scholarly journals Risk factors for Lyme disease stage and manifestation using electronic health records

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katherine A. Moon ◽  
Jonathan S. Pollak ◽  
Melissa N. Poulsen ◽  
Christopher D. Heaney ◽  
Annemarie G. Hirsch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Health Care ◽  
Socioeconomic Status ◽  
Lyme Disease ◽  
Erythema Migrans ◽  
Disease Stage ◽  
Free Text ◽  
Medical Assistance ◽  
Electronic Health

Abstract Background Little is known about risk factors for early (e.g., erythema migrans) and disseminated Lyme disease manifestations, such as arthritis, neurological complications, and carditis. No study has used both diagnoses and free text to classify Lyme disease by disease stage and manifestation. Methods We identified Lyme disease cases in 2012–2016 in the electronic health record (EHR) of a large, integrated health system in Pennsylvania. We developed a rule-based text-matching algorithm using regular expressions to extract clinical data from free text. Lyme disease cases were then classified by stage and manifestation using data from both diagnoses and free text. Among cases classified by stage, we evaluated individual, community, and health care variables as predictors of disseminated stage (vs. early) disease using Poisson regression models with robust errors. Final models adjusted for sociodemographic factors, receipt of Medical Assistance (i.e., Medicaid, a proxy for low socioeconomic status), primary care contact, setting of diagnosis, season of diagnosis, and urban/rural status. Results Among 7310 cases of Lyme disease, we classified 62% by stage. Overall, 23% were classified using both diagnoses and text, 26% were classified using diagnoses only, and 13% were classified using text only. Among the staged diagnoses (n = 4530), 30% were disseminated stage (762 arthritis, 426 neurological manifestations, 76 carditis, 95 secondary erythema migrans, and 76 other manifestations). In adjusted models, we found that persons on Medical Assistance at least 50% of time under observation, compared to never users, had a higher risk (risk ratio [95% confidence interval]) of disseminated Lyme disease (1.20 [1.05, 1.37]). Primary care contact (0.59 [0.54, 0.64]) and diagnosis in the urgent care (0.22 [0.17, 0.29]), compared to the outpatient setting, were associated with lower risk of disseminated Lyme disease. Conclusions The associations between insurance payor, primary care status, and diagnostic setting with disseminated Lyme disease suggest that lower socioeconomic status and less health care access could be linked with disseminated stage Lyme disease. Intervening on these factors could reduce the individual and health care burden of disseminated Lyme disease. Our findings demonstrate the value of both diagnostic and narrative text data to identify Lyme disease manifestations in the EHR.

Epidemiology of Asthma and Influence of Ethnicity

2018 ◽  
Vol 39 (01) ◽  
pp. 003-011 ◽  
Author(s):  
Theo Moraes ◽  
Malcolm Sears ◽  
Padmaja Subbarao
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Socioeconomic Status ◽  
Asthma Prevalence ◽  
Modifiable Risk Factors ◽  
Prevalence Rates ◽  
Mechanistic Studies ◽  
The Past ◽  
Health Care Interventions ◽  
Insight Into

AbstractAsthma is a heterogeneous disorder with a complex etiology. Prevalence rates for asthma have been increasing in many countries over the past few decades. While it is unclear why this increase is occurring, the variation reported in asthma prevalence and severity associated with ethnicity offers some insight into the determinants of asthma. In this chapter, we discuss the data linking asthma to ethnicity and some of the factors that may explain this association. These include socioeconomic status, environmental exposures, the host microbiome, and genetics. A better understanding of these processes may inform future mechanistic studies and identify modifiable risk factors for targeted health care interventions.

scholarly journals Readmission Patterns After GI Cancer Hospitalizations: The Medical Versus Surgical Patient

2018 ◽  
Vol 14 (3) ◽  
pp. e137-e148 ◽  
Author(s):  
Joanna-Grace M. Manzano ◽  
Ming Yang ◽  
Hui Zhao ◽  
Linda S. Elting ◽  
Marina C. George ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Disease Stage ◽  
Surgical Patient ◽  
Unplanned Readmission ◽  
Gi Cancer ◽  
Value Based Care ◽  
Shared Risk

Purpose: Readmission within 30 days has been used as a metric for quality of care received at hospitals for certain diagnoses. In the era of accountability, value-based care, and increasing cancer costs, policymakers are looking into cancer readmissions as well. It is important to describe the readmission profile of patients with cancer in the most clinically relevant approach to inform policy and health care delivery that can positively impact patient outcomes. Patients and Methods: We conducted a retrospective cohort study using linked Texas Cancer Registry and Medicare claims data. We included elderly Texas residents diagnosed with GI cancer and identified risk factors for unplanned readmission using generalized estimating equations, comparing medical with surgical cancer-related hospitalizations. Results: We analyzed 69,693 hospitalizations from 31,736 patients. The unplanned readmission rate was higher after medical hospitalizations than after surgical hospitalizations (21.6% v 13.4%, respectively). Shared risk factors for readmission after medical and surgical hospitalizations included advanced disease stage, high comorbidity index, and emergency room visit and radiation therapy within 30 days before index hospitalization. Several other associated factors and reasons for readmission were noted to be unique to medical or surgical hospitalizations alone. Conclusion: Unplanned readmissions among elderly patients with GI cancer are more common after medical hospitalizations compared with surgical hospitalizations. There are shared risk factors and unique risk factors for these hospitalizations that can inform policy, health care delivery, and interventions to reduce readmissions. Other findings underscore the importance of care coordination and comorbidity management in this patient population.

scholarly journals Analysis of risk factors for osteopenia and osteoporosis among adults and elderly in primary health care

2020 ◽  
Vol 8 (1) ◽  
pp. 263-274
Author(s):  
Aniandra Karol Gonçalves Sgarbi ◽  
Kátia Gianlupi Lopes ◽  
Márcia Regina Martins Alvarenga
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Health Care ◽  
Body Mass Index ◽  
Primary Health Care ◽  
Body Mass ◽  
Family Health ◽  
Normal Body Mass Index ◽  
Primary Care Center ◽  
Primary Health

Objective: To analyze the distribution of risk factors for osteopenia and osteoporosis among adults and elderly in primary care. Method: sectional study of quantitative approach. Random sample extracted from registered adults and elderly from the five Family Health Strategy units belonging to an Expanded Family Health and Primary Care Center in Dourados, MS. Data collected between March and December 2015. The sample consisted of 44 adults and 103 elderly, of which only 109 performed all examinations. Body mass index, bone densitometry, serum calcium, 25 serum hydroxyvitamin D and a structured questionnaire were used. Results: The factors that were significantly associated with the risk of osteopenia and osteoporosis (p <0,05) were female gender, alcohol consumption and normal body mass index. Conclusion: the identification of these risk factors made it possible to trace their distribution profile, which will be of great value for carrying out health promotion actions and prevention of these diseases in Primary Health Care.

scholarly journals Natural language processing for disease phenotyping in UK primary care records for research: a pilot study in myocardial infarction and death

2019 ◽  
Vol 10 (S1) ◽  
Author(s):  
Anoop D. Shah ◽  
Emily Bailey ◽  
Tim Williams ◽  
Spiros Denaxas ◽  
Richard Dobson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Electronic Health Records ◽  
Natural Language ◽  
Cause Of Death ◽  
Free Text ◽  
Health Records ◽  
Death Registry ◽  
Primary Care Record ◽  
Electronic Health

Abstract Background Free text in electronic health records (EHR) may contain additional phenotypic information beyond structured (coded) information. For major health events – heart attack and death – there is a lack of studies evaluating the extent to which free text in the primary care record might add information. Our objectives were to describe the contribution of free text in primary care to the recording of information about myocardial infarction (MI), including subtype, left ventricular function, laboratory results and symptoms; and recording of cause of death. We used the CALIBER EHR research platform which contains primary care data from the Clinical Practice Research Datalink (CPRD) linked to hospital admission data, the MINAP registry of acute coronary syndromes and the death registry. In CALIBER we randomly selected 2000 patients with MI and 1800 deaths. We implemented a rule-based natural language engine, the Freetext Matching Algorithm, on site at CPRD to analyse free text in the primary care record without raw data being released to researchers. We analysed text recorded within 90 days before or 90 days after the MI, and on or after the date of death. Results We extracted 10,927 diagnoses, 3658 test results, 3313 statements of negation, and 850 suspected diagnoses from the myocardial infarction patients. Inclusion of free text increased the recorded proportion of patients with chest pain in the week prior to MI from 19 to 27%, and differentiated between MI subtypes in a quarter more patients than structured data alone. Cause of death was incompletely recorded in primary care; in 36% the cause was in coded data and in 21% it was in free text. Only 47% of patients had exactly the same cause of death in primary care and the death registry, but this did not differ between coded and free text causes of death. Conclusions Among patients who suffer MI or die, unstructured free text in primary care records contains much information that is potentially useful for research such as symptoms, investigation results and specific diagnoses. Access to large scale unstructured data in electronic health records (millions of patients) might yield important insights.

Considerations for Integrating Advance Care Planning Into the Electronic Health Record: A Primer for Clinicians

2020 ◽  
Vol 37 (12) ◽  
pp. 1004-1008
Author(s):  
Adam Moses ◽  
Ajay Dharod ◽  
Jeff Williamson ◽  
Nicholas M. Pajewski ◽  
Daniel Tuerff ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Electronic Health Record ◽  
Advance Care Planning ◽  
Health Record ◽  
Care Planning ◽  
Basic Understanding ◽  
Advance Care ◽  
Electronic Health ◽  
Outpatient Settings

Opportunities for expanding advance care planning (ACP) throughout the health-care system make it critical that primary care (PC) providers have a basic understanding of how the electronic health record (EHR) can aid promoting ACP discussions and documentation. This article will offer PC providers 5 useful tips for implementing ACP in outpatient settings utilizing the EHR.

scholarly journals Workarounds and Test Results Follow-up in Electronic Health Record-Based Primary Care

2016 ◽  
Vol 07 (02) ◽  
pp. 543-559 ◽  
Author(s):  
Shailaja Menon ◽  
Daniel Murphy ◽  
Hardeep Singh ◽  
Ashley N. Meyer ◽  
Dean Sittig
Keyword(s):  
Primary Care ◽  
Organizational Support ◽  
Qualitative Content Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Free Text ◽  
Test Results ◽  
Electronic Health ◽  
Results Management ◽  
Primary Care Practitioners

SummaryElectronic health records (EHRs) have potential to facilitate reliable communication and follow-up of test results. However, limitations in EHR functionality remain, leading practitioners to use workarounds while managing test results. Workarounds can lead to patient safety concerns and signify indications as to how to build better EHR systems that meet provider needs.To understand why primary care practitioners (PCPs) use workarounds to manage test results by analyzing data from a previously conducted national cross-sectional survey on test result management.We conducted a secondary data analysis of quantitative and qualitative data from a national survey of PCPs practicing in the Department of Veterans Affairs (VA) and explored the use of workarounds in test results management. We used multivariate logistic regression analysis to examine the association between key sociotechnical factors that could affect test results follow-up (e.g., both technology-related and those unrelated to technology, such as organizational support for patient notification) and workaround use. We conducted a qualitative content analysis of free text survey data to examine reasons for use of workarounds.Of 2554 survey respondents, 1104 (43%) reported using workarounds related to test results management. Of these 1028 (93%) described the type of workaround they were using; 719 (70%) reported paper-based methods, while 230 (22%) used a combination of paper- and computer-based workarounds. Primary care practitioners who self-reported limited administrative support to help them notify patients of test results or described an instance where they personally (or a colleague) missed results, were more likely to use workarounds (p=0.02 and p=0.001, respectively). Qualitative analysis identified three main reasons for workaround use: 1) as a memory aid, 2) for improved efficiency and 3) for facilitating internal and external care coordination.Workarounds to manage EHR-based test results are common, and their use results from unmet provider information management needs. Future EHRs and the respective work systems around them need to evolve to meet these needs.

scholarly journals The prevalence of cardiovascular risk factors and cardiovascular disease among primary care patients in Poland: results from the LIPIDOGRAM2015 study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Jozwiak ◽  
K Studzinski ◽  
T Tomasik ◽  
A Windak ◽  
M Banach
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Waist Circumference ◽  
Overweight And Obesity ◽  
Funding Source ◽  
Medical Reason ◽  
Primary Health

Abstract Background Cardiovascular disease (CVD) is currently one of the leading cause of mortality in the European Union. Well-established, modifiable cardiovascular (CV) risk factors include hypertension (HTN), hypercholesterolaemia, diabetes mellitus (DM), obesity, low activity levels, poor diet and smoking. There are no current estimates on the prevalence of CV risk factors among Polish patients solely in the primary care setting. Methods A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the 4th quarter of 2015 and 1st and 2nd quarters of 2016. 438 primary care physicians enrolled 13,724 adult patients that sought medical care for any medical reason in primary health care practices. Results Nearly 19% of men and approximately 12% of women had CVD. Over 60% of the recruited patients had HTN, &gt;80% had dyslipidaemia and &lt;15% of patients were previously diagnosed with DM. All of these disorders were more frequent in men. Overweight and obesity were present in more than 75% of patients with 80% of them exceeding the waist circumference norm for the European population. Slightly less than half of the patients were current smokers or had smoked in the past. Patients with CVD had significantly higher blood pressure and glucose levels but lower low density lipoprotein-cholesterol level (LDL-C). In patients with CVD, HTN and dyslipidaemia were twice as frequent and DM three times more so than in patients without it (Figure 1). Conclusions The incidence of CVD and CV risk factors among patients attending primary healthcare in Poland is high. CVD is more common in men than in women. The most common CV risk factors are excess waist circumference, dyslipidaemia and HTN. Family physicians working in primary health care, as well as health authorities should conduct activities to prevent, diagnose early and treat CVD in the primary health care population. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The present study was an initiative of the Polish Lipid Association (PoLA) and the College of Family Physician in Poland (CFPiP). The present study was funded by an unrestricted educational grant from Valeant.

scholarly journals Evaluating a specialist primary care service for patients experiencing homelessness: a qualitative study

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101049
Author(s):  
Emily Clark ◽  
Emily Player ◽  
Tara Gillam ◽  
Sarah Hanson ◽  
Nicholas Steel
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Service Use ◽  
Care Service ◽  
Service Planning ◽  
Primary Care Service ◽  
Care Staff ◽  
City Centre ◽  
Free Text

BackgroundPeople experiencing homelessness (PEH) often experience poor health, multimorbidity, and early mortality and experience barriers to accessing high quality health care. Little is known about how best to provide specialist primary care for these patients.AimTo evaluate the health care provided to patients experiencing homelessness who were seen in a specialist primary care service.Design & settingA qualitative evaluation of a city centre primary healthcare service for excluded and vulnerable people, such as rough sleepers, who find it difficult to visit mainstream GP services.MethodData on patient characteristics and service use were extracted from primary care records using electronic and free-text searches to provide context to the evaluation. Semi-structured interviews with 11 patients and four staff were used to explore attitudes and experiences.ResultsPatients had high needs compared with the general population. Patients valued continuity of care, ease of access, multidisciplinary care, and person-centred care. Staff were concerned that they lacked opportunities for reflection and learning, and that low clinical capacity affected service safety and quality. Staff also wanted more patient involvement in service planning.ConclusionPEH’s complex health and social problems benefited from a specialist primary care service, which is thought to reduce barriers to access, treat potentially challenging patients in a non-judgmental way, and provide personal continuity of care in order to develop trust.

Sign in / Sign up

Export Citation Format

Share Document