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Documentation of patient care is essential for both out-of-hospital and in-hospital clinical management. Secondarily, documentation is key for monitoring and improving quality; however, in some EMS systems initial care is often provided by non-transporting agencies whose personnel may not routinely complete patient care reports. Limited data exist describing effective methods for increasing complete patient care documentation among non-transporting agencies. The aim of this quality improvement project was to increase electronic health record (EHR) documentation compliance in a large urban fire-based non-transporting EMS agency. The improvement project began in May 2020. Our primary outcome was the proportion of completed EHR records for EMS responses. Primary drivers were determined from informal interviews with front-line firefighters. Interventions were implemented following a Plan-Do-Study-Act (PDSA) approach first at a single station, then battalion, and ultimately at the entire department. Interventions included performance reports, modifications of chart requirements, localized directive requiring EHR completion for all EMS runs, directive to officers that EHRs are required, documentation training, and a department-wide directive. We used statistical process control charts (p-chart) to identify special cause variation following interventions. The baseline of EHR completion for the entire fire department was 5% (373/7423 records) for the month of January 2020. Front-line interviews with 58 firefighters revealed drivers including lack of accountability and unfamiliarity with the software. After implementing a station performance report at one fire station, the station's EHR rate climbed from 0.9% (3/337 records) to 26.7% (179/671) after 9 weeks. This test was expanded to a battalion of six stations with similar results. After multiple PDSA cycles focused on agency policy and training, overall department wide EHR compliance per month improved to 89% (4,816/5,439 records) for the month of February 2021 and sustained in following months. Within this large urban fire department, EHR documentation compliance improved significantly through a series of tests of change. Informal interviews with front-line personnel were instrumental in determining primary drivers to develop change ideas. Performance reports, training and facilitation of the reporting process, and department-wide directives led to acceptance and improvement with EHR compliance. [ABSTRACT FROM AUTHOR]

Digital approaches to support advance care planning (ACP) documentation and sharing are increasingly being used, with a lack of research to characterise their design, content, and use. This study aimed to characterise how digital approaches are being used to support ACP documentation and sharing internationally. A scoping review was performed in accordance with the JBI (formerly Joanna Briggs Institute) guidelines and the PRISMA 2020 checklist, prospectively registered on Open Science Framework (). MEDLINE, EMBASE, PsycINFO, ACM Digital, IEEE Xplore and CINAHL were searched in February 2023. Only publications in English, published from 2008 onwards were considered. Eligibility criteria included a focus on ACP and electronic systems. Out of 2,393 records, 34 reports were included, predominantly from the USA (76.5%). ACP documentation is typically stored in electronic health records (EHRs) (67.6%), with a third (32.4%) enabling limited patient access. Non-standard approaches (n = 15;44.1%) were the commonest study design of included reports, with outcome measures focusing on the influence of systems on the documentation (i.e. creation, quantity, quality, frequency or timing) of ACP information (n = 23;67.6%). Digital approaches to support ACP are being implemented and researched internationally with an evidence base dominated by non-standard study designs. Future research is needed to extend outcome measurement to consider aspects of care quality and explore whether the content of existing systems aligns with aspects of care that are valued by patients. [ABSTRACT FROM AUTHOR]

Agricultural injuries remain a major concern in North America, with a fatal injury rate of 19.5 deaths per 100,000 workers in the United States. Numerous research efforts have sought to compile and analyze records of agricultural-related injuries and fatalities at a national level, utilizing resources, ranging from newspaper clippings and hospital records to Emergency Medical System (EMS) data, death certifications, surveys, and other multiple sources. Despite these extensive efforts, a comprehensive understanding of injury trends over extended time periods and across diverse types of data sources remains elusive, primarily due to the duration of data collection and the focus on specific subsets. This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, consolidates and analyzes agricultural injury surveillance data from 48 eligible papers published between 1985 and 2022 to offer a holistic understanding of trends and challenges. These papers, reporting an average of 25,000 injuries each, were analyzed by database source type, injury severity, nature of injury, body part, source of injury, event/exposure, and age. One key finding is that the top source of injury or event/exposure depends on the chosen surveillance system and injury severity, underscoring the need of diverse data sources for a nuanced understanding of agricultural injuries. This study provides policymakers, researchers, and practitioners with crucial insights to bolster the development and analysis of surveillance systems in agricultural safety. The overarching aim is to address the pressing issue of agricultural injuries, contributing to a safer work environment and ultimately enhancing the overall well-being of individuals engaged in agriculture. [ABSTRACT FROM AUTHOR]

Background: Transgender individuals are known to be at a higher risk for certain chronic conditions compared to cisgender individuals. Similarly, research also shows justice-involved individuals have a higher risk of chronic conditions compared to non-justice-involved individuals.Aim: This study aims to investigate the differences in chronic disease diagnoses between transgender and cisgender individuals who either utilized healthcare services provided by a US county health system or who were incarcerated in the same county’s jail. Method: We leveraged electronic health record data from a United States county health system, including data from the local jail, to evaluate the difference in diagnosis of certain chronic conditions among transgender and cisgender individuals. We also compared individuals who experienced incarceration and those who did not. Results: We found transgender individuals experiencing recent incarceration were more likely to be diagnosed with substance use disorder, HIV/AIDS, and Hepatitis C than cisgender individuals. Transgender individuals not experiencing recent incarceration were more likely to be diagnosed with HIV/AIDS, seizure disorder, major depressive disorder, and bipolar disorder than cisgender individuals. Conclusion: These results highlight how transgender individuals may be disproportionately impacted by certain diseases within and outside carceral settings. [ABSTRACT FROM AUTHOR]

We evaluated first-pass endotracheal intubation (ETI) success within the critical care transport (CCT) environment using a natural experiment created by the COVID-19 pandemic. Our primary objective was to evaluate if the use of personal protective equipment (PPE) or the COVID-19 time period was associated with differences in first-pass success rates of ETI within a large CCT system with a high baseline ETI first-pass success rate. We hypothesized that pandemic-related challenges would be associated with decreased first-pass success rates. We performed a retrospective before-after cohort study of airway management by CCT personnel relative to the COVID-19 pandemic. We used a mixed effects logistic regression to evaluate the association between enhanced PPE (N95 mask, eye protection) use and the pandemic time period on first-pass intubation success, while controlling for other factors potentially associated with intubation success. Variables in the final model included patient demographics (age, sex, and race), body mass index, medical category (trauma versus non-trauma), interfacility or scene response, blade size (Macintosh 3 versus 4), use of face mask, use of eye protection, and crew member length of service. We identified 1279 cases involving intubation attempts on adult patients during the study period. A total of 1133 cases were included in the final analysis, with an overall first-pass success rate of 95.7% (96.4% pre-COVID-19 and 94.8% during COVID-19). In our final mixed effects logistic regression model, enhanced PPE use and the COVID-19 time period were not associated with first-pass intubation success rate. In a large regional CCT system with a high ETI first-pass success rate, neither PPE use nor the COVID-19 time period were associated with differences in ETI first-pass success while controlling for relevant patient and operational factors. Other emergency medical services (EMS) systems may have encountered different effects of pandemic-related PPE use on intubation success rates. Further studies are needed to evaluate the influence of sustained use of enhanced PPE or changes in training or procedural experience on post-pandemic ETI first-pass success rates for non-CCT EMS clinicians. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the effect of transitioning from direct laryngoscopy (DL) to video laryngoscopy (VL) on endotracheal intubation success overall and with enhanced precautions implemented during the COVID-19 pandemic. We examined electronic transport records from Mayo Clinic Ambulance Service, a large advanced life support (ALS) provider serving rural, suburban, and urban areas in Minnesota and Wisconsin, USA. We determined the success of intubation attempts when using DL (March 10, 2018 to December 19, 2019), VL (December 20, 2019 to September 29, 2021), and VL with an enhanced COVID-19 guideline that restricted intubation to one attempt, performed by the most experienced clinician, who wore enhanced personal protective equipment (April 1 to December 18, 2020). Success rates at first attempt and after any attempt were assessed for association with type of laryngoscopy (VL vs DL) after adjusting for patient age group, patient weight, use of enhanced COVID-19 guideline, medical vs trauma patient, and ALS vs critical care clinician. A secondary analysis further adjusted for degree of glottic visualization. We identified 895 intubation attempts using DL and 893 intubation attempts using VL, which included 382 VL intubation attempts using the enhanced COVID-19 guideline. Success on first intubation attempt was 69.2% for encounters with DL, 82.9% overall with VL, and 83.2% with VL and enhanced COVID-19 protocols (DL vs overall VL: p < 0.001; COVID-19 vs non-COVID VL: p = 0.86). In multivariable analysis, use of VL was associate with higher odds of successful intubation on first attempt (odds ratio, 2.28; 95%CI, 1.73–3.01; p < 0.001) and on any attempt (odds ratio, 2.16; 95%CI, 1.58–2.96; p < 0.001) compared with DL. Inclusion of glottic visualization in the model resulted in a nonsignificant association between laryngoscopy type and successful first intubation (p = 0.41) and a significant association with the degree of glottic visualization (p < 0.001). VL is designed to improve glottic visualization. The use of VL by a large, U.S. multistate ALS ambulance service was associated with increased odds of successful first-pass and overall attempted intubation, which was mediated by better visualization of the glottis. COVID-19 protocols were not associated with success rates. [ABSTRACT FROM AUTHOR]

Through automated electronic health record (EHR) data extraction and analysis, this project systematically quantified actual care delivery for children with cerebral palsy (CP) and evaluated alignment with current evidence-based recommendations. Utilizing EHR data for over 8000 children with CP, we developed an approach to define and quantify receipt of optimal care, and pursued proof-of-concept with two children with unilateral CP, Gross Motor Function Classification System (GMFCS) Level II. Optimal care was codified as a cluster of four components including physical medicine and rehabilitation (PMR) care, spasticity management, physical therapy (PT), and occupational therapy (OT). A Receipt of Care Score (ROCS) quantified the degree of adherence to recommendations and was compared with the Pediatric Outcomes Data Collection Instrument (PODCI) and Pediatric Quality of Life Inventory (PEDS QL). The two children (12 year old female, 13 year old male) had nearly identical PMR and spasticity component scores while PT and OT scores were more divergent. Functional outcomes were higher for the child who had higher adjusted ROCS. ROCSs demonstrate variation in real-world care delivered over time and differentiate between components of care. ROCSs reflect overall function and quality of life. The ROCS methods developed are novel, robust, and scalable and will be tested in a larger sample. Optimal practice, with an emphasis on integrated multidisciplinary care, can be defined and quantified utilizing evidence-based recommendations. Receipt of optimal care for childhood cerebral palsy can be scored using existing electronic health record data. Big Data approaches can contribute to the understanding of current care and inform approaches for improved care. [ABSTRACT FROM AUTHOR]

Physical activity (PA) improves quality of life and prevents chronic disease, yet many adults are inactive. Planning with health care providers in the form of exercise "prescriptions" may increase PA, but the role of individual psychosocial factors within exercise prescription programs is not well understood. Therefore, the purpose of this study is to describe the role of self-regulation strategies (e.g., goal setting, self-monitoring, reinforcements) in PA behavior change within the context of an exercise prescription program. Patients at a large, Federally Qualified Health Center with an on-site exercise facility (ie, "Wellness Center") referral were eligible to exercise with a personal fitness advisor. Self-reported PA and use of 15 self-regulation strategies were measured via survey at two time points and merged with electronic health records and attendance data. Patients (n = 151) were, on average, 50.3 ± 13.3 years and mostly female (76.8%). Almost one-third (30.5%) were Hispanic/Latino, 48.3% were non-Hispanic Black, and 20.5% were non-Hispanic white. Participants completed 10.7 ± 12.0 in-person exercise sessions with a fitness advisor. Between baseline and follow-up, the self-regulation strategies that had the largest change in frequency over time were keeping track of PA (p < 0.001), thinking about surroundings (p < 0.001), rewarding yourself for PA (p < 0.001), making PA more enjoyable (p < 0.001), setting goals (p < 0.001), and trying different kinds of PA (p < 0.001). Among exercise prescription program participants, the total self-regulation strategies score was significantly associated with physical activity at follow-up (p = 0.04). Leveraging self-regulatory skill-building activities within the context of exercise prescription programs in clinical settings may provide a personalized and multicomponent approach to PA promotion. Self-regulation strategy training for fitness advisors and/or health care providers has great potential for supporting long-term health behaviors like PA for managing chronic disease among underserved patients. [ABSTRACT FROM AUTHOR]

This study assessed predictors of stable HIV viral suppression in a racially diverse sample of persons living with HIV (PWH) in the southern US. A total of 700 PWH were recruited from one of four HIV clinics in Metro Atlanta, GA. Data were collected from September 2012 to July 2017, and HIV viral loads were retrieved from EMR for 18 months. The baseline visits and EMR data were used for current analyses. Durable viral suppression was categorized as 1. Remain suppressed, 2. Remain unsuppressed, and 3. Unstable suppression. The number of antiretroviral medications and age were significantly associated with durable viral suppression. Older age, fewer ART medications and availability of social support were positively associated with durable viral suppression over the 18-month observation period. Findings suggest that regimen complexity is potentially a better predictor of viral suppression than self-reported medication adherence. The need for consensus on the definition of durable viral suppression is also urged. [ABSTRACT FROM AUTHOR]

Introduction: Hereditary gelsolin (AGel) amyloidosis is a systemic disease that is characterised by neurologic, ophthalmologic, dermatologic, and other organ involvements. We describe the clinical features with a focus on neurological manifestations in a cohort of patients with AGel amyloidosis referred to the Amyloidosis Centre in the United States. Methods: Fifteen patients with AGel amyloidosis were included in the study between 2005 and 2022 with the permission of the Institutional Review Board. Data were collected from the prospectively maintained clinical database, electronic medical records and telephone interviews. Results: Neurologic manifestations were featured in 15 patients: cranial neuropathy in 93%, peripheral and autonomic neuropathy in 57% and bilateral carpal tunnel syndrome in 73% of cases. A novel p.Y474H gelsolin variant featured a unique clinical phenotype that differed from the one associated with the most common variant of AGel amyloidosis. Discussion: We report high rates of cranial and peripheral neuropathy, carpal tunnel syndrome and autonomic dysfunction in patients with systemic AGel amyloidosis. The awareness of these features will enable earlier diagnosis and timely screening for end-organ dysfunction. The characterisation of pathophysiology will assist the development of therapeutic options in AGel amyloidosis. [ABSTRACT FROM AUTHOR]

Non-alcoholic steatohepatitis (NASH) and type 2 diabetes (T2D) are both linked to substantial healthcare costs and are often co-occurring. We aim to quantify the incremental cost of NASH and T2D using real-world data. Adults (≥18 years old) with ≥2 diagnosis codes for NASH and/or ≥2 diagnosis codes for T2D between 1/1/2016 and 12/31/2021 and ≥24 months of continuous claims enrollment (study period) were identified in electronic health records or claims in the Veradigm Integrated Dataset. Patients were stratified into 3 cohorts: NASH-only, T2D-only, and NASH + T2D. We calculated annualized costs for the 24-month study period and fit a generalized linear model (excluding the most expensive 1%) that controlled for disease cohort, age, sex, and modified Charlson comorbidity index to estimate the per year all-cause healthcare costs and incremental cost of adding T2D to a NASH diagnosis (or vice versa). We identified 23,111 patients diagnosed with NASH-only, 3,548,786 patients with T2D-only, and 30,339 patients with NASH + T2D. The model-predicted mean costs per year were $7,668 for patients with NASH-only, $11,226 for patients with T2D-only, and $16,812 for patients with NASH + T2D. The incremental increase in costs per year of adding T2D to NASH was 63% (+$4,846), and the incremental increase in costs per year of adding NASH to T2D was 42% (+$4,692). Both NASH and T2D contribute to the high healthcare costs among patients with a dual diagnosis. Results from our analysis indicate that NASH comprises a high portion of total healthcare costs among patients with NASH and T2D. [ABSTRACT FROM AUTHOR]

Real-world data evaluating weight changes in people living with HIV (PLWH) following switch to integrase strand transfer inhibitor (INSTI), specifically bictegravir (BIC), are limited. This retrospective cohort study analyzed weight changes upon switching to INSTI from non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) in treatment-experienced PLWH. Adult PLWH (≥18 years) treated with NNRTI or PI (non-switch cohorts) and those switching to INSTI (switch cohorts) between January 1, 2014 and August 31, 2019 were identified using IQVIA's Ambulatory Electronic Medical Records linked to a prescription drug claims database. The associations of switching to INSTI and individual INSTI agents with having ≥5% weight gain at 12 months of follow-up were evaluated, adjusting for demographics and baseline clinical characteristics. At 12 months of follow-up, PLWH in the NNRTI–INSTI switch cohort (n = 508) were more likely to have ≥5% weight gain over 12 months compared to the NNRTI non-switch cohort (n = 614; odds ratio, OR [95% CI], 1.7 [1.2–2.4]). Switching from NNRTI to dolutegravir (DTG: OR [95% CI], 2.1 [1.4–3.0]) or BIC (2.0 [1.0–4.2]) resulted in significantly higher odds of ≥5% weight gain. PI–INSTI switch (n = 295) and non-switch (n = 228) cohorts had similar proportions of PLWH with ≥5% (21.1–23.4%) or ≥10% (7.8–7.9%) weight gain, and no significant association was found between switching from PI to INSTI and weight gain. Weight gain and related metabolic health of PLWH switching from NNRTI to DTG or BIC should be closely monitored by clinicians. Further research is needed to assess other metabolic outcomes in PLWH remaining on PI and those who switch from PI to INSTI. [ABSTRACT FROM AUTHOR]

Introduction: While prior research has identified racial disparities in prehospital analgesia for traumatic pain, little is known about non-traumatic pain. Using a national prehospital dataset, we sought to evaluate for racial and ethnic disparities in analgesia given by EMS for non-traumatic pain. Methods: We analyzed the 2018 and 2019 data from the ESO Data Collaborative, a collection of de-identified prehospital electronic health records from nearly 1,300 participating EMS agencies in the US. We included all transported, adult, non-traumatic encounters with a primary or secondary impression of a pain complaint, and we stratified encounters based on race and ethnicity as recorded by the EMS clinicians. We performed a mixed model analysis, modeling EMS agency as a random intercept and adjusting for age, sex, pain location, level of service, location of incident, and highest pain score. With non-Hispanic White patients as the reference group, we then evaluated the association between race/ethnicity and receiving any pain medication (acetaminophen, non-steroidal anti-inflammatories, or opioids), receiving opioid pain medication, and receiving pain medication within 20 minutes of EMS arrival. Results: We included 1,035,486 patients; 67.5% non-Hispanic White, 26.8% Black, 4.9% Hispanic, 0.5% Asian, 0.1% Native Hawaiian or Other Pacific Islander, and 0.2% American Indian or Alaska Native patients. 4.7% of patients received pain medications. Compared to White patients (5.1%), Black patients were less likely to receive pain medication (3.3%, aOR 0.7; 95% CI 0.7-0.7) and Hispanics were more likely to receive pain medication (7.6%, aOR 1.5; 95% CI 1.4-1.6). Black patients were also less likely to receive opioids (1.8% for Black v 3.0% for White, aOR 0.7; 95% CI 0.6-0.7), while Hispanic patients were more likely to receive opioids (4.9%, aOR 1.4; 95% CI 1.3-1.5). The odds of receiving pain medication within 20 minutes was lower for Black patients (aOR 0.9; 95% CI 0.8-0.95) but no different for Hispanic patients (aOR 1.0; 95% CI 0.9-1.1), when compared to White patients. Conclusion: Pain medication administration is uncommon for non-traumatic pain complaints. While Black patients were less likely than White patients to receive pain medications and receive pain medication within 20 minutes, Hispanics were more likely to receive pain medications. [ABSTRACT FROM AUTHOR]

Treatment guidelines recommend integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) regimens for treatment naïve people living with HIV (PLWH) in the United States (US). This retrospective database study compared weight changes following initiation of INSTI-, non-nucleoside reverse transcriptase inhibitor (NNRTI)-, or protease inhibitor (PI)-based ART in treatment-naïve PLWH. Adult (≥18 years) PLWH initiated on INSTI, NNRTI, or PI plus ≥2 nucleoside reverse transcriptase inhibitors (NRTI) between 1 January 2014 to 31 August 2019 were identified in IQVIA's Ambulatory Electronic Medical Records (AEMR) linked to prescription drug claims (LRx). Weight changes over up to 36 months (M) of follow-up were compared among PLWH on INSTI- vs. NNRTI- and PI-based ART separately using non-linear mixed effect models, adjusting for demographics and baseline clinical characteristics. The INSTI, NNRTI, and PI cohorts included 931, 245, and 124 PLWH, respectively. For all three cohorts, the majority were male (78.2–81.2%) and overweight/obese (53.6–61.6%) at baseline; 40.8–45.2% of the groups were African American. The INSTI vs. NNRTI/PI cohorts were younger (median age: 38 years vs. 44 years/46 years), had lower weight at ART initiation (mean: 80.9 kg vs. 85.7 kg/85.0 kg), and had higher TAF usage during follow-up (55.6% vs. 24.1%/25.8%; all p <.05). Multivariate models showed higher weight gain among PLWH in INSTI vs. NNRTI and PI cohorts during treated follow-up (estimated weight gain after 36 M: 7.1 kg vs. 3.8 kg and 3.8 kg, both p <.05). Study findings highlight the need to monitor an increase in weight and potential metabolic complications among PLWH starting ART with INSTI. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine hospital costs and revenue of universal opt-out HIV ED screening. An electronic medical record (EMR)-directed, automated ED screening program was instituted at an academic medical center in San Diego, California. A base model calculated net income in US dollars for the hospital by comparing annual testing costs with reimbursements using payor mixes and cost variables. To account for differences in payor mixes, testing costs, and reimbursement rates across hospitals in the US, we performed a probabilistic sensitivity analysis. The base model included a total of 12,513 annual 4th generation HIV tests with the following payor mix: 18% Medicare, 9% MediCal, 28% commercial and 8% self-payers, with the remainder being capitated contracts. The base model resulted in a net profit for the hospital. In the probabilistic sensitivity analysis, universal 4th generation HIV screening resulted in a net profit for the hospital in 81.9% of simulations. Universal 4th generation opt-out HIV screening in EDs resulted in a net profit to an academic hospital. Sensitivity analysis indicated that ED HIV screening results in a net-profit for the majority of simulations, with higher proportions of self-payers being the major predictor of a net loss. [ABSTRACT FROM AUTHOR]

Social institutions increasingly appear as data-driven entities, with data analytics and information technology transforming social life across health care, education, and criminal justice. Social science scholarship characterizes the political nature of this paradigm by emphasizing technology's role in the governance of life and the sociocultural values embedded within technical design. But little research has examined the intimate work taking place inside these very institutions, resulting in inadequate attention to everyday data practices as they intertwine with evolving technopolitics. Drawing on ethnographic fieldwork of the integration of Electronic Health Records at a large safety-net health system in the United States, in this article I emphasize the intimate work involved in becoming data-driven and how this work shapes the material contours of contemporary data politics. I compare the implementation of two health system initiatives, including a Complex Care Program for an algorithm-defined population and a Disparity Reduction Plan targeting Latinos with Type 2 diabetes, to demonstrate how on the ground actors make intimate decisions about what constitutes the 'right data' in becoming data-driven. As data analytics expands to transform organizational decision-making, redistribute resources, and reconfigure the professional gaze, social science must follow data politics on the move to fully account for the evolving technopolitics of data-driven society. [ABSTRACT FROM AUTHOR]

This study evaluated prognostic performance of International Staging System (ISS), revised ISS, and chromosomal abnormalities (CA) in newly diagnosed multiple myeloma patients to describe treatment patterns (cohort 1; n = 1979) and survival outcomes (cohort 2; n = 1382). In both cohorts, ∼18%, 41%, and 37% of patients were high-risk according to the R-ISS, ISS, and high-risk CA criteria, respectively. Across all risk stratification criteria, 60% of patients received triplets. In cohort 2, the median modified progression-free survival decreased with each increasing risk stage (23.5, 12.1, and 8.8 months in R-ISS I, II, and III, respectively, and 16.0, 12.7, and 10.4 months in ISS I, II, and III). Similar trends were observed in the proportions of two-year overall survival. In conclusion, R-ISS has greater discriminatory power than ISS or high-risk CA alone and can be implemented in a real-world setting. Accordingly, a more risk-adapted approach can be feasible, with a greater population-level impact. [ABSTRACT FROM AUTHOR]

Approximately 5% of global preterm births are extremely premature (EP), defined as occurring at less than 28 weeks gestational age. Advances in care have led to an increase in the survival of EP infants during the neonatal period. However, EP infants have a higher risk of developing complications such as bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). BPD and other respiratory morbidities are particularly prevalent among this population. To understand the healthcare resource utilization (HRU) of EP infants in the United States, the clinical and economic burden of extreme prematurity was examined in this retrospective study of data extracted from electronic medical records in the Kaiser Permanente Northern California (KPNC) health system. The analysis included data from EP infants live-born between January 1997 and December 2016, and focused on complications and HRU up to 3 years corrected age (CA), covering the period up to December 2018. Stillbirths, infants born at <22 weeks gestational age, and infants with major congenital malformations were excluded. Complications of interest (BPD, IVH, and ROP) and medication use were compared by age group (≤1 year, >1 year and ≤2 years, and >2 years and ≤3 years CA). Analysis of HRU included hospital readmissions, ambulatory visits, and emergency room (ER) visits. A total of 2154 EP births (0.32% of total live births and 4.0% of preterm births that met the inclusion/exclusion criteria) were analyzed. The prevalence of EP birth showed a declining trend over time. ROP was the most commonly recorded complication during the birth hospitalization (37.1% any stage; 2.9% Stages 3 and 4). BPD was recorded in 34.3% of EP infants. IVH (any grade) was recorded in 22.7% of EP infants (6.4% Grades III and IV). A majority (78.7%) of EP infants were diagnosed with at least one respiratory condition during the first year CA, the most common being pneumonia (68.9%); the prevalence of respiratory conditions decreased over the second and third years CA. During the first 3 years CA, the most common medications prescribed to children born EP were inhaled bronchodilators (approximately 30% of children); at least 15% of children received systemic corticosteroids and inhaled steroids during this period. During the first 3 years CA, at least one hospital readmission was recorded for 16.4% of children born EP; 57.1% of these readmissions were related to respiratory conditions. At least one ER visit was recorded for 33.8% of children born EP, for which 53.1% were due to a respiratory condition. Ambulatory visits were recorded for 54.2% of EP children, for which 82.9% were due to a respiratory condition. The short- and long-term clinical burden of EP birth was high. The onset of BPD, IVH, and ROP was common during the birth hospitalization for EP infants. Medication use, hospital readmission, and clinic visits (ER and ambulatory) occurred frequently in these children during the first 3 years CA, and were commonly due to respiratory conditions. Strategies prioritizing the reduction of risk and severity of respiratory conditions may alleviate the clinical burden of EP birth over the long term. [ABSTRACT FROM AUTHOR]

Background: The current epidemic of opioid overdoses in the United States necessitates a robust public health and clinical response. We described patterns of non-fatal opioid overdoses (NFOODs) in a small western region using data from the 9-1-1 Computer Assisted Dispatch (CAD) record and electronic Patient Clinical Records (ePCR) completed by EMS responders. We determined whether CAD and ePCR variables could identify NFOOD cases in 9-1-1 data for intervention and surveillance efforts. Methods: We conducted a retrospective analysis of 1 year of 9-1-1 emergency medical CAD and ePCR (including naloxone administration) data from the sole EMS provider in the response area. Cases were identified based on clinician review of the ePCR, and categorized as definitive NFOOD, probable NFOOD, or non-OOD. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the most prevalent CAD and ePCR variables were calculated. We used a machine learning technique—Random-Forests (RF) modeling—to optimize our ability to accurately predict NFOOD cases within census blocks. Results: Of 37,960 9-1-1 calls, clinical review identified 158 NFOOD cases (0.4%), of which 123 (77.8%) were definitive and 35 (22.2%) were probable cases. Overall, 106 (67.1%) received naloxone from the EMS responder at the scene. As a predictor of NFOOD, naloxone administration by paramedics had 67.1% sensitivity, 99.6% specificity, 44% PPV, and 99.9% NPV. Using CAD variables alone achieved a sensitivity of 36.7% and specificity of 99.7%. Combining ePCR variables with CAD variables increased the diagnostic accuracy with the best RF model yielding 75.9% sensitivity, 99.9% specificity, 71.4% PPV, and 99.9% NPV. Conclusion: CAD problem type variables and naloxone administration, used alone or in combination, had sub-optimal predictive accuracy. However, a Random Forests modeling approach improved accuracy of identification, which could foster improved surveillance and intervention efforts. We identified the set of NFOODs that EMS encountered in a year and may be useful for future surveillance efforts. [ABSTRACT FROM AUTHOR]

To examine the real-world incidence and management of select adverse events (AEs) among female patients with hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (MBC), receiving a cyclin-dependent kinase 4 and 6 (CDK4 and 6) inhibitor (palbociclib, abemaciclib, or ribociclib). This retrospective study analyzed data from the US Oncology Network iKnowMed electronic health record database for 396 patients with an initial MBC diagnosis on/after 1 January 2014 and receipt of first CDK4 and 6 regimen between 1 January 2017 and 31 December 2018. In this descriptive study, the proportion of patients who experienced select AEs and associated dose modifications or discontinuations were reported. The occurrence of select healthcare resource utilization categories was also reported. Median follow-up time was 451, 262, and 355 days for patients in the palbociclib, abemaciclib, and ribociclib cohorts, respectively. The most common AEs were neutropenia (palbociclib, 44.8%; abemaciclib, 10.6%; ribociclib, 36.3%), diarrhea (palbociclib, 8.0%; abemaciclib, 43.0%; ribociclib, 8.8%), and fatigue (palbociclib, 12.9%; abemaciclib, 17.6%; ribociclib, 16.5%). AEs resulted in a treatment hold among 91 (23.0%), a dose reduction among 86 (21.7%), and permanent discontinuation among 48 (12.1%) patients overall. This real-world study provides insight into the occurrence of AEs which varied by CDK4 and 6 inhibitor. Compared to clinical trials, frequencies of AEs were numerically lower but dose reductions due to AEs were numerically higher. It is possible these differences reflect proactive management of AEs on the part of clinicians to help patients remain on therapy. Cyclin-dependent kinase 4 and 6 inhibitors (CDK4 and 6 inhibitors) have changed the landscape for the treatment of metastatic breast cancer (MBC) among patients who are hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2−). An understanding of the real-world management of adverse events (AEs) will help optimize treatment strategies. Here, data from the US Oncology Network electronic health record database for 396 HR+, HER2−, MBC patients receiving a CDK4 and 6 inhibitor were examined to describe the proportion of patients who experienced select AEs and the associated outcomes of these AEs. Compared to clinical trials, frequencies of AEs were numerically lower but dose reductions due to AEs were numerically higher. It is possible that these differences reflect a proactive management of AEs on the part of clinicians to help patients remain on therapy. [ABSTRACT FROM AUTHOR]

The Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) was developed to identify prescription opioid misuse and abuse among patients with chronic pain. A clinical scoring algorithm was developed and refined to align with the patient experience. This study utilized data from the POMAQ validation study (3033-4, NCT02660606) conducted on a sample of patients with chronic pain living in the United States. The study was carried out in two phases. Two purposefully enriched patient samples, one for each phase, were created based on patient responses to select POMAQ items and the availability of urine and hair samples. Two clinical experts (SHS, SFB) reviewed patient data to classify prescription opioid use behavior. Classification differences were adjudicated by a third clinical expert (JTF). Comparisons were made between the final clinical classification determined by the experts and the proposed classification based on the POMAQ algorithm. Sixty patients were included in Phase I (only POMAQ data) and 52 in Phase II (including POMAQ and ancillary sources [e.g. electronic medical records, urine toxicity screen]). Refinements were made to the POMAQ scoring algorithm following discussions with clinical experts to ensure it was clinically relevant. For both phases, classifications were reviewed and discussed to achieve maximal concordance of classifications across experts. The proposed scoring algorithm was then modified to maximize agreement with the expert interpretation of clinically relevant patient experiences. The clinical scoring algorithm for the POMAQ was developed and refined to reflect clinically relevant patient behaviors identified by expert review. Future testing is needed to determine the sensitivity and specificity of this measure. [ABSTRACT FROM AUTHOR]

This study describes the current treatment landscape in adult atopic dermatitis (AD), overall and by disease severity. Adult patients with an AD diagnosis in dermatology-specific electronic medical records during 2018 were identified and linked to an administrative claims database. Disease severity was determined using Physician's Global Assessment (PGA). Written and dispensed prescriptions, within and between class cycling for AD therapies occurring in 2018 were assessed. In total, 4,364 patients were included. Among patients with available PGA, 43.2% had clear-to-mild, 37.3% had moderate, and 19.6% had severe disease. Most patients (71.0%) had written prescriptions for topical therapies only in 2018. Among the patients with claims for topical therapies alone, 80.7% used topical corticosteroids only. Within and between class cycling was observed in 33.7% and 12.8% of topical users, respectively. In patients with systemic therapy (40.6%), nearly 84.9% also used topical therapy, 25.8% cycled within systemic drug classes, and 24.8% cycled between systemic drug classes. Overall, cycling was more prevalent in patients with more severe disease. Cycling within and between both topical and systemic drug classes was more common in patients with more severe disease, indicating difficulty of managing these patients and highlighting a need for more treatment options. [ABSTRACT FROM AUTHOR]

Objective To determine levels of Electronic Health Record (EHR) satisfaction in order to add to the body of knowledge and assist professionals in the college/university health field with system/vendor selection. Methods: Nine health centers, all within highly selective colleges and universities, participated in this benchmarking study. Multidisciplinary staff (n = 316) received an anonymous 32-item survey to assess levels of agreement/satisfaction on statements pertaining to their EHR's functionality. Results: The EHRs most commonly used were Point and Click, Medicat, Allscripts, and EPIC. There was considerable variation on levels of user satisfaction/agreement within features among the EHR systems, but differences were not statistically significant. Conclusion: No systems emerged as clear "winners" in terms of user satisfaction. Features were identified within systems that can be leveraged to meet specific care delivery and quality reporting needs among college/university health professionals, and could be considered in the use of EHRs by health services. [ABSTRACT FROM AUTHOR]

This survey study employed a framework of self-presentation motives in physical exercise to advance the understanding of exercise monitoring apps users' sharing behaviours on social networking sites (SNS). 551 participants were recruited using Qualtrics national research panel. A model of moderated mediation was proposed and analysed. The results suggested that both agentic and communal self-presentation motives significantly predicted fitness sharing on SNS and fitness app use. Perceived self-presentation outcome value for agentic purposes significantly enhances the agentic motive in predicting sharing on SNS. Fitness sharing on SNS mediated the significant effect of both agentic and communal presentational motives on fitness app use. A number of theoretical and design implications to extend the understanding of fitness social sharing to health technology applications were discussed. [ABSTRACT FROM AUTHOR]

This study evaluated body mass index (BMI) and weight changes in people living with human immunodeficiency virus (HIV-1; PLWH) initiated on single-tablet darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/c/FTC/TAF) or bictegravir/FTC/TAF (BIC/FTC/TAF). Electronic medical record (EMR) data for treatment-naïve or virologically suppressed adults with HIV-1 who initiated treatment with DRV/c/FTC/TAF or BIC/FTC/TAF (index date) were obtained from Decision Resources Group's EMRs (17 July 2017–1 March 2020). Inverse probability of treatment weighting was used to account for differences in baseline characteristics between the two cohorts. BMI and weight changes from pre-index to 3, 6, 9 and 12 months following the index date were compared using weighted mean differences (MDs). The time until an increase in BMI or weight ≥5% or ≥10% was compared using weighted hazard ratios (HRs). The weighted DRV/c/FTC/TAF and BIC/FTC/TAF cohorts comprised 1116 and 1134 PLWH, respectively (mean age = ∼49 years, females: ∼28%). Larger increases in BMI and weight from pre-index to each post-index time point were observed in PLWH initiating BIC/FTC/TAF vs DRV/c/FTC/TAF (12 months: MD in BMI = 1.23 kg/m2, p <.001; MD in weight = 2.84 kg [6.26 lbs], p =.008). PLWH receiving BIC/FTC/TAF were significantly more likely to experience weight gain ≥5% (HR = 1.76, p =.004) and ≥10% (HR = 2.01, p =.020), and BMI increase ≥5% (HR = 1.77, p =.004) and ≥10% (HR = 1.76, p =.044) than those receiving DRV/c/FTC/TAF. BIC/FTC/TAF was associated with greater BMI and weight increases compared to DRV/c/FTC/TAF. Weight gain and its sequelae may add to the clinical burden of PLWH and should be considered among other factors when selecting antiretroviral single-tablet regimens. [ABSTRACT FROM AUTHOR]

To reveal the extent of obesity in a single healthcare system and provide a blueprint for other health systems to perform similar analyses, this study describes characteristics and weight change patterns of patients classified with overweight and obesity at a large integrated delivery network (IDN) in the South-Central United States. A descriptive, observational, retrospective study was conducted using electronic medical records and claims data. Patients were ≥18 years old, body mass index (BMI) ≥27 kg/m2, and continuously enrolled in the IDN plan for ≥6 months before and ≥12 months after the index date. Demographics, comorbidities, BMI, and weight were collected. Weight changes were assessed annually, and anti-obesity medications (AOM) use was also captured. A total of 36,430 eligible patients were identified. A subset of 22,712 patients was continuously enrolled for the entire study period (mean age: 57.2) and were primarily white (83.3%) and commercially insured (54.3%). Most patients were categorized as overweight (40.1%) or obesity class I (32.5%) at baseline. At years 1 and 4 post-index, patients who maintained index weight (±3%) was 56.2% and 37.0%, respectively, whereas weight gain (≥3% increase) was 23.7% and 33.3%, respectively. AOM use (1.1%) primarily consisted of phentermine-hydrochloride (n = 114, 0.5%) and orlistat (n = 115, 0.5%). An increasing proportion of patients gained weight over time, combined with low AOM use, emphasizing the need for weight-loss interventions in this population. Findings from this study provide a foundation for health systems to perform similar analyses. [ABSTRACT FROM AUTHOR]

Currently, the aging adult population is rising fast and presenting multiple challenges for the US healthcare system. Older adults present unique challenges in their care of medical and psychiatric conditions. This study retrospectively examined characteristics that are associated with length of stay on an inpatient geriatric psychiatric unit in an urban located psychiatric hospital. A sample of 74 individuals was examined. Factors that influenced length of stay included commitment status and discharge to a different level of care. Reducing the length of stay for geriatric patients can help reduce costs and improve health outcomes. [ABSTRACT FROM AUTHOR]

To better understand treatment patterns in US patients with multiple sclerosis (MS) initiating generic glatiramer acetate (GA), this study examined adherence, discontinuation and switching patterns from generic follow-on glatiramer acetate (FOGA) therapy in real-world patient cohorts. Retrospective analyses utilized data from two large US databases (administrative claims and linked electronic medical records). Eligible adult MS patients had ≥1 pharmacy claim for FOGA during the identification period; the first FOGA claim was the index date. All analyses were descriptive; proportion of days covered (PDC) was calculated as a measure of adherence to FOGA during the follow-up period. The first cohort consisted of 95 patients, with 93.6% having a branded GA claim for Copaxone during the baseline period. Half these patients (48.4%) had high adherence to FOGA therapy (PDC: 0.8–1.0). Fifty-five patients (57.9%) initially discontinued FOGA with a mean persistence of 112 days. Of those who discontinued, 7.3% had no subsequent disease-modifying therapy (DMT), 30.9% restarted FOGA and 61.8% did not restart FOGA. The second cohort consisted of 1957 patients, with 63.8% having a branded GA claim for Copaxone during the baseline period and 33.5% were treatment naïve. The majority of patients (61.9%) had high adherence to FOGA therapy. A total of 1597 patients (81.6%) initially discontinued FOGA with a mean persistence of 93 days. Of those who discontinued, 55.8% switched to another DMT, 16.7% restarted FOGA and 37.5% had no subsequent DMT. Adherence to FOGA therapy was reasonably high across cohorts; however, most patients discontinued their initial FOGA within four months of the index date and most switches from FOGA were to branded GA products. [ABSTRACT FROM AUTHOR]

Encouraged by multiple federal policies, healthcare organizations are assuming greater responsibility for patients' social needs. This study describes the individual and co-occurring social needs that lead to a referral to social workers in primary care. In a secondary data analysis of a longitudinal cohort, we used natural language processing (NLP) to categorize reasons for social work referral documented in electronic health records referral orders (n = 9,473) from a federally qualified health center (2011–2016) in the United States, using a literature-derived classification scheme. We used market basket analysis (MBA) to identify co-occurring social needs. The most frequent needs leading to a social work referral were financial (25%), pregnancy (25%), behavioral health (16%), and family/social support (9%) needs. The most frequently co-occurring needs are pregnancy with language limitation (support = 0.07; confidence = 0.78); behavioral health with family/social support (support = 0.03; confidence = 0.28); and financial with behavioral health (support = 0.025; confidence = 0.14). The diversity of reasons for social work referrals signifies the complexities of social needs among patients and the potential role for social workers in addressing these needs. A clearer understanding of patients' social needs helps inform social work staffing decisions and the development of effective intervention packages to address patients' social needs. [ABSTRACT FROM AUTHOR]

While immunization practice guidelines for children have been applied within primary schools, little research exists about how immunization practice guidelines are applied within summer camp settings and barriers to policy implementation within those settings. To identify perceived barriers to effective immunization policy implementation in summer camps, data were collected from a purposeful sample of 925 unique summer camp representatives using the CampDoc.com online electronic health record system. Fifty-nine percent (n = 541) of the sample completed an open-ended question about immunization policy barriers, including directors (38%, n = 205), nurses (26%, n = 140), other (20%, n = 106), office staff (13%, n = 73), and physicians (3%, n = 17). Inductive analyses and coder triangulation were used to develop themes. Constructed themes included a lack of parental support for vaccination, difficulties collecting and verifying immunization documentation, variable immunization policy guidelines, immunization exemptions, and organizational focus on financial outcomes. In addition, one-fifth of responding camps perceive no barriers. Camp administrators should work with pediatricians to implement clear and consistent immunization policies emphasizing parent education and informed by local and state guidelines. [ABSTRACT FROM AUTHOR]

Every country will have to prepare for climate change. Despite obvious risks to national security in terms of safety, food, and infrastructure as well as impending economic losses, countries like the United States (US) have declined to pursue meaningful federal action. The human impact of climate change – specifically climate migration and its health implications – has been largely neglected at a policy level. Yet climate migration is predicted to have tremendous consequences for people in the next 30 years and beyond, and with it comes a host of difficulties – political, cultural, economic, and structural. Preparedness will be of great importance to potential migrants and how they adapt to their receiving (host) locations. Health systems are one of the most significant institutions impacting long-term migration and these systems' strengths and weaknesses will determine the integration and well-being of migrants for years to come. A critical analysis of existing literature exposes that there is little current research on health system preparedness as it relates to climate migration, especially in the US. To help address this gap, this paper focuses on how the American health system, already fraught with limitations, can prepare for the expected increase in mostly internal migrants in the face of climate change. Key policy insights Climate migration in the US will pose huge challenges for health systems because of the American health system's unique, pre-existing weaknesses. To prepare for climate migration, federal, state, local, tribal, and territorial governments should focus on adopting a universal healthcare policy, shifting primary care tasks away from physicians and towards other qualified and more ubiquitous professionals, and investing in telemedicine, retail clinics, and a national electronic health record system. A 'health in all policies' approach, which applies a health lens to legislation, needs to be applied in the context of health system strengthening for climate migration since countless environmental determinants of health and infrastructural decisions shape the vulnerability of communities. [ABSTRACT FROM AUTHOR]

Therapeutic advances for the treatment of patients with advanced/metastatic non-small cell lung cancer (NSCLC) have led to additional options for care. This observational study was designed to describe emerging treatment patterns and survival outcomes. Flatiron Health's oncology electronic health records database was to identify eligible patients who were age 18+ who initiated second-line therapy for NSCLC Survival analyses were conducted using Kaplan Meier methods and Cox proportional hazard model using SAS 9.4. both unadjusted and adjusted, using generalized propensity score, to account for imbalances between groups. The 10,060 eligible patients from Dec 2014 to Feb 2019 were 52.6% male; mean age 67.1 years; 70.3% white; 26.0% squamous/70.0% non-squamous (4.1% not specified); and 92.7% were treated at community practices. Immune checkpoint inhibitors (ICIs) were used by 79.9% of the cohort during any line of therapy; 12.1% and 53.7% used ICIs during first- and second-line therapy, respectively. There was heterogeneity in treatment sequencing, as the three most common first→second line sequences accounted for 7.7% (carboplatin + paclitaxel→nivolumab), 5.0% (carboplatin + pemetrexed→nivolumab), and 3.8% (carboplatin + nab-paclitaxel→nivolumab) of the total population, respectively. Unadjusted median overall survival was 21.1 months (95% confidence interval, CI: 20.5–21.6) from metastatic diagnosis. Median survival was 23.0 months (95% CI, 22.3–23.6) for non-squamous and 18.1 months (95% CI, 17.3–18.8) for squamous disease. There is heterogeneity in sequencing strategies that limit the ability to conduct robust comparative effectiveness research of treatment sequences. Since few patients follow a similar treatment trajectory, comparative effectiveness research will be challenged to identify treatment sequences with sufficient sample size. [ABSTRACT FROM AUTHOR]

A chronic pain patient sample living in the United States who participated in a cross-sectional study to evaluate the validity and reproducibility of the Prescription Opioid Misuse and Abuse Questionnaire is characterized. Patients with chronic pain identified through electronic medical records as refilling at least one opioid prescription within the prior 3 months were recruited from five United States Department of Defense Military Health System clinics. Patients completed the Prescription Opioid Misuse and Abuse Questionnaire, Brief Pain Inventory-Short Form, Medical Outcomes Study: 36-item Short Form, and sociodemographic questions online. Clinical characteristics and electronic medical records for 1 year prior to consent were collected. 809 (86.2%) participants completed the Prescription Opioid Misuse and Abuse Questionnaire. Mean (± standard deviation) age was 55.4 ± 12.7 years; the majority female (55.5%) and white (74.8%). Mean duration of chronic pain was 14.7 ± 10.5 years; the most common pain conditions were lower back pain (76.6%), neck or shoulder pain (60.3%), and osteoarthritis (38.7%). The most commonly prescribed opioids were oxycodone (35.7%), tramadol (34.5%), and hydrocodone (26.9%); 54.8% took one opioid, 44.9% took 2 or more opioids. Participants' health status was poor; pain severity and interference were moderate. Electronic medical record data revealed high healthcare resource utilization. This chronic pain population was severely impacted by their pain condition(s). [ABSTRACT FROM AUTHOR]

The Prescription Opioid Misuse and Abuse Questionnaire was developed to identify prescription opioid abuse and misuse among patients with chronic pain, however, evidence of construct validity and reproducibility is needed. Chronic pain patients were recruited from five Department of Defense Military Health System clinics across the United States. Construct validity was examined using subjective clinician-reported and patient-reported measures as well as objective information (e.g. hair/urine drug screens and electronic medical records). Test-retest reliability was assessed across 2 timepoints among a subgroup of patients with stable chronic pain. Of 3,263 screened patients, 938 (28.7%) met eligibility and were enrolled; 809 (86.2%) completed the Prescription Opioid Misuse and Abuse Questionnaire. Construct validity was supported by comparison to other validated questionnaires and hair and urine screens which yielded high agreements with patient reports on the Prescription Opioid Misuse and Abuse Questionnaire. Electronic medical record data supported patients' Prescription Opioid Misuse and Abuse Questionnaire responses regarding physician and emergency room visits and opioid refills. The Prescription Opioid Misuse and Abuse Questionnaire had excellent test–retest reliability; the percentage agreement between the two Prescription Opioid Misuse and Abuse Questionnaire administrations was high (>90%) for most questions. Results suggest that the Prescription Opioid Misuse and Abuse Questionnaire is a valid and reproducible tool that can be used to assess the presence of prescription opioid misuse and abuse among patients with chronic pain. [ABSTRACT FROM AUTHOR]

This study examines the convergent validity of the substantive scales of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in the Veteran Affairs (VA) population. The sample includes test protocols drawn from all administrations of the MMPI-2-RF or MMPI-2 entered into the electronic medical record system between January 1, 2008 and May 31, 2015 at any VA across the United States. After excluding invalid protocols, substantive scale scores were correlated with external measures of depression, anxiety, and posttraumatic stress disorder if they were administered within |14| days of the MMPI-2/-RF. Results supported the convergent validity of the MMPI-2-RF emotional dysfunction domain scores. Discriminant validity for the remaining MMPI-2-RF substantive scale scores was also adequate. Limitations and implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Various screening tools, ranging in complexity, have been developed to predict large vessel occlusion (LVO) stroke in the prehospital setting. Our objective was to determine whether newly-developed LVO stroke scales offer a clinically-meaningful advantage over the Cincinnati Prehospital Stroke Scale (CPSS). We retrospectively analyzed prehospital patient care records linked with hospital data from 151 EMS agencies in the United States, between January 1, 2018 and December 31, 2018. We compared the CPSS to the Rapid Arterial Occlusion Evaluation (RACE), Los Angeles Motor Scale (LAMS), and the Vision, Aphasia, Neglect (VAN) assessment for LVO prediction. For each stroke scale, we used the intersection of sensitivity and specificity curves to determine optimal prediction cut-points. We used area under the ROC curve and 95% confidence intervals to assess for differences in discriminative ability between scales. We identified 13,596 prehospital records with one or more documented stroke scales of interest. Among these, 4,228 patients were diagnosed with stroke. Over half (57%, n = 2,415) of patients diagnosed with stroke experienced an acute ischemic stroke. Of patients with ischemic stroke, 26% (n = 628) were diagnosed with LVO. A CPSS score of 2 or higher demonstrated sensitivity = 69% and specificity = 78% for LVO. A RACE score of 4 or higher demonstrated sensitivity = 63%, specificity = 73%. A LAMS score of 3 or higher demonstrated sensitivity = 63%, specificity = 72% and a positive VAN score demonstrated sensitivity = 86%, specificity = 65%. Comparing the area under the ROC curve for each scale revealed no statistically significant differences in discriminative ability for LVO stroke. In this large sample of real-world prehospital patient encounters, the CPSS demonstrated similar predictive performance characteristics compared to the RACE, LAMS, and VAN for detecting LVO stroke. Prior to implementing a specific screening tool, EMS agencies should evaluate ease of use and associated implementation costs. Scored 0–3, the simple, widely-used CPSS may serve as a favorable prehospital screening instrument for LVO detection with a cut-point of 2 or higher maximizing the tradeoff between sensitivity and specificity. [ABSTRACT FROM AUTHOR]

In clinical trials, disability progression in multiple sclerosis (MS) is measured by the Kurtzke expanded disability status scale (EDSS), which is not captured in routine clinical care in the U.S. This study developed a claims-based disability score (CDS) based on the EDSS for assigning MS disability level in a U.S. claims database. This retrospective cohort study of patients with MS in the U.S., utilized adjudicated health plan claims data linked to electronic medical records (EMRs) data. Patients were identified between 1 January 2012 and 31 December 2016 and indexed on the first date of MS diagnosis. The CDS was developed to assign disability level at baseline using claims and ambulatory EMR records observed over the 1-year baseline period. All-cause healthcare costs were assessed by baseline disability level to validate the CDS. In total, 45,687 patients were identified in claims (full sample) and 1,599 linked to EMR (core sample). Over half of patients in both samples were classified with mild disability at baseline. Adjusted healthcare costs in patients with moderate and severe disability were 15% (p<.0001) and 20% higher, respectively, than in patients with mild disability at baseline in the full sample. Disease-modifying therapy (DMT) costs accounted for 89%, 82%, and 78% of outpatient pharmacy costs in patients with mild, moderate, and severe disability, respectively. The CDS is the first claims-based measure of MS disability utilizing data from EMR. This novel measure advances the opportunity to examine outcomes by disability accumulation in the absence of standard markers of disease progression. Although formal validation of the CDS was not possible due to lack of available EDSS in the EMR, the economic burden results align with prior publications and show that healthcare costs increase with increasing disability. Future validation studies of the CDS are warranted. [ABSTRACT FROM AUTHOR]

Hospitalization represents a unique opportunity to re-engage out-of-care individuals, improve HIV outcomes and reduce health disparities. Electronic health records of HIV-positive individuals hospitalized at an urban, public hospital between September 2013 and December 2015 were reviewed. In October 2014, a multidisciplinary HIV consult team (HIV specialist, case manager, and transitional care nurse (TCN)) was implemented. Engagement in care, retention in care and virologic suppression before and after hospitalization were compared between the pre- and post-intervention periods and by treatment received. Of 1056 inpatient admissions (pre-intervention = 571, post-intervention = 485), the majority were among males (69%) and racial/ethnic minorities (55% Black, 23% Hispanic). Each step of the HIV care cascade increased after hospitalization for both time periods (p < 0.01 for each comparison). Those who received the HIV consult (N = 131) or consult + TCN (N = 128) had greater increases in engagement in care (23.7% and 30.5% v. 11.1%, p = 0.04 and <0.01 respectively) and virologic suppression (28.3% and 29.7% v.7.1%, p <0.01 for both) than the no intervention (N = 225) subgroup. Hospitalized patients with HIV have low rates of engagement in care, retention in care and virologic suppression, though all three outcomes improved after hospitalization. A multidisciplinary transitions team improved care engagement and virologic suppression in those who received the intervention. [ABSTRACT FROM AUTHOR]

Individuals experiencing homelessness are at risk for cognitive impairment and decreased functional skills due to complex comorbidities and restricted contexts. A retrospective analysis of occupational therapy evaluations within an integrated, interprofessional primary care clinic serving adults experiencing homelessness was completed. Evaluations included a standardized cognitive screening assessment and a standardized functional assessment. Assessment results were analyzed to determine the prevalence of cognitive impairment, differences between cognitive and functional assessment performance, and the relationship between cognitive impairment and functional performance. Although most participants' performance indicated cognitive impairment, functional performance was varied demonstrating the need for individualized evaluation and care planning in the transition from homelessness to housing. [ABSTRACT FROM AUTHOR]

Although patient-centered care (PCC) is one of the cornerstones of modern healthcare, the role that health information technology (HIT) plays in supporting PCC remains unclear. In this qualitative study, we interviewed academic and clinical experts from the US and Israel to understand to what extent current HIT systems are supportive of PCC and how PCC should be supported by HIT in the future. A maximum variation sampling approach was used to identify nine experts in both HIT and PCC from clinical and academic settings in Israel and the US. A qualitative descriptive method was used to analyze the interviews and identify major themes. Experts suggested that patient ownership of their disease is a core component of PCC. The majority of the experts agreed that in both Israel and the US, the current situation of PCC implementation is relatively poor. However, HIT should play an important role in making patients owners of their health and treatment and helping providers in delivering better PCC. Central domains of PCC via HIT were providing clear information and support for patients and promoting care that is based on patient values and preferences. [ABSTRACT FROM AUTHOR]

Background: Electronic Health Records (EHR) can help create patient ownership of information, enhance patient-centered collaborative advising, and increase advice utilization through increases in trust and memory of the information. Using research from advice and collaborative decision-making, we theorized about how doctors' screen sharing EHR during an appointment should be beneficial. Method: Thirteen doctors were interviewed about their perception and experience with screen sharing EHR with patients. Two coders, who are experts in collaborative decision-making, developed nine categories and then independently coded each interview. Results: Doctors reported using screen sharing for repetition and increased recollection of doctor instructions. They reported that screen sharing increased collaborative decision-making and trust, promoted a common ground between the doctor and patient, and helped validate and create ownership of the information for patients. Doctors noted using screen sharing more for younger patients, who they perceived as expecting more use of technology, and new patients, to help increase trust. Further, doctors were more likely to share information they perceived that patients could understand, rather than complex information. Finally, doctors reported problems with screen sharing, like patients seeing sensitive information. Conclusions: Doctor responses support previous research about the benefits of shared information for trusting information and utilizing advice. [ABSTRACT FROM AUTHOR]

Importance: Intravenous alteplase is an effective treatment for acute ischemic stroke and is significantly underutilized. It is known that stroke centers with accreditation are more likely to provide intravenous alteplase treatment, and therefore, policies that increase the number of certified stroke centers and the number of acute ischemic stroke patients routed to these centers may be beneficial. Objective: To determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Design: An observational, longitudinal study to examine treatment trends with log-link binomial regression modeling to compare pre-post policy implementation changes in the proportions of patients treated with intravenous alteplase in two counties. Setting: Two urban counties, Santa Clara and San Mateo, in the western region of US that regionalized acute stroke care between 2005 and 2010. Participants: Patients with primary or secondary diagnosis of stroke were identified from the statewide patient discharge database by International Classification of Diseases (ICD-9) codes. We linked ambulance and hospital data to create complete patient care records. Main outcomes and measures: Stroke treatment, defined as a documented primary procedure code for intravenous alteplase administration (ICD-9: 99.10). Results: In Santa Clara County, intravenous alteplase was administered to 35 patients (1.7%) in the pre-regionalization period and 240 patients (2.1%) in the post-regionalization period. In San Mateo County, intravenous alteplase was administered to 29 patients (1.3%) in the pre-policy period and 135 patients (3.2%) in the post-policy period. After regionalization of stroke care, intravenous alteplase increased two-fold in San Mateo County [adjusted RR 2.20, p = 0.003, 95% CI (1.31, 3.69)] but did not show any statistically significant change in Santa Clara County [adjusted RR 1.10, p = 0.55, 95% CI (0.80, 1.51)]. In the post-regionalization phase, when compared with Santa Clara County, we found that San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers and more frequent use of intravenous alteplase at stroke centers. Conclusions: Our findings suggest that greater post-regionalization improvements in San Mateo County contributed to significantly better county-level thrombolysis use than Santa Clara County. [ABSTRACT FROM AUTHOR]

Objective: To examine the potential sociodemographic disparities in type 2 diabetes (T2D) management and care among US adult individuals, after controlling for clinical and behavioral factors.Methods: This was a retrospective cohort study of individuals with T2D (N = 4552) from a linked database of the National Health and Wellness Survey and a large US ambulatory electronic health record (EHR) database. This study period was between 1 January 2015 and 31 December 2018 and individuals were followed up for at least 6 months through EHR after the completion of the survey. The sociodemographic characteristics included gender, race, ethnicity, marital status, education, employment status, household income, insurance status, and geographic region. The independent variables included testing and control of HbA1c, blood pressure (BP), and low-density lipoprotein-cholesterol (LDL-C); hypoglycemia, emergency room (ER) visits, and all-cause hospitalization. Multivariable analyses were conducted using generalized linear models.Results: The percentage of uncontrolled HbA1c was 38.6%. With clinical and behavioral characteristics adjusted, individuals living in the Northeast region had 30% higher odds of having HbA1c testing than those who lived in the South. Blacks and Asians were less likely to have HbA1c control than Whites. Uninsured individuals had a lower likelihood of receiving HbA1c, BP, or LDL-C testing compared with commercial insurers. Individuals with low income were more likely to have higher ER visits and hospitalizations.Conclusion: Potential sociodemographic disparities exist in T2D management and care in the US, indicating the needs for improvement in healthcare access, educational and behavioral programs, as well as disease and treatment management in these subgroups. [ABSTRACT FROM AUTHOR]

Background: A substantial proportion of patients with type 2 diabetes mellitus (T2DM) do not reach their target HbA1c level on metformin. The objective of this retrospective observational cohort study is to better characterize the distance between HbA1c target and patient's actual HbA1c level (the distance to goal), using a target HbA1c of 7.0% (53 mmol/mol), in patients with T2DM who have started metformin monotherapy.Methods: We used data from the GE Centricity Electronic Medical Record database by IQVIA in 2016 in the United States (US) to identify adults with T2DM who started metformin monotherapy (MM) and received at least 90 days of treatment. Patients were categorized into three groups: those who achieved the goal of HbA1c <7.0%, those who did not achieve the goal of HbA1c <7.0% (i.e. failed MM) and received intensified treatment, and those who failed MM and did not receive intensified treatment. Distance to goal was computed for patients in each group.Results: We identified 20,704 patients in the US database who started MM; 1741 (8.4%) failed MM and received intensified treatment, while 4977 (24.0%) failed MM and did not receive intensified treatment. The mean post-MM HbA1c for those who failed MM and received intensified treatment was 8.7% (72 mmol/mol) (median 8.2%, 66 mmol/mol) and the mean distance to goal was 1.7% (median 1.2%). The mean post-MM HbA1c for those who failed MM and did not receive intensified treatment was 8.0% (64 mmol/mol) (median 7.5%, 58 mmol/mol) and the mean distance to goal was 1.0% (median 0.5%).Conclusion: A proportion of US T2DM patients do not achieve glycemic control (target HbA1c < 7.0%) despite 90 days of MM. Patients who failed MM and eventually received intensified treatment did so when their HbA1c distance to goal exceeded the level at which one add-on therapy alone might be sufficient to bring them to goal. [ABSTRACT FROM AUTHOR]

Medical photographs have been used for decades to document clinical findings. The ease with which medical photographs can be captured and integrated into the electronic health record (EHR) has increased as digital cameras obviated the need for the film development process. Today, cameras integrated into smartphones allow for high-resolution images to be instantly uploaded and integrated into the EHR. With major EHR vendors offering mobile smartphone applications for the conduct of point-of-care medical photography, health care providers and institutions need to be aware of legal questions that arise in the conduct of medical photography. Namely, (1) what are the requirements for consent when taking medical photographs, and how may photographs be used after consent is obtained, (2) are medical photographs admissible as evidence in court, and (3) how should a provider respond to a request by a patient or parent requesting that a photograph be deleted from the medical record? Herein, we review relevant laws and legal cases in the context of accepted standards of medical practice pertaining to point-of-care medical photography. This review is intended to aid health care providers and institutions seeking to develop or revise policies regarding using a mobile application at their clinical practice. [ABSTRACT FROM AUTHOR]

The study's objective was to assess temporal changes in birth country and age among newly diagnosed Latino men who have sex with men (MSM). We used records from Hispanics/Latinos (2007–2016) who were reported to the Florida HIV/AIDS surveillance system. We compared trends in birth country/region and age by year using a two-sided Cochran–Armitage Trend Test. Of 12,427 new diagnoses, 85.9% were among men. Of men, 79.5% were MSM. The proportion attributable to MSM increased from 70.0% in 2007–85.7% in 2016 (p-value <.0001). Compared with the trend in the proportion of MSM cases born in US-mainland, the proportion born in Cuba (20.0–29.9%; p-value <.0001) and South America (13.8% to 23.2%; p-value <.0001) increased significantly over time, and the proportion born in Central America (8.1% to 4.5%; p-value <.0001) decreased significantly over time. Compared with the trend in the proportion of MSM aged 35–49 years, the proportion aged 13–24 (15.4% to 20.6%; p-value <.0001) and 25–34 (25.0% to 35.6%; p-value <.0001) years increased significantly over time. In Florida, HIV prevention and screening strategies should be enhanced for Cuban and South American immigrants and young Latinos to address the increasing trend in new diagnoses among Latino MSM. [ABSTRACT FROM AUTHOR]

In an emergency department (ED) sample, we investigated the concordance between identification of suicide-related visits through standardized comprehensive chart review versus a subset of 3 specific chart elements: ICD-9-CM codes, free-text presenting complaints, and free-text physician discharge diagnoses. The method for this study was review of medical records for adults (≥18 years) at 8 EDs across the United States. A total of 3,776 charts were reviewed. A combination of the 3 chart elements (ICD-9-CM, presenting complaints, and discharge diagnoses) provided the most robust data with 85% sensitivity, 96% specificity, 92% PPV, and 92% NPV. These findings highlight the use of key discrete fields in the medical record that can be extracted to facilitate identification of whether an ED visit was suicide-related. [ABSTRACT FROM AUTHOR]

The article focuses on the case Barker and Todd Inc. v. Anthony Hope in the U.S. Supreme Court. It mentions case involves allegations that Barker & Todd, Inc. was negligent in storing the electronic protected health information of individuals who applied for its prescription assistance program. It also mentions patient application form requests personal information including income, date of birth, social security number, medical insurance policy numbers.

Objective: A regular care provider is an important measure of access to health services, but little is known about the association between having a regular provider and patients' access to services associated with electronic health records (EHR). Furthermore, the composition of the additional electronic services made available to patients is not well studied. Methods: We analyzed the most recent data from the Health Information National Trends Survey (HINTS5-Cycle1, 2017, n = 3,285). We estimated a weighted multivariable logistic regression model to assess the association between having a regular provider (65.3%) and access to EHR (29%). Control variables were selected based on Andersen's Behavioral Model. Results: In the adjusted model, participants with a regular provider had significantly greater access to an EHR (aOR 2.91, p <.001) compared to participants without a regular provider. Participants were more likely to have access to an EHR if they were females (aOR 1.56, p <.01), had a tablet computer (aOR 1.55, p <.05), smartphone (aOR 2.27, p <.01), a former smoker (aOR 1.67, p <.05) or had two or more chronic medical conditions (aOR 1.79, p <.01). Discussion: Individuals who have a regular provider are roughly three times as likely to have access to services linked to an EHR. Access to an EHR enhances both potential and realized access to many healthcare services. Conclusion: The availability of a regular care provider impacts the "digital divide." The expansion of electronic health services intensifies the importance of a regular care provider. [ABSTRACT FROM AUTHOR]

Routine distress screening in United States oncology clinics has been mandatory since 2015. Objective: This study was the first to assess distress in a geographically diverse sample of cancer patients following mandated distress screening implementation by oncology social workers. Methods: Sites were self-selected via social workers who applied to participate in the Association of Oncology Social Work's Project to Assure Quality Cancer Care, advertised through their social media outlets and conference. Electronic screening records were collected from 55 cancer treatment centers in the United States and Canada. Cases required cancer diagnoses and Distress Thermometer (DT) scores to be included. Distress rates and rates by age, sex, cancer type, and ethnicity were examined. Results: Of 4664 cases, 46% (2157) experienced significant distress (DT score ≥ 4). Being female, age 40-59, and having diagnoses of pancreatic or lung cancer was associated with increased likelihood of distress. Half of cases experience clinically-significant distress, though this need was not evenly distributed across patient or cancer types. Conclusion: Identifying those at risk for distress may help inform optimal resource allocation. Methods to address needs of distressed patients in cases of limited resources are discussed. [ABSTRACT FROM AUTHOR]