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Hatsek A, Hochberg I, Daoud Naccache D, Biderman A, Shahar Y. Design of a bi-directional methodology for automated assessment of compliance to continuous application of clinical guidelines, and its evaluation in the type 2 diabetes domain. PLoS One 2024; 19:e0303542. [PMID: 38768161 PMCID: PMC11104637 DOI: 10.1371/journal.pone.0303542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 04/25/2024] [Indexed: 05/22/2024] Open
Abstract
We introduce a new approach for automated guideline-based-care quality assessment, the bidirectional knowledge-based assessment of compliance (BiKBAC) method, and the DiscovErr system, which implements it. Our methodology compares the guideline's Asbru-based formal representation, including its intentions, with the longitudinal medical record, using a top-down and bottom-up approach. Partial matches are resolved using fuzzy temporal logic. The system was evaluated in the type 2 Diabetes management domain, comparing it to three expert clinicians, including two diabetes experts. The system and the experts commented on the management of 10 patients, randomly selected from 2,000 diabetes patients. On average, each record spanned 5.23 years; the data included 1,584 medical transactions. The system provided 279 comments. The experts made 181 different unique comments. The completeness (recall) of the system was 91% when the gold standard was comments made by at least two of the three experts, and 98%, compared to comments made by all three experts. The experts also assessed all of the 114 medication-therapy-related comments, and a random 35% of the 165 tests-and-monitoring-related comments. The system's correctness (precision) was 81%, compared to comments judged as correct by both diabetes experts, and 91%, compared to comments judged as correct by one diabetes expert and at least as partially correct by the other. 89% of the comments were judged as important by both diabetes experts, 8% were judged as important by one expert, and 3% were judged as less important by both experts. Adding the validated system comments to the experts' comments, the completeness scores of the experts were 75%, 60%, and 55%; the expert correctness scores were respectively 99%, 91%, and 88%. Thus, the system could be ranked first in completeness and second in correctness. We conclude that systems such as DiscovErr can effectively assess the quality of continuous guideline-based care.
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Affiliation(s)
- Avner Hatsek
- Department of Software and Information Systems Engineering, Ben Gurion University, Beer Sheva, Israel
| | - Irit Hochberg
- Endocrinology, Diabetes, and Metabolism Institute, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Deeb Daoud Naccache
- Endocrinology, Diabetes, and Metabolism Institute, Rambam Health Care Campus, Haifa, Israel
| | - Aya Biderman
- Department of Family Medicine and the Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben‐Gurion University of the Negev and Clalit Health Care Services, Beer Sheva, Israel
| | - Yuval Shahar
- Department of Software and Information Systems Engineering, Ben Gurion University, Beer Sheva, Israel
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Shafei I, Karnon J, Crotty M. Process mining and customer journey mapping in healthcare: Enhancing patient-centred care in stroke rehabilitation. Digit Health 2024; 10:20552076241249264. [PMID: 38766357 PMCID: PMC11102702 DOI: 10.1177/20552076241249264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/08/2024] [Indexed: 05/22/2024] Open
Abstract
Background Patient-centred care and enhancing patient experience is a priority across Australia. Stroke rehabilitation has multiple consumer touchpoints that would benefit from a better understanding of customer journeys, subsequently impacting better patient-centred care, and contributing to process improvements and better patient outcomes. Customer journey mapping through process mining extracts process data from event logs in existing information systems discovering patient journeys, which can be utilized to monitor guideline compliance and uncover nonconformance. Methodology Utilizing process mining and variant analysis, customer journey maps were developed for 130 stroke rehabilitation patients from referral to discharge. In total, 168 cases from the Australasian Rehabilitation Outcomes Centre dataset were matched with 6291 cases from inpatient stroke data. Variants were explored for age, gender, outcome measures, length of stay and functional independence measure (FIM) change. Results The study illustrated the process, process variants and patient journey map in stroke rehabilitation. Process characteristics of stroke rehabilitation patients were extracted and represented utilizing process mining and results highlighted process variation, attributes, touchpoints and timestamps across stroke rehabilitation patient journeys categorized by patient demographics and outcome variables. Patients demonstrated a mean and median duration of 49.5 days and 44 days, respectively, across the patient journeys. Nine variants were discovered, with 78.46% (n = 102) of patients following the expected sequence of activities in their stroke rehabilitation patient journey. Relationships involving age, gender, length of stay and FIM change along the patient journeys were evident, with four cases experiencing stroke rehabilitation journeys of more than 100 days, warranting further investigation. Conclusion Process mining can be utilized to visualize and analyse patient journeys and identify gaps in service quality, thus contributing to better patient-centred care and improved patient outcomes and experiences in stroke rehabilitation.
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Affiliation(s)
- Ingy Shafei
- The University of Adelaide, Adelaide, SA, Australia
- Flinders University, Adelaide, SA, Australia
| | - Jonathan Karnon
- The University of Adelaide, Adelaide, SA, Australia
- Flinders University, Adelaide, SA, Australia
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Syed R, Eden R, Makasi T, Chukwudi I, Mamudu A, Kamalpour M, Kapugama Geeganage D, Sadeghianasl S, Leemans SJJ, Goel K, Andrews R, Wynn MT, Ter Hofstede A, Myers T. Digital Health Data Quality Issues: Systematic Review. J Med Internet Res 2023; 25:e42615. [PMID: 37000497 PMCID: PMC10131725 DOI: 10.2196/42615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/07/2022] [Accepted: 12/31/2022] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The promise of digital health is principally dependent on the ability to electronically capture data that can be analyzed to improve decision-making. However, the ability to effectively harness data has proven elusive, largely because of the quality of the data captured. Despite the importance of data quality (DQ), an agreed-upon DQ taxonomy evades literature. When consolidated frameworks are developed, the dimensions are often fragmented, without consideration of the interrelationships among the dimensions or their resultant impact. OBJECTIVE The aim of this study was to develop a consolidated digital health DQ dimension and outcome (DQ-DO) framework to provide insights into 3 research questions: What are the dimensions of digital health DQ? How are the dimensions of digital health DQ related? and What are the impacts of digital health DQ? METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a developmental systematic literature review was conducted of peer-reviewed literature focusing on digital health DQ in predominately hospital settings. A total of 227 relevant articles were retrieved and inductively analyzed to identify digital health DQ dimensions and outcomes. The inductive analysis was performed through open coding, constant comparison, and card sorting with subject matter experts to identify digital health DQ dimensions and digital health DQ outcomes. Subsequently, a computer-assisted analysis was performed and verified by DQ experts to identify the interrelationships among the DQ dimensions and relationships between DQ dimensions and outcomes. The analysis resulted in the development of the DQ-DO framework. RESULTS The digital health DQ-DO framework consists of 6 dimensions of DQ, namely accessibility, accuracy, completeness, consistency, contextual validity, and currency; interrelationships among the dimensions of digital health DQ, with consistency being the most influential dimension impacting all other digital health DQ dimensions; 5 digital health DQ outcomes, namely clinical, clinician, research-related, business process, and organizational outcomes; and relationships between the digital health DQ dimensions and DQ outcomes, with the consistency and accessibility dimensions impacting all DQ outcomes. CONCLUSIONS The DQ-DO framework developed in this study demonstrates the complexity of digital health DQ and the necessity for reducing digital health DQ issues. The framework further provides health care executives with holistic insights into DQ issues and resultant outcomes, which can help them prioritize which DQ-related problems to tackle first.
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Affiliation(s)
- Rehan Syed
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Rebekah Eden
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Tendai Makasi
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Ignatius Chukwudi
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Azumah Mamudu
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Mostafa Kamalpour
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Dakshi Kapugama Geeganage
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Sareh Sadeghianasl
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Sander J J Leemans
- Rheinisch-Westfälische Technische Hochschule, Aachen University, Aachen, Germany
| | - Kanika Goel
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Robert Andrews
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Moe Thandar Wynn
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Arthur Ter Hofstede
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Trina Myers
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
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Derakhshan P, Azadmanjir Z, Naghdi K, Habibi Arejan R, Safdarian M, Zarei MR, Jazayeri SB, Sharif-Alhoseini M, Arab Kheradmand J, Amirjamshidi A, Ghodsi Z, Faghih Jooybari M, Mohammadzadeh M, Khazaeipour Z, Abdollah Zadegan S, Abedi A, Oreilly G, Noonan V, Benzel EC, Vaccaro AR, Sadeghian F, Rahimi-Movaghar V. The impact of data quality assurance and control solutions on the completeness, accuracy, and consistency of data in a national spinal cord injury registry of Iran (NSCIR-IR). Spinal Cord Ser Cases 2021; 7:51. [PMID: 34112766 DOI: 10.1038/s41394-020-00358-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/29/2020] [Accepted: 10/27/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Descriptive study. OBJECTIVE This study aimed to develop and evaluate a systematic arrangement for improvement and monitoring of data quality of the National Spinal Cord (and Column) Injury Registry of Iran (NSCIR-IR)-a multicenter hospital-based registry. SETTING SCI community in Iran. METHODS Quality assurance and quality control were the primary objectives in improving overall quality of data that were considered in designing a paper-based and computerized case report. To prevent incorrect data entry, we implemented several validation algorithms, including 70 semantic rules, 18 syntactic rules, seven temporal rules, and 13 rules for acceptable value range. Qualified and trained staff members were also employed to review and identify any defect, inaccuracy, or inconsistency in the data to improve data quality. A set of functions were implemented in the software to cross-validate, and feedback on data was provided by reviewers and registrars. RESULTS Socio-demographic data items were 100% complete, except for national ID and education level, which were 97% and 92.3% complete, respectively. Completeness of admission data and emergency medical services data were 100% except for arrival and transfer time (99.4%) and oxygen saturation (48.9%). Evaluation of data received from two centers located in Tehran proved to be 100% accurate following validation by quality reviewers. All data was also found to be 100% consistent. CONCLUSIONS This approach to quality assurance and consistency validation proved to be effective. Our solutions resulted in a significant decrease in the number of missing data.
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Affiliation(s)
- Pegah Derakhshan
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Azadmanjir
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Habibi Arejan
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Safdarian
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zarei
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behzad Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Faghih Jooybari
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Khazaeipour
- Brain and Spinal Injuries Research Center (BASIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Abdollah Zadegan
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aidin Abedi
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Gerard Oreilly
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3800, Australia
| | - Vanessa Noonan
- Rick Hansen Institute, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Edward C Benzel
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Farideh Sadeghian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Brain and Spinal Injuries Research Center (BASIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Charnock V. Electronic healthcare records and data quality. Health Info Libr J 2019; 36:91-95. [PMID: 30811882 DOI: 10.1111/hir.12249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/30/2022]
Abstract
This paper is based on Victoria Charnock's MA dissertation carried out as part of her Masters in Leadership and Management in Healthcare at the University of Salford and supervised by Professor Hardiker. A review of current literature was conducted to provide a robust and dimensional definition of data quality in the field of health care. This was used as the basis on which to assess the effect that electronic health care records has had in practice, specifically on data quality and according to the dimensions of accuracy, completeness and use of data. All of the papers reviewed referred to the importance of accuracy and completeness, identifying the advantages of electronic health records in their use of standardized data entry controls. Drawing on the third dimension in the definition, use of data, the impact that system design may have on data quality and implications for staff training is further discussed and recommendations made. F.J.
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Affiliation(s)
- Victoria Charnock
- College of Health and Social Care, University of Salford, Salford, UK
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Pruinelli L, Simon GJ, Monsen KA, Pruett T, Gross CR, Radosevich DM, Westra BL. A Holistic Clustering Methodology for Liver Transplantation Survival. Nurs Res 2019; 67:331-340. [PMID: 29877986 PMCID: PMC6023761 DOI: 10.1097/nnr.0000000000000289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Liver transplants account for a high number of procedures with major investments from all stakeholders involved; however, limited studies address liver transplant population heterogeneity pretransplant predictive of posttransplant survival. OBJECTIVE The aim of the study was to identify novel and meaningful patient clusters predictive of mortality that explains the heterogeneity of liver transplant population, taking a holistic approach. METHODS A retrospective cohort study of 344 adult patients who underwent liver transplantation between 2008 through 2014. Predictors were summarized severity scores for comorbidities and other suboptimal health states grouped into 11 body systems, the primary reason for transplantation, demographics/environmental factors, and Model for End Liver Disease score. Logistic regression was used to compute the severity scores, hierarchical clustering with weighted Euclidean distance for clustering, Lasso-penalized regression for characterizing the clusters, and Kaplan-Meier analysis to compare survival across the clusters. RESULTS Cluster 1 included patients with more severe circulatory problems. Cluster 2 represented older patients with more severe primary disease, whereas Cluster 3 contained healthiest patients. Clusters 4 and 5 represented patients with musculoskeletal (e.g., pain) and endocrine problems (e.g., malnutrition), respectively. There was a statistically significant difference for mortality between clusters (p < .001). CONCLUSIONS This study developed a novel methodology to address heterogeneous and high-dimensional liver transplant population characteristics in a single study predictive of survival. A holistic approach for data modeling and additional psychosocial risk factors has the potential to address holistically nursing challenges on liver transplant care and research.
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Affiliation(s)
- Lisiane Pruinelli
- Lisiane Pruinelli, PhD, MS, RN, is Assistant Professor, University of Minnesota School of Nursing, Minneapolis. György J. Simon, PhD, is Assistant Professor, University of Minnesota Institute for Health Informatics and School of Medicine, Minneapolis. Karen A. Monsen, PhD, RN, FAAN, is Associate Professor, University of Minnesota School of Nursing, Minneapolis. Timothy Pruett, MD, is Professor and Chief, Division of Transplantation, University of Minnesota Department of Surgery, Minneapolis. Cynthia R. Gross, PhD, is Professor Emerita, University of Minnesota Department of Experimental and Clinical Pharmacology and School of Nursing, Minneapolis. David M. Radosevich, PhD, RN, is Adjunct Assistant Professor, University of Minnesota School of Public Health, Minneapolis. Bonnie L. Westra, PhD, RN, FAAN, FACMI, is Associate Professor, University of Minnesota School of Nursing and Institute for Health Informatics, Minneapolis
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Abstract
OBJECTIVE Process mining offers ways to discover patient flow, check how actual processes conform to a standard, and use data to enhance or improve processes. Process mining has been used in health care for about a decade, however, with limited focus on quality improvement. Hence, the aim of the article is to present how process mining can be used to support quality improvement, thereby bridging the gap between process mining and quality improvement. METHOD We have analyzed current literature to perform a comparison between process mining and process mapping. RESULT To better understand how process mining can be used for quality improvement we provide 2 examples. We have noted 4 limitations that must be overcome, which have been formulated as propositions for practice. We have also formulated 3 propositions for future research. CONCLUSION In summary, although process mapping is still valuable in quality improvement, we suggest increased focus on process mining. Process mining adds to quality improvement by providing a better understanding of processes in terms of uncovering (un)wanted variations as to obtain better system results.
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Kurniati AP, Rojas E, Hogg D, Hall G, Johnson OA. The assessment of data quality issues for process mining in healthcare using Medical Information Mart for Intensive Care III, a freely available e-health record database. Health Informatics J 2018; 25:1878-1893. [PMID: 30488750 DOI: 10.1177/1460458218810760] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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. Our article aims to (1) explore data quality issues for healthcare process mining using Medical Information Mart for Intensive Care III, (2) provide a structured assessment of Medical Information Mart for Intensive Care III data quality and challenge for process mining, and (3) provide a worked example of cancer treatment as a case study of process mining using Medical Information Mart for Intensive Care III to illustrate an approach and solution to data quality challenges. The electronic health record software was upgraded partway through the period over which data was collected and we use this event to explore the link between electronic health record system design and resulting process models.
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Affiliation(s)
| | - Eric Rojas
- Pontificia Universidad Catolica de Chile, Chile
| | | | - Geoff Hall
- University of Leeds, UK; St James's University Hospital, Leeds, UK
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Developing a Rural, Community-Based Registry for Cardiovascular Quality Improvement. Qual Manag Health Care 2018; 27:209-214. [PMID: 30260928 DOI: 10.1097/qmh.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular disease is one of the leading causes of death, yet most evidence is collected from small clinical trials or individual hospital providers. Achieving scalable data to enable quality improvements (QIs) remains a challenge. We investigate whether a registry that is shared by multiple providers and integrates data longitudinally could help drive QIs across a large rural geographic region. METHODS We describe a case study involving the development of an informatics infrastructure across the entire state of Wyoming. This rural, regional, community-based cardiovascular system of care involved all interventional hospitals in the state as well as all surrounding states. Data exchange was initiated between 36 hospitals, and 56 ambulance agencies, to a centralized registry for clinical analytics and QI for patients with acute myocardial infarction. RESULTS After 3 years, the registry maintained all documented acute myocardial infarctions across Wyoming. Median total ischemic time (time from patient's symptom onset to definitive treatment) had a 36.7% improvement during the program. Changes in quality for the rural community included reduction in overall treatment times, as well as enhanced training, standardized protocols, and community awareness. We also share key lessons learned. CONCLUSIONS Collaborative data registries for emergency cardiovascular care can help providers and communities measure and improve the quality of the care across regions.
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Leveraging semantic labels for multi-level abstraction in medical process mining and trace comparison. J Biomed Inform 2018; 83:10-24. [DOI: 10.1016/j.jbi.2018.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/16/2018] [Accepted: 05/19/2018] [Indexed: 11/17/2022]
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Lanzola G, Bossi P, Quaglini S, Zini EM. An Environment for Guidelinebased Decision Support Systems for Outpatients Monitoring. Methods Inf Med 2018; 56:283-293. [DOI: 10.3414/me16-01-0142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/19/2017] [Indexed: 01/31/2023]
Abstract
SummaryObjectives: We propose an architecture for monitoring outpatients that relies on mobile technologies for acquiring data. The goal is to better control the onset of possible side effects between the scheduled visits at the clinic.Methods: We analyze the architectural components required to ensure a high level of abstraction from data. Clinical practice guidelines were formalized with Alium, an authoring tool based on the PROforma language, using SNOMED-CT as a terminology standard. The Alium engine is accessible through a set of APIs that may be leveraged for implementing an application based on standard web technologies to be used by doctors at the clinic. Data sent by patients using mobile devices need to be complemented with those already available in the Electronic Health Record to generate personalized recommendations. Thus a middleware pursuing data abstraction is required. To comply with current standards, we adopted the HL7 Virtual Medical Record for Clinical Decision Support Logical Model, Release 2.Results: The developed architecture for monitoring outpatients includes: (1) a guideline-based Decision Support System accessible through a web application that helps the doctors with prevention, diagnosis and treatment of therapy side effects; (2) an application for mobile devices, which allows patients to regularly send data to the clinic. In order to tailor the monitoring procedures to the specific patient, the Decision Support System also helps physicians with the configuration of the mobile application, suggesting the data to be collected and the associated collection frequency that may change over time, according to the individual patient’s conditions. A proof of concept has been developed with a system for monitoring the side effects of chemo-radiotherapy in head and neck cancer patients.Conclusions: Our environment introduces two main innovation elements with respect to similar works available in the literature. First, in order to meet the specific patients’ needs, in our work the Decision Support System also helps the physicians in properly configuring the mobile application. Then the Decision Support System is also continuously fed by patient-reported outcomes.
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Multiple Overimputation to Address Missing Data and Measurement Error: Application to HIV Treatment During Pregnancy and Pregnancy Outcomes. Epidemiology 2018; 27:642-50. [PMID: 27054651 DOI: 10.1097/ede.0000000000000494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Investigations of the association of combination antiretroviral therapy (ART) with pregnancy outcomes often rely on routinely collected clinical data, which are prone to missing data and measurement error. Measurement error in gestational age may bias the relation between combination ART and gestational age-based outcomes. METHODS We demonstrate the use of multiple overimputation to address missing data and measurement error in gestational age. Using routinely collected clinical data from public health facilities in Lusaka, Zambia, we multiply imputed missing data and multiply overimputed observed values of gestational age. Poisson models with robust variance estimators were used to estimate risk ratios (RRs) for the associations of duration of combination ART with small for gestational age (SGA) and preterm birth. We compared results from a complete-case analysis, using multiple imputation to address missing data only and using multiple overimputation to address missing data and measurement error. RESULTS In the complete-case analysis, there was no evidence of an association between duration of combination ART and SGA or preterm birth. When we performed multiple overimputation, RRs for SGA moved past the null, but remained imprecise. For preterm birth, RRs for 9-32 weeks of combination ART moved away from the null as the variance due to measurement error increased. CONCLUSION When we used multiple overimputation to account for measurement error and missing data, we observed an increased risk of preterm birth with longer duration of combination ART. Future analyses examining associations between combination ART and pregnancy outcomes should consider using multiple overimputation to address measurement error in gestational age.
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Mansmann U, Lindoerfer D. A Comprehensive Assessment Tool for Patient Registry Software Systems: The CIPROS Checklist. Methods Inf Med 2018; 54:447-54. [DOI: 10.3414/me14-02-0026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/24/2015] [Indexed: 12/21/2022]
Abstract
SummaryBackground: Patient registries are an important instrument in medical research. Often their structure is complex and their implementation uses composite software systems to meet the wide spectrum of challenges.Objectives: For the implementation of a registry, there is a wide range of commercial, open source, and self-developed systems available and a minimal standard for the critical appraisal of their architecture is needed.Methods: We performed a systematic review of the literature to define a catalogue of relevant criteria to construct a minimal appraisal standard.Results: The CIPROS list is developed based on 64 papers which were found by our systematic review. The list covers twelve sections and contains 72 items.Conclusions: The CIPROS list supports developers to assess requirements on existing systems and strengthens the reporting of patient registry software system descriptions. It can be a first step to create standards for patient registry software system assessments.
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Marco-Ruiz L, Bønes E, de la Asunción E, Gabarron E, Aviles-Solis JC, Lee E, Traver V, Sato K, Bellika JG. Combining multivariate statistics and the think-aloud protocol to assess Human-Computer Interaction barriers in symptom checkers. J Biomed Inform 2017; 74:104-122. [PMID: 28893671 DOI: 10.1016/j.jbi.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 08/28/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
Abstract
Symptom checkers are software tools that allow users to submit a set of symptoms and receive advice related to them in the form of a diagnosis list, health information or triage. The heterogeneity of their potential users and the number of different components in their user interfaces can make testing with end-users unaffordable. We designed and executed a two-phase method to test the respiratory diseases module of the symptom checker Erdusyk. Phase I consisted of an online test with a large sample of users (n=53). In Phase I, users evaluated the system remotely and completed a questionnaire based on the Technology Acceptance Model. Principal Component Analysis was used to correlate each section of the interface with the questionnaire responses, thus identifying which areas of the user interface presented significant contributions to the technology acceptance. In the second phase, the think-aloud procedure was executed with a small number of samples (n=15), focusing on the areas with significant contributions to analyze the reasons for such contributions. Our method was used effectively to optimize the testing of symptom checker user interfaces. The method allowed kept the cost of testing at reasonable levels by restricting the use of the think-aloud procedure while still assuring a high amount of coverage. The main barriers detected in Erdusyk were related to problems understanding time repetition patterns, the selection of levels in scales to record intensities, navigation, the quantification of some symptom attributes, and the characteristics of the symptoms.
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Affiliation(s)
- Luis Marco-Ruiz
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, N-9038 Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, 9037 Tromsø, Norway.
| | - Erlend Bønes
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, N-9038 Tromsø, Norway
| | - Estela de la Asunción
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, N-9038 Tromsø, Norway
| | - Elia Gabarron
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, N-9038 Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Juan Carlos Aviles-Solis
- Department of Community Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Eunji Lee
- SINTEF, Forskningsveien 1, 0373 Oslo, Norway
| | - Vicente Traver
- Instituto de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Keiichi Sato
- Institute of Design, Illinois Institute of Technology, 565 West Adams Street, Chicago, IL 60661, United States; Department of Computer Science, UIT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Johan G Bellika
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, N-9038 Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, 9037 Tromsø, Norway
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Nasir A, Liu X, Gurupur V, Qureshi Z. Disparities in patient record completeness with respect to the health care utilization project. Health Informatics J 2017; 25:401-416. [DOI: 10.1177/1460458217716005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Quaglini S, Sacchi L, Lanzola G, Viani N. Personalization and Patient Involvement in Decision Support Systems: Current Trends. Yearb Med Inform 2017; 10:106-18. [PMID: 26293857 DOI: 10.15265/iy-2015-015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. METHODS We considered papers published on scientific journals, by querying PubMed and Web of ScienceTM. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. RESULTS We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. CONCLUSIONS Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large.
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Affiliation(s)
- S Quaglini
- Silvana Quaglini, Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Via Ferrata 5, 27100 Pavia, Italy, Tel: +39 0382 985058, Fax: +39 0382 985060, E-mail:
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Canavero I, Cavallini A, Sacchi L, Quaglini S, Arnò N, Perrone P, DeLodovici ML, Marcheselli S, Micieli G. Safely Addressing Patients with Atrial Fibrillation to Early Anticoagulation after Acute Stroke. J Stroke Cerebrovasc Dis 2016; 26:7-18. [PMID: 27614403 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/25/2016] [Accepted: 08/12/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It has been widely reported that anticoagulants (ACs) are underused for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation (AFib). Furthermore, precise evidence-based guidelines about the best timing for AC initiation after acute stroke are currently lacking. METHODS AND RESULTS In this retrospective, observational study, we analyzed prescription trends in AFib patients with acute ischemic stroke who were hospitalized in four neurologic stroke units of our region (Lombardia, Italy). In-hospital antithrombotic prescription was performed in highly heterogeneous patterns. A prestroke treatment with AC was the leading factor enhancing AC prescription during hospitalization. The other factors promoting AC were male gender, younger age, lower prestroke disability and stroke severity, and smaller stroke volumes. AFib subtype influenced AC prescription only in AC-naïve patients. Interestingly, Congestive heart failure, Hypertension, Age higher than 75 years, Diabetes, previous Stroke or TIA or thromboembolism, Vascular disease, Age 64-75 years, female Sex (CHA2DS2-VASc) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs and alcohol (HAS-BLED) scores were not associated with AC prescription. However, patients who were treated with AC, including early treatment (<48 hours), showed a low rate of bleeding. CONCLUSIONS Our findings potentially suggest that, although apparently neglecting the common risk stratification tools, our neurologists were able to select the more suitable candidates for prompt AC treatment. Further studies are needed to develop new scoring systems to aid ischemic and hemorrhagic risk estimation in the secondary prevention of stroke.
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Affiliation(s)
- Isabella Canavero
- Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy.
| | - Anna Cavallini
- Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Natale Arnò
- Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy
| | - Patrizia Perrone
- Department of Neurosciences, Neurology Unit, "Ospedale Civile", Legnano, Italy
| | - Maria Luisa DeLodovici
- Stroke Unit, Department of Neurology, "Fondazione Macchi-Ospedale di Circolo", Insubria University, Varese, Italy
| | - Simona Marcheselli
- Emergency Neurology and Stroke Unit, "Istituto Clinico Humanitas", Milan, Italy
| | - Giuseppe Micieli
- Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy
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18
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Nasir A, Gurupur V, Liu X. A New Paradigm to Analyze Data Completeness of Patient Data. Appl Clin Inform 2016; 7:745-64. [PMID: 27484918 DOI: 10.4338/aci-2016-04-ra-0063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/04/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a need to develop a tool that will measure data completeness of patient records using sophisticated statistical metrics. Patient data integrity is important in providing timely and appropriate care. Completeness is an important step, with an emphasis on understanding the complex relationships between data fields and their relative importance in delivering care. This tool will not only help understand where data problems are but also help uncover the underlying issues behind them. OBJECTIVES Develop a tool that can be used alongside a variety of health care database software packages to determine the completeness of individual patient records as well as aggregate patient records across health care centers and subpopulations. METHODS The methodology of this project is encapsulated within the Data Completeness Analysis Package (DCAP) tool, with the major components including concept mapping, CSV parsing, and statistical analysis. RESULTS The results from testing DCAP with Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) data show that this tool is successful in identifying relative data completeness at the patient, subpopulation, and database levels. These results also solidify a need for further analysis and call for hypothesis driven research to find underlying causes for data incompleteness. CONCLUSION DCAP examines patient records and generates statistics that can be used to determine the completeness of individual patient data as well as the general thoroughness of record keeping in a medical database. DCAP uses a component that is customized to the settings of the software package used for storing patient data as well as a Comma Separated Values (CSV) file parser to determine the appropriate measurements. DCAP itself is assessed through a proof of concept exercise using hypothetical data as well as available HCUP SID patient data.
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Affiliation(s)
| | - Varadraj Gurupur
- Varadraj Gurupur, Department of Health Management and Informatics, University of Central Florida, ,
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Kaiser AM, de Jong E, Evelein-Brugman SF, Peppink JM, Vandenbroucke-Grauls CM, Girbes AR. Development of trigger-based semi-automated surveillance of ventilator-associated pneumonia and central line-associated bloodstream infections in a Dutch intensive care. Ann Intensive Care 2014; 4:40. [PMID: 25646148 PMCID: PMC4303743 DOI: 10.1186/s13613-014-0040-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/11/2014] [Indexed: 11/24/2022] Open
Abstract
Background Availability of a patient data management system (PDMS) has created the opportunity to develop trigger-based electronic surveillance systems (ESSs). The aim was to evaluate a semi-automated trigger-based ESS for the detection of ventilator-associated pneumonia (VAP) and central line-associated blood stream infections (CLABSIs) in the intensive care. Methods Prospective comparison of surveillance was based on a semi-automated ESS with and without trigger. Components of the VAP/CLABSI definition served as triggers. These included the use of VAP/CLABSI-related antibiotics, the presence of mechanical ventilation or an intravenous central line, and the presence of specific clinical symptoms. Triggers were automatically fired by the PDMS. Chest X-rays and microbiology culture results were checked only on patient days with a positive trigger signal from the ESS. In traditional screening, no triggers were used; therefore, chest X-rays and culture results had to be screened for all patient days of all included patients. Patients with pneumonia at admission were excluded. Results A total of 553 patients were screened for VAP and CLABSI. The incidence of VAP was 3.3/1,000 ventilation days (13 VAP/3,927 mechanical ventilation days), and the incidence of CLABSI was 1.7/1,000 central line days (24 CLABSI/13.887 central line days). For VAP, the trigger-based screening had a sensitivity of 92.3%, a specificity of 100%, and a negative predictive value of 99.8% compared to traditional screening of all patients. For CLABSI, sensitivity was 91.3%, specificity 100%, and negative predictive value 99.6%. Conclusions Pre-selection of patients to be checked for signs and symptoms of VAP and CLABSI by a computer-generated automated trigger system was time saving but slightly less accurate than conventional surveillance. However, this after-the-fact surveillance was mainly designed as a quality indicator over time rather than for precise determination of infection rates. Therefore, surveillance of VAP and CLABSI with a trigger-based ESS is feasible and effective.
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Affiliation(s)
- Anna Maria Kaiser
- Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands ; Department of Intensive Care, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands
| | - Evelien de Jong
- Department of Intensive Care, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands
| | | | - Jan M Peppink
- Department of Intensive Care, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands
| | | | - Armand Rj Girbes
- Department of Intensive Care, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands
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