Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions

2021 ◽  
Vol 12 (05) ◽  
pp. 1101-1109
Author(s):  
Ashley B. Stephens ◽  
Chelsea S. Wynn ◽  
Annika M. Hofstetter ◽  
Chelsea Kolff ◽  
Oscar Pena ◽  
...  
Keyword(s):  
New York ◽  
Low Income ◽  
Age Groups ◽  
Clinical Decision ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Chi Square ◽  
Control And Prevention ◽  
Electronic Health ◽  
The Impact

Abstract Background Immunization reminders in electronic health records (EHR) provide clinical decision support (CDS) that can reduce missed immunization opportunities. Little is known about using CDS rules from a regional immunization information system (IIS) to power local EHR immunization reminders. Objective This study aimed to assess the impact of EHR reminders using regional IIS CDS-provided rules on receipt of immunizations in a low-income, urban population for both routine immunizations and those recommended for patients with chronic medical conditions (CMCs). Methods We built an EHR-based immunization reminder using the open-source resource used by the New York City IIS in which we overlaid logic regarding immunizations needed for CMCs. Using a randomized cluster-cross-over pragmatic clinical trial in four academic-affiliated clinics, we compared captured immunization opportunities during patient visits when the reminder was “on” versus “off” for the primary immunization series, school-age boosters, and adolescents. We also assessed coverage of CMC-specific immunizations. Up-to-date immunization was measured by end of quarter. Rates were compared using chi square tests. Results Overall, 15,343 unique patients were seen for 26,647 visits. The alert significantly impacted captured opportunities to complete the primary series in both well-child and acute care visits (57.6% on vs. 54.3% off, p = 0.001, and 15.3% on vs. 10.1% off, p = 0.02, respectively), among most age groups, and several immunization types. Captured opportunities for CMC-specific immunizations remained low regardless of alert status. The alert did not have an effect on up-to-date immunization overall (89.1 vs. 88.3%). Conclusion CDS in this population improved captured immunization opportunities. Baseline high rates may have blunted an up-to-date population effect. Converting Centers for Disease Control and Prevention (CDC) rules to generate sufficiently sensitive and specific alerts for CMC-specific immunizations proved challenging, and the alert did not have an impact on CMC-specific immunizations, potentially highlighting need for more work in this area.

scholarly journals Determinan pemberantasan sarang nyamuk pada ibu rumah tangga di Bogor

2016 ◽  
Vol 32 (6) ◽  
pp. 189
Author(s):  
Mayumi Nitami ◽  
Sri Tjahyani Budiutami
Keyword(s):  
Age Groups ◽  
Cross Sectional Study ◽  
Influential Factor ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Job Knowledge ◽  
Control And Prevention ◽  
Dengue Control ◽  
Prevention Counseling

Determinants of dengue mosquito eradication (PSN) in the households in Bogor in 2016PurposeThis study aimed to determine the factors that affect of PSN on housewives in Cibinong and the factors found that influence were: job, knowledge, attitude, behavior of housewife, counselling, active jumantik, giving abatement and the number of container.MethodsA cross-sectional study was conducted using 125 housewifes in Cibinong sub-district. The statistical analysis used chi-square and multiple logistic regression tests.ResultsThis study showed that counseling and the existence of jumantik cadre were the determinants of the application of mosquito nest eradication. Counseling was the most influential factor on the application of mosquito nest eradication.Conclusion Dengue control and prevention counseling should be given to all age groups in the community regularly and it is recommended to reactivate jumantik cadres.

scholarly journals Influenza With and Without Fever: Clinical Predictors and Impact on Outcomes in Patients Requiring Hospitalization

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Benjamin J Smith ◽  
David J Price ◽  
Douglas Johnson ◽  
Bruce Garbutt ◽  
Michelle Thompson ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Antiviral Treatment ◽  
Delayed Diagnosis ◽  
Clinical Decision ◽  
Case Definition ◽  
Influenza B ◽  
Clinical Predictors ◽  
Chi Square ◽  
Chi Square Test ◽  
The Impact

Abstract Background The Infectious Diseases Society of America influenza guidelines no longer require fever as part of their influenza case definition in patients requiring hospitalization. However, the impact of fever or lack of fever on clinical decision-making and patient outcomes has not been studied. Methods We conducted a retrospective review of adult patients admitted to our tertiary health service between April 2016 and June 2019 with laboratory-confirmed influenza, with and without fever (≥37.8ºC). Patient demographics, presenting features, and outcomes were analyzed using Pearson’s chi-square test, the Wilcoxon rank-sum test, and logistic regression. Results Of 578 influenza inpatients, 219 (37.9%) had no fever at presentation. Fever was less likely in individuals with a nonrespiratory syndrome (adjusted odds ratio [aOR], 0.44; 95% CI, 0.26–0.77), symptoms for ≥3 days (aOR, 0.53; 95% CI, 0.36–0.78), influenza B infection (aOR, 0.45; 95% CI, 0.29–0.70), chronic lung disease (aOR, 0.55; 95% CI, 0.37–0.81), age ≥65 (aOR, 0.36; 95% CI, 0.23–0.54), and female sex (aOR, 0.69; 95% CI, 0.48–0.99). Patients without fever had lower rates of testing for influenza in the emergency department (64.8% vs 77.2%; P = .002) and longer inpatient stays (median, 2.4 vs 1.9 days; P = .015). These patients were less likely to receive antiviral treatment (55.7% vs 65.6%; P = .024) and more likely die in the hospital (3.2% vs 0.6%; P = .031), and these differences persisted after adjustment for potential confounders. Conclusions Absence of fever in influenza is associated with delayed diagnosis, longer length of stay, and higher mortality.

scholarly journals Functional health status, chronic medical conditions and disorders of mood

2003 ◽  
Vol 183 (4) ◽  
pp. 299-303 ◽  
Author(s):  
Paul G. Surtees ◽  
Nicholas W. J. Wainwright ◽  
Kay-Tee Khaw ◽  
Nicholas E. Day
Keyword(s):  
Health Status ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Functional Health ◽  
Medical Illness ◽  
Chronic Medical Conditions ◽  
Functional Health Status ◽  
Medical Conditions ◽  
Chronic Medical Illness ◽  
The Impact

BackgroundUnderstanding of the impact of depressive and anxiety disorders on functional health status in the context of chronic medical illness has been gained almost exclusively from the study of patient populations.AimsTo compare the impact of major depressive and generalised anxiety disorder with that of chronic medical conditions on functional health in a UK resident population.MethodThe functional health of 20 921 study participants was assessed using the Medical Outcomes Study Short Form 36 questionnaire. Depressive and anxiety disorder episode histories and chronic medical conditions were assessed using independent self-completed questionnaires.ResultsThe degree of physical functional impairment associated with mood disorders was of equivalent magnitude to that associated with the presence of chronic medical conditions or with being some 12 years older.ConclusionsDepressive and anxiety disorders have a profound impact on functional health that is independent of chronic medical illness. Chronic anxiety is associated with physical health limitations in excess of those associated with chronic depression or any of the physical health conditions considered, except for stroke.

scholarly journals MP03: Strategies to minimize impact of electronic health record implementation on emergency department flow

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S42-S43
Author(s):  
E. Grafstein ◽  
S. Horak ◽  
J. Kung ◽  
J. Bonilla ◽  
R. Stenstrom
Keyword(s):  
Electronic Health Record ◽  
Productivity Loss ◽  
Admission Rate ◽  
Richmond Hospital ◽  
Health Record ◽  
Chi Square ◽  
Control Hospital ◽  
Time Periods ◽  
Electronic Health ◽  
The Impact

Introduction: Electronic health record (EHR) implementation can be associated with a slowdown in performance and delayed return to pre go-live productivity. The objective of this study is to describe the impact of a go-live strategy including diversion, public advertising of the go-live, and extra physician staffing to mitigate productivity loss. Methods: Lions Gate Hospital (LGH), an urban community hospital and rural referral centre with 250 beds and 65,000 annual ED visits went live with Cerner HER (Cerner Corporation, Kansas, MO) on April 28, 2018. The implementation included complete electronic ordering and electronic physician documentation. We compared patients seen per hour, time to physician (TTMD), ED length of stay (EDLOS), patients per hour left without being seen (LWBS), and admission rate (AR) for the 6 weeks prior to implementation (Pre), 2 weeks during (Imp), and 6 weeks after (Post) for LGH and a control hospital (Richmond Hospital – comparable in size/acuity) for the same periods. Medians were compared using the Mann-Whitney test for patients/hour, EDLOS and TTMD, and chi-square for AR and LWBS. Results: Patients/hour seen went from 2.1/hour in the pre phase, but dropped to 1.7/hr in the 2 week period following implementation (P < 0.05). During weeks 2-8 post implementation, 2,3 patients per hour were seen (P = 0.38 compared to Pre phase). At the control hospital, patients per hour were comparable across all time periods (Ps > 0.3). Median time to physician was 54, 56, and 54 minutes at LGH for the Pre, Imp, and Post time periods (Ps > 0.3). Median EDLOS was 184, 196, and 184 minutes in the pre, Imp, and post phases (P Imp versus pre = 0.11; Pre versus post = 0.54). LWBS rate was 1.3%, 2.9, and 2.4% (Ps for Imp and Post versus pre <0.05) at LGH, but the pattern was similar for the control hospital (2.9%, 4.1% and 4.0%’ Ps <0.05). There was no significant change in ambulance arrivals or admission rate at either hospital (Ps > 0.2). Conclusion: A deliberate implementation strategy that focuses on ED physician upstaffing and visit diversion can smooth the impact of the implementation of an EHR so that patient care is not impacted significantly. Return to normal productivity occurred by 8 weeks post go-live. We demonstrate a strategy that may support easier implementation at other sites.

scholarly journals Mobility, Targeting, and Private-School Vouchers

2000 ◽  
Vol 90 (1) ◽  
pp. 130-146 ◽  
Author(s):  
Thomas J Nechyba
Keyword(s):  
New York ◽  
School District ◽  
School Districts ◽  
Residential Mobility ◽  
Low Income ◽  
Private School ◽  
School Vouchers ◽  
School Voucher ◽  
The Impact

This paper uses general-equilibrium simulations to explore the role of residential mobility in shaping the impact of different private-school voucher policies. The simulations are derived from a three-district model of low-, middle-, and high-income school districts (calibrated to New York data) with housing stocks that vary within and across districts. In this model, it is demonstrated that school-district targeted vouchers are similar in their impact to nontargeted vouchers but vastly different from vouchers targeted to low-income households. Furthermore, strong migration effects are shown to significantly improve the likely equity consequences of voucher programs. (JEL I22, I28, H73)

scholarly journals The impact of Hurricane Maria on out-migration from Puerto Rico: Evidence from Facebook data

2019 ◽  
Author(s):  
Monica Alexander ◽  
Emilio Zagheni ◽  
Kivan Polimis
Keyword(s):  
New York ◽  
Puerto Rico ◽  
Return Migration ◽  
Age Groups ◽  
Population Characteristics ◽  
Population Movements ◽  
Demographic Indicators ◽  
Migration Data ◽  
The Us ◽  
The Impact

Natural disasters such as hurricanes can cause substantial population out-migration. However, the magnitude of population movements is difficult to estimate using only traditional sources of migration data. We utilize data obtained from Facebook's advertising platform to estimate out-migration from Puerto Rico in the months after Hurricane Maria. We find evidence to indicate a 17.0% increase in the number of Puerto Rican migrants present in the US over the period October 2017 to January 2018. States with the biggest increases were Florida, New York and Pennsylvania, and there were disproportionately larger increases in the 15-30 age groups and for men compared to women. Additionally, we find evidence of subsequent return migration to Puerto Rico over the period January 2018 to March 2018. These results illustrate the power of complementing social media and traditional data to monitor demographic indicators over time, particularly after a shock, such as a natural disaster, to understand large changes in population characteristics.

The Impact of a Less Restrictive Poststernotomy Activity Protocol Compared With Standard Sternal Precautions in Patients Following Cardiac Surgery

2020 ◽  
Vol 100 (7) ◽  
pp. 1074-1083
Author(s):  
Caitlyn Holloway ◽  
Neeti Pathare ◽  
Jean Huta ◽  
Dana Grady ◽  
Andrea Landry ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Median Sternotomy ◽  
Clinical Decision ◽  
Functional Mobility ◽  
Pain Rating ◽  
Chi Square ◽  
Cross Sectional ◽  
Discharge Disposition ◽  
Alternative Approaches ◽  
The Impact

Abstract Objective Guidelines following median sternotomy typically include strict sternal precautions (SP). Recently, alternative approaches propose less functional restrictions while avoiding excessive stress to the sternum. The study aimed to determine the effect of a less restrictive (LR) approach versus a standard SP protocol after median sternotomy. Methods The study was a cross-sectional design (n = 364; SP: n = 172, 66.3 [SD = 11.2] years; LR: n = 196, 65.2 [SD = 11.2] years). This study ran in 2 consecutive phases and compared 2 groups after median sternotomy at a community-based hospital. The LR group received instructions on the Keep Your Move in the Tube approach. At 2 to 3 weeks after discharge, sternal instability was assessed using the Sternal Instability Scale, and patients completed a self-reported survey (perceived pain rating/frequency, sternal instability, and functional mobility). The 2 groups were compared using the Mann-Whitney U test and chi-square test (P < .05). Results There were no significant differences between the 2 groups for all the outcomes, Sternal Instability Scale, pain rating, pain frequency, perceived sternal instability, difficulty with functional mobility, length of stay, and discharge disposition. Conclusions In our study, the implementation of the LR approach, Keep Your Move in the Tube, had no adverse effect on outcomes 2 to 3 weeks following median sternotomy. Although no statistically significant differences were noted for all outcomes, patients with the LR approach reported less difficulty with functional mobility. Impact Statement These data are useful in clinical decision-making regarding alternative approaches for mobility following sternotomy.

How mHealth Providers Meet the Emerging Demands of Consumers in China: A Survey from Patient-Users (Preprint)

2019 ◽  
Author(s):  
Jinlei Guo ◽  
Thanh Nguyen ◽  
Tongbin Zhang ◽  
Fanggao Chang ◽  
Jichao Chen ◽  
...  
Keyword(s):  
Social Networking ◽  
Prior Knowledge ◽  
Mobile Health ◽  
Age Groups ◽  
Quality Of Healthcare ◽  
Application Development ◽  
Chi Square ◽  
Healthcare Settings ◽  
Original Survey ◽  
The Impact

BACKGROUND Background: The adoption of mobile health information technology (mHealth), consisting primarily of electronic medical record (EMR) in hospitals and mobile health (mHealth) application among consumers outside of healthcare settings, have been booming in China. There have been investigations on the impact of mHealth on improving the quality of healthcare. However, it remains unclear whether emerging mHealth providers, particularly mHealth providers, fill in emerging consumer needs in China. OBJECTIVE Objective: This study aims to survey prior knowledge, current usage, and future preference of mHealth applications among two distinct cohorts (online vs hospital visitor) that we surveyed in China. METHODS Methods: We categorized main mHealth features into 9 groups. We surveyed two Chinese cohorts: hospitalized patients (n = 299) and the general public outside the hospital using WeChat—a popular social networking APPs (n = 156), on mHealth usage and expectations on these 9 feature groups. The original survey was conducted in Chinese. We performed data analysis of user reponses in the survey using descriptive statistics techniques: t-test and chi-square fitness test. RESULTS Results: Although most of the survey participants show prior knowledge on some features of EMR, most of them (66%) have never used mHealth applications. In addition, the participants consider predictive analytic features as the most important ones for the mHealth applications. The responses vary according to different cohort demographics, in particular, age groups. CONCLUSIONS Conclusions: Despite tremendous efforts in adopting EMR and developing mHealth applications, it is still too early to conclude that mHealth are readily adopted among patients in China. There are significant gaps among what the implementers offer, what providers expect, and what patients and consumers demands. Current Chinese mHealth applications implement features heavily focused on social networking and communication; however, it has been shown that patients do not consider these features as the top priority in mHealth applications. Instead, our study suggests that analytic features should be the future focus for successful mHealth application development in China.

Impact of leucovorin shortage on patient treatment.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17566-e17566
Author(s):  
Mina Samir Erian Hanna ◽  
Peter Kozuch ◽  
Molly Thorn ◽  
Janna Roitman ◽  
Michael L. Grossbard ◽  
...  
Keyword(s):  
New York ◽  
Low Dose ◽  
Economic Effect ◽  
Patient Characteristics ◽  
Patient Treatment ◽  
Additional Patient ◽  
Drug Shortage ◽  
Chi Square ◽  
Nccn Guidelines ◽  
The Impact

e17566 Background: Shortages of intravenous leucovorin were initially reported in late 2008, and availability plummeted nationally and at Continuum Cancer Centers of New York (CCCNY) in late 2011. NCCN guidelines recommend either the use of levoleucovorin or low dose leucovorin during the shortage. The impact of the leucovorin shortage on patient therapy remains unknown. Methods: We reviewed patient charts for all outpatients treated with leucovorin at CCCNY between April and September of 2010, 2011, and 2012. We recorded patient characteristics, and leucovorin use (dose, number of treatments); and calculated descriptive statistics. We classified each dose as either low (20-40 mg/m2) or high (200-500mg/m2) and compared leucovorin use between years with Chi Square and ANOVA tests. We also reviewed pharmacy purchasing data to evaluate the economic effect of the leucovorin shortage. Results: We identified 55 patients treated with 313 doses of leucovorin in 2010, 99 patients treated with 582 doses in 2011 and 118 patients treated with 742 doses in 2012. No patients received levoleucovorin. Patient characteristics, disease and stage were similar between years with colorectal cancer accounting for 78%, 69%, and 70% of patients in 2010, 2011, and 2012 (p=0.87). Low dose leucovorin was used in 30.0% of doses in 2010, 30.4% in 2011, and 99.1% in 2012 (p<0.0001). The mean dose/treatment (SD) was 459 mg (296), 499 mg (328), and 47 mg (89), in 2010, 2011, 2012, respectively (p<0.0001). Among patients treated for colon cancer we found no association between stage (III vs. IV) and use of low dose leucovorin in 2010 or 2011. Quantity of leucovorin purchased at one hospital decreased by 63% from 171.75 g in 2010 and 157.50g in 2011 to 63.00 g in 2012. The price of leucovorin was similar at 0.017 $/mg in 2011 and 0.013 $/mg in 2012. Conclusions: Worsening leucovorin drug shortage was associated with a profound change in leucovorin use at CCCNY between 2011 and 2012. In accordance with NCCN guidelines, physicians used more low dose leucovorin. The price of leucovorin remained constant despite limited supply. Additional patient follow up is warranted to evaluate the outcomes of patients treated during the shortage.

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