for hip fracture prediction were 82.7% for QFracture, 81.5% for FRAX, and 77.8% for Garvan. For major osteoporotic fractures, AUCs were 71.2% for QFracture and 71.4% for FRAX. All the tools underestimated the fracture risk, but the average observed to predicted ratios and the calibration slopes of FRAX were closest to 1. Tool specific validation analyses yielded hip fracture prediction AUCs of 88.0% for QFracture (among those aged 30-100 years), 81.5% for FRAX (50-90 years), and 71.2% for Garvan (60-95 years). CONCLUSIONS Both QFracture and FRAX had high discriminatory power for hip fracture prediction, with QFracture performing slightly better. This performance gap was more pronounced in previous studies, likely because of broader age inclusion criteria for QFracture validations. The simpler FRAX performed almost as well as QFracture for hip fracture prediction, and may have advantages if some of the input data required for QFracture are not available. However, both tools require calibration before implementation.
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Affiliation(s)
- Noa Dagan
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Computer Science Department, Ben Gurion University of the Negev, Be'er Sheba, Israel
| | - Chandra Cohen-Stavi
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Maya Leventer-Roberts
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Department of Preventive Medicine and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ran D Balicer
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Epidemiology Department, Ben Gurion University of the Negev, Be'er Sheba, Israel
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17
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Komur B, Lohse T, Can HM, Khalilova G, Geçimli ZN, Aydoğdu MO, Kalkandelen C, Stan GE, Sahin YM, Sengil AZ, Suleymanoglu M, Kuruca SE, Oktar FN, Salman S, Ekren N, Ficai A, Gunduz O. Fabrication of naturel pumice/hydroxyapatite composite for biomedical engineering. Biomed Eng Online 2016; 15:81. [PMID: 27388324 PMCID: PMC4937607 DOI: 10.1186/s12938-016-0203-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/22/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We evaluated the Bovine hydroxyapatite (BHA) structure. BHA powder was admixed with 5 and 10 wt% natural pumice (NP). Compression strength, Vickers micro hardness, Fourier transform infrared spectroscopy, scanning electron microscopy (SEM) and X-ray diffraction studies were performed on the final NP-BHA composite products. The cells proliferation was investigated by MTT assay and SEM. Furthermore, the antimicrobial activity of NP-BHA samples was interrogated. RESULTS Variances in the sintering temperature (for 5 wt% NP composites) between 1000 and 1300 °C, reveal about 700 % increase in the microhardness (~100 and 775 HV, respectively). Composites prepared at 1300 °C demonstrate the greatest compression strength with comparable result for 5 wt% NP content (87 MPa), which are significantly better than those for 10 wt% and those that do not include any NP (below 60 MPa, respectively). CONCLUSION The results suggested the optimal parameters for the preparation of NP-BHA composites with increased mechanical properties and biocompatibility. Changes in micro-hardness and compression strength can be tailored by the tuning the NP concentration and sintering temperature. NP-BHA composites have demonstrated a remarkable potential for biomedical engineering applications such as bone graft and implant.
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Affiliation(s)
- Baran Komur
- />Orthopaedics and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, Kucukcekmece, Halkali, 34303 Istanbul, Turkey
| | - Tim Lohse
- />Faculty of Engineering, Institute for Materials Science, Christian-Albrechts-University Kiel, 24143 Kiel, Germany
- />Advanced Nanomaterials Research Laboratory, Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
| | - Hatice Merve Can
- />Department of Bioengineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
- />Department of Pharmaceutical Biotechnology, Institute of Health Sciences, Marmara University, Istanbul, Turkey
- />Advanced Nanomaterials Research Laboratory, Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
| | - Gulnar Khalilova
- />Department of Bioengineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
- />Advanced Nanomaterials Research Laboratory, Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
| | - Zeynep Nur Geçimli
- />Department of Industrial Product Design, Bachelor Science, Istanbul Arel University, Istanbul, Turkey
| | - Mehmet Onur Aydoğdu
- />Department of Biology, Bachelor Science, Faculty of Arts and Sciences, Marmara University, Istanbul, Turkey
- />Advanced Nanomaterials Research Laboratory, Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
| | - Cevriye Kalkandelen
- />Vocational School of Technical Sciences, Biomedical Devices Technology Department, Istanbul University, Istanbul, Turkey
| | - George E. Stan
- />National Institute of Materials Physics, 077125 Magurele-Ilfov, Romania
| | - Yesim Muge Sahin
- />Department of Biomedical Engineering, Faculty of Engineering–Architecture, Istanbul Arel University, Istanbul, Turkey
- />Advanced Nanomaterials Research Laboratory, Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
| | - Ahmed Zeki Sengil
- />School of Medicine, Department of Medical Microbiology, Medipol University, Istanbul, Turkey
| | - Mediha Suleymanoglu
- />Department of Physiology Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Serap Erdem Kuruca
- />Department of Physiology Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Faik Nuzhet Oktar
- />Department of Bioengineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
- />Advanced Nanomaterials Research Laboratory, Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
| | - Serdar Salman
- />Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
| | - Nazmi Ekren
- />Advanced Nanomaterials Research Laboratory, Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
- />Department of Electrical and Electronics Engineering, Faculty of Technology, Marmara University, Istanbul, Turkey
| | - Anton Ficai
- />Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1-7 Polizu Street, 011061 Bucharest, Romania
| | - Oguzhan Gunduz
- />Advanced Nanomaterials Research Laboratory, Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
- />Department of Metallurgy and Materials Engineering, Faculty of Technology, Marmara University, Goztepe Campus, 34722 Istanbul, Turkey
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Abstract
The electronic medical record has evolved from a digital representation of individual patient results and documents to information of large scale and complexity. Big Data refers to new technologies providing management and processing capabilities, targeting massive and disparate data sets. For an individual patient, techniques such as Natural Language Processing allow the integration and analysis of textual reports with structured results. For groups of patients, Big Data offers the promise of large-scale analysis of outcomes, patterns, temporal trends, and correlations. The evolution of Big Data analytics moves us from description and reporting to forecasting, predictive modeling, and decision optimization.
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Liles EG, Schneider JL, Feldstein AC, Mosen DM, Perrin N, Rosales AG, Smith DH. Implementation challenges and successes of a population-based colorectal cancer screening program: a qualitative study of stakeholder perspectives. Implement Sci 2015; 10:41. [PMID: 25890079 PMCID: PMC4391591 DOI: 10.1186/s13012-015-0227-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 03/03/2015] [Indexed: 12/18/2022] Open
Abstract
Background Few studies describe system-level challenges or facilitators to implementing population-based colorectal cancer (CRC) screening outreach programs. Our qualitative study explored viewpoints of multilevel stakeholders before, during, and after implementation of a centralized outreach program. Program implementation was part of a broader quality-improvement initiative. Methods During 2008–2010, we conducted semi-structured, open-ended individual interviews and focus groups at Kaiser Permanente Northwest (KPNW), a not-for-profit group model health maintenance organization using the practical robust implementation and sustainability model to explore external and internal barriers to CRC screening. We interviewed 55 stakeholders: 8 health plan leaders, 20 primary care providers, 4 program managers, and 23 endoscopy specialists (15 gastroenterologists, 8 general surgeons), and analyzed interview transcripts to identify common as well as divergent opinions expressed by stakeholders. Results The majority of stakeholders at various levels consistently reported that an automated telephone-reminder system to contact patients and coordinate mailing fecal tests alleviated organizational constraints on staff’s time and resources. Changing to a single-sample fecal immunochemical test (FIT) lessened patient and provider concerns about feasibility and accuracy of fecal testing. The centralized telephonic outreach program did, however, result in some screening duplication and overuse. Higher rates of FIT completion and a higher proportion of positive results with FIT required more colonoscopies. Conclusions Addressing barriers at multiple levels of a health system by changing the delivery system design to add a centralized outreach program, switching to a more accurate and easier-to-use fecal test, and providing educational and electronic support had both benefits and problematic consequences. Other health care organizations can use our results to understand the complexities of implementing centralized screening programs.
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Affiliation(s)
- Elizabeth G Liles
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA. .,Northwest Permanente, Kaiser Permanente Northwest, 500 NE Multnomah St, Suite 100, Portland, OR, 97232, USA.
| | - Jennifer L Schneider
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - Adrianne C Feldstein
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA. .,Northwest Permanente, Kaiser Permanente Northwest, 500 NE Multnomah St, Suite 100, Portland, OR, 97232, USA.
| | - David M Mosen
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - Nancy Perrin
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - Ana Gabriela Rosales
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - David H Smith
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
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20
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Damji AN, Bies K, Alibhai SMH, Jones JM. Bone health management in men undergoing ADT: examining enablers and barriers to care. Osteoporos Int 2015; 26:951-9. [PMID: 25526712 DOI: 10.1007/s00198-014-2997-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 12/08/2014] [Indexed: 01/08/2023]
Abstract
UNLABELLED The study determined prostate cancer specialists' knowledge and concordance to guidelines regarding the diagnosis, management, and prevention of androgen deprivation therapy-induced osteoporosis. Despite high knowledge regarding bone health, most respondents did not routinely measure bone mineral density or use fracture risk assessment tools, suggesting a significant gap in the screening/monitoring of bone health. INTRODUCTION The purpose of this study was to determine prostate cancer specialists' knowledge, practices, self-perceived competencies and barriers to providing guideline-concordant care in the diagnosis, prevention, and management of androgen deprivation therapy (ADT)-induced osteoporosis (OP). METHODS A number of 73 Canadian radiation oncologists and 83 urologists completed questionnaires assessing (i) knowledge regarding OP and consensus guidelines for bone health management in men receiving ADT, (ii) self-assessed competencies regarding bone health management, (iii) current practices regarding OP prevention and management, and (iv) self-perceived barriers to providing guideline-concordant care. RESULTS The majority of respondents were able to correctly identify the guideline-concordant frequency of repeat dual-energy X-Ray absorptiometry (DXA) scans (76.3%), vitamin D (70.3%), and calcium (53.2%) intake and that bisphosphonates/denosumab should always be considered for patients with a history of one low-trauma fracture (57.6%). Just under 1/3 (32.5%) reported routinely measuring bone mineral density (BMD) prior to starting ADT and routinely measuring BMD 1-2 years following the initiation of ADT (36.6%). Only 4.6% of respondents routinely used a validated fracture risk assessment tool. Lowest self-assessed competency levels were reported in providing self-management education to patients to foster the uptake of healthy bone behaviors (HBBs) and managing patients who present with or develop osteopenia and OP. The most significant barriers to providing OP prevention and management were lack of time and lack of supporting structures. CONCLUSIONS Despite high knowledge about appropriate bone health care among prostate cancer specialists, there remain significant gaps in screening and monitoring of bone health, suggesting the need to develop innovative strategies to overcome barriers to implementation.
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Affiliation(s)
- A N Damji
- Undergraduate Medical Education Program, University of Toronto, Toronto, Canada
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21
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Low rates of bone mineral density measurement in Medicare beneficiaries with prostate cancer initiating androgen deprivation therapy. Support Care Cancer 2013; 22:537-44. [PMID: 24146343 DOI: 10.1007/s00520-013-2008-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 10/01/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Men with prostate cancer who undergo androgen deprivation therapy (ADT) are at risk for bone loss and fractures. Our objective was to determine if Medicare beneficiaries with prostate cancer in the state of Texas underwent DXA scans when initiating ADT. METHODS We identified men diagnosed with prostate cancer between 2005 and 2007 in the Texas Cancer Registry/Medicare linked database, and who received parenteral ADT or orchiectomy. We identified DXA claims within 1 year before or 6 months after starting ADT. We examined use of bone conservation agents in the subgroup of patients enrolled in Medicare Part D. Multivariate logistic regression models were used to examine determinants of DXA use. RESULTS The analysis included 2,290 men (2,262 parenteral ADT, 28 orchiectomy); 197 (8.6 %) underwent DXA within 1 year before and 6 months after starting ADT. Men aged 75 years or older were more likely to undergo DXA than men aged 66-74 years (OR 1.5; 95 % CI 1.1-2.1). Those living in small urban areas were less likely to undergo DXA than those in big areas (OR 0.40; 95 % CI 0.19-0.82). Of the 1,060 men enrolled in Medicare part D, 59 (5.6 %) received bone conservation agents when starting ADT; 134 (12.6 %) either received bone conservation agents or underwent DXA. CONCLUSIONS Fewer than one in ten Medicare beneficiaries with prostate cancer initiating ADT underwent a DXA exam. Variation in utilization was also related to residence area size. Further research is needed to identify whether the use of DXA in patients with prostate cancer receiving ADT will result in fracture prevention.
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Abstract
BACKGROUND Health information technology (HIT) systems have the potential to reduce delayed, missed or incorrect diagnoses. We describe and classify the current state of diagnostic HIT and identify future research directions. METHODS A multi-pronged literature search was conducted using PubMed, Web of Science, backwards and forwards reference searches and contributions from domain experts. We included HIT systems evaluated in clinical and experimental settings as well as previous reviews, and excluded radiology computer-aided diagnosis, monitor alerts and alarms, and studies focused on disease staging and prognosis. Articles were organised within a conceptual framework of the diagnostic process and areas requiring further investigation were identified. RESULTS HIT approaches, tools and algorithms were identified and organised into 10 categories related to those assisting: (1) information gathering; (2) information organisation and display; (3) differential diagnosis generation; (4) weighing of diagnoses; (5) generation of diagnostic plan; (6) access to diagnostic reference information; (7) facilitating follow-up; (8) screening for early detection in asymptomatic patients; (9) collaborative diagnosis; and (10) facilitating diagnostic feedback to clinicians. We found many studies characterising potential interventions, but relatively few evaluating the interventions in actual clinical settings and even fewer demonstrating clinical impact. CONCLUSIONS Diagnostic HIT research is still in its early stages with few demonstrations of measurable clinical impact. Future efforts need to focus on: (1) improving methods and criteria for measurement of the diagnostic process using electronic data; (2) better usability and interfaces in electronic health records; (3) more meaningful incorporation of evidence-based diagnostic protocols within clinical workflows; and (4) systematic feedback of diagnostic performance.
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Affiliation(s)
- Robert El-Kareh
- Division of Biomedical Informatics, UCSD, , San Diego, California, USA
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23
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Abstract
Clinical decision support systems can improve efficiency and standardization in patient care by flagging patient records due for recommended health maintenance screening. Despite the staggering numbers of people affected by osteoporosis, rates of bone mineral density screening by dual-emission X-ray absorptiometry remain low.
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Affiliation(s)
- Kori Dewing
- Virginia Mason Medical Center in Seattle, Washington, USA
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Fuad A, Kumar A, Wang YC, Hsu CY. Use of a clinical decision support system to increase osteoporosis screening: how similar is the historical control? J Eval Clin Pract 2012; 18:925. [PMID: 22747583 DOI: 10.1111/j.1365-2753.2012.01872.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ajit Kumar
- Graduate Institute of Biomedical Informatics; Taipei Medical University; Taiwan
| | - Yao-Chin Wang
- Graduate Institute of Biomedical Informatics; Taipei Medical University; Taiwan
| | - Chien-Yeh Hsu
- Graduate Institute of Biomedical Informatics; Taipei Medical University; Taiwan
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25
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Bruyère O, Nicolet D, Compère S, Rabenda V, Jeholet P, Zegels B, Maassen P, Pire G, Reginster JY. Perception, knowledge, and use by general practitioners of Belgium of a new WHO tool (FRAX) to assess the 10-year probability of fracture. Rheumatol Int 2012; 33:979-83. [PMID: 22842980 DOI: 10.1007/s00296-012-2461-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 07/07/2012] [Indexed: 10/28/2022]
Abstract
The FRAX tool that calculates the 10-year probability of having a fracture has recently been validated for Belgium. Little is known about the perception and knowledge that GPs have about this tool in their daily practice. A survey has been conducted as part of a screening campaign for various diseases. The primary objective of the present study was to assess the perception and the knowledge of the FRAX tool by GPs. The secondary objective was to assess the impact of an information brochure about the FRAX tool on these outcomes. The survey was sent to a sample of 700 GPs after only half of them had received the information brochure. The survey results show that, out of the 193 doctors who responded to the survey, one-third know the FRAX tool but less than 20 % use it in their daily clinical practice. Among those who use it, the FRAX tool is largely seen as a complementary but not as an essential tool in the diagnosis or in the management of osteoporosis. It appears that the brochure could improve the knowledge of the FRAX tool but it would not be more efficient on its use in daily practice than the other sources of information. At present, the use of the FRAX tool in Belgium is limited but an information brochure could have a positive impact on the knowledge of the FRAX tool.
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Affiliation(s)
- O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart-Tilman, Bât B23, Av. de l'Hôpital 3, 4000 Liège, Belgium.
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DeJesus RS, Chaudhry R, Angstman KB, Cha SS, Tulledge-Scheitel SM, Kesman RL, Bernard ME, Stroebel RJ. Predictors of osteoporosis screening completion rates in a primary care practice. Popul Health Manag 2011; 14:243-7. [PMID: 21506729 DOI: 10.1089/pop.2010.0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The United States Preventive Services Task Force and the National Osteoporosis Foundation recommend routine osteoporosis screening for women aged 65 years or older. Previous studies have shown that the use of a clinical decision-support tool significantly improves screening rates. In a recently published study, a statistically significant improvement was found in the screening rates for eligible women with use of the tool. To evaluate whether a clinical decision-support tool independently predicts completion of osteoporosis screening tests and to identify predictors of screening completion, we examined the records of 2462 female patients who were eligible for osteoporosis screening but had no prior baseline screening and who were seen in our primary care practices in 2007 and 2008. Patient and provider characteristics and clinic visit type were identified, and their association with screening test completion was statistically analyzed using both univariate and multivariate models. Screening completion rates increased significantly from 2007 to 2008. Factors associated with increased likelihood of screening completion included race, marital status, residence, presence of comorbidity (cancer, rheumatologic disease), and the year and type of visit. Screening was less likely for women aged 80 years or older. The use of a point-of-care decision-support tool not only improved osteoporosis screening rates significantly but appeared to be an independent predictor of screening completion. It potentially can facilitate the systematic and effective delivery of preventive health services to patients in the primary care setting.
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Affiliation(s)
- Ramona S DeJesus
- Division of Primary Care Internal Medicine, Center for Innovation, Mayo Clinic, Rochester, Minnesota 55905, USA.
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