scholarly journals Real-world electronic health record identifies antimalarial underprescribing in patients with lupus nephritis

Lupus ◽  
2019 ◽  
Vol 28 (8) ◽  
pp. 977-985 ◽  
Author(s):  
W W Xiong ◽  
J B Boone ◽  
L Wheless ◽  
C P Chung ◽  
L J Crofford ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Real World ◽  
Lupus Erythematosus ◽  
Odds Ratio ◽  
Health Record ◽  
Urine Protein ◽  
Provider Characteristics ◽  
Reduce Disease Activity ◽  
Disease Damage ◽  
Electronic Health

Antimalarials (AMs) reduce disease activity and improve survival in patients with systemic lupus erythematosus (SLE), but studies have reported low AM prescribing frequencies. Using a real-world electronic health record cohort, we examined if patient or provider characteristics impacted AM prescribing. We identified 977 SLE cases, 94% of whom were ever prescribed an AM. Older patients and patients with SLE nephritis were less likely to be on AMs. Current age (odds ratio = 0.97, p < 0.01) and nephritis (odds ratio = 0.16, p < 0.01) were both significantly associated with ever AM use after adjustment for sex and race. Of the 244 SLE nephritis cases, only 63% were currently on AMs. SLE nephritis subjects who were currently prescribed AMs were more likely to be followed by a rheumatologist than a nephrologist and less likely to have undergone dialysis or renal transplant (both p < 0.001). Non-current versus current SLE nephritis AM users had higher serum creatinine ( p < 0.001), higher urine protein ( p = 0.05), and lower hemoglobin levels ( p < 0.01). As AMs reduce disease damage and improve survival in patients with SLE, our results demonstrate an opportunity to target future efforts to improve prescribing rates among multi-specialty providers.

Real-world evaluation of weight loss in patients with T2DM treated with canagliflozin (CANA) – An electronic health-record (EHR)-based study

2016 ◽  
Vol 120 ◽  
pp. S118-S119
Author(s):  
Patrick Lefebvre ◽  
Wing Chow ◽  
Dominic Pilon ◽  
Bruno Emond ◽  
Marie-Hélène Lafeuille ◽  
...  
Keyword(s):  
Weight Loss ◽  
Electronic Health Record ◽  
Real World ◽  
Health Record ◽  
Electronic Health

scholarly journals Are specific elements of electronic health record use associated with clinician burnout more than others?

2020 ◽  
Vol 27 (9) ◽  
pp. 1401-1410
Author(s):  
Ross W Hilliard ◽  
Jacqueline Haskell ◽  
Rebekah L Gardner
Keyword(s):  
Confidence Interval ◽  
Electronic Health Record ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Well Being ◽  
Health Record ◽  
Face To Face ◽  
Efficiency Measures ◽  
Electronic Health ◽  
Copy And Paste

Abstract Objective The study sought to examine the association between clinician burnout and measures of electronic health record (EHR) workload and efficiency, using vendor-derived EHR action log data. Materials and Methods We combined data from a statewide clinician survey on burnout with Epic EHR data from the ambulatory sites of 2 large health systems; the combined dataset included 422 clinicians. We examined whether specific EHR workload and efficiency measures were independently associated with burnout symptoms, using multivariable logistic regression and controlling for clinician characteristics. Results Clinicians with the highest volume of patient call messages had almost 4 times the odds of burnout compared with clinicians with the fewest (adjusted odds ratio, 3.81; 95% confidence interval, 1.44-10.14; P = .007). No other workload measures were significantly associated with burnout. No efficiency variables were significantly associated with burnout in the main analysis; however, in a subset of clinicians for whom note entry data were available, clinicians in the top quartile of copy and paste use were significantly less likely to report burnout, with an adjusted odds ratio of 0.22 (95% confidence interval, 0.05-0.93; P = .039). Discussion High volumes of patient call messages were significantly associated with clinician burnout, even when accounting for other measures of workload and efficiency. In the EHR, “patient calls” encompass many of the inbox tasks occurring outside of face-to-face visits and likely represent an important target for improving clinician well-being. Conclusions Our results suggest that increased workload is associated with burnout and that EHR efficiency tools are not likely to reduce burnout symptoms, with the exception of copy and paste.

Hysterectomy utilization among newly diagnosed endometrial cancer patients by body mass index category: A real-world analysis using a claims and electronic health record database.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17112-e17112
Author(s):  
Debra E. Irwin ◽  
Ellen Thiel
Keyword(s):  
Endometrial Cancer ◽  
Electronic Health Record ◽  
Real World ◽  
Patient Population ◽  
Morbidly Obese ◽  
Health Record ◽  
Newly Diagnosed ◽  
Data Set ◽  
Electronic Health

e17112 Background: For endometrial cancer (EC), laparoscopic hysterectomy (LH) is an effective, minimally invasive surgical treatment; however, this approach may not be recommended for obese patients due to increased risk for complications. Methods: This retrospective study utilized insurance claims linked to electronic health record (EHR) data contained in the IBM MarketScan Explorys Claims-EHR Data Set. Newly diagnosed EC patients (1/1/2007 - 6/30/2017) with continuous enrollment during a 12-month baseline and 6-month follow-up period were selected. Patients were stratified into four BMI subgroups based on baseline BMI on the EHR: normal or underweight (BMI < 25), overweight (BMI 25- < 30), obese (BMI 30- < 40), morbidly obese (BMI > 40), and were required to have had a hysterectomy within the follow-up period. Emergency room visits and rehospitalization within 30 days of hysterectomy were measured. Results: A total of 1,090 newly-diagnosed EC patients met the selection criteria, of whom, 16% were normal/underweight, 19% were overweight, 39% were obese, and 26% were morbidly obese. The proportion of patients receiving LH increased as BMI category increased (Table 1). Among those with LH between 6% and 15% had an ER visit or rehospitalization in 30 days, and rates were higher among other hysterectomy modalities. Conclusions: This real-world analysis shows that LH is utilized in a high proportion of morbidly obese EC patients, despite that it is frequently deemed infeasible in this patient population. Although the rate of ER visits and rehospitalization is lower among LH patients than those undergoing traditional hysterectomy across all BMI strata, further research is needed to determine the optimal patient population to receive LH.[Table: see text]

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