Assessing the completeness of periodontal disease documentation in the EHR: a first step in measuring the quality of care

Abstract Background Our objective was to measure the proportion of patients for which comprehensive periodontal charting, periodontal disease risk factors (diabetes status, tobacco use, and oral home care compliance), and periodontal diagnoses were documented in the electronic health record (EHR). We developed an EHR-based quality measure to assess how well four dental institutions documented periodontal disease-related information. An automated database script was developed and implemented in the EHR at each institution. The measure was validated by comparing the findings from the measure with a manual review of charts. Results The overall measure scores varied significantly across the four institutions (institution 1 = 20.47%, institution 2 = 0.97%, institution 3 = 22.27% institution 4 = 99.49%, p-value < 0.0001). The largest gaps in documentation were related to periodontal diagnoses and capturing oral homecare compliance. A random sample of 1224 charts were manually reviewed and showed excellent validity when compared with the data generated from the EHR-based measure (Sensitivity, Specificity, PPV, and NPV > 80%). Conclusion Our results demonstrate the feasibility of developing automated data extraction scripts using structured data from EHRs, and successfully implementing these to identify and measure the periodontal documentation completeness within and across different dental institutions.

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Assessing The Completeness of Periodontal Disease Documentation in The EHR: A First Step in Measuring The Quality of Care

10.21203/rs.3.rs-156335/v1 ◽

2021 ◽

Author(s):

Joanna Mullins ◽

Alfa Yansane ◽

Shwetha Kumar ◽

Suhasini Bangar ◽

Ana Neumann ◽

...

Keyword(s):

Periodontal Disease ◽

Disease Risk ◽

Data Extraction ◽

P Value ◽

Related Information ◽

Diabetes Status ◽

Sensitivity Specificity ◽

Manual Review ◽

Automated Database

Abstract Background: Our objective was to measure the proportion of patients for which comprehensive periodontal charting, periodontal disease risk factors (diabetes status, tobacco use, and oral home care compliance), and periodontal diagnoses were documented in the electronic health record (EHR). We developed an EHR-based quality measure to assess how well four dental institutions documented periodontal disease-related information. An automated database script was developed and implemented in the EHR at each institution. The measure was validated by comparing the findings from the measure with a manual review of charts. Results: The overall measure scores varied significantly across the four institutions (site 1=20.47%, site 2=0.97%, site 3=22.27% site 4= 99.49%, p-value <0.0001). The largest gaps in documentation were related to periodontal diagnoses and capturing oral homecare compliance. A random sample of 1,224 charts were manually reviewed and showed excellent validity when compared with the data generated from the EHR-based measure (Sensitivity, Specificity, PPV, and NPV >80%). Conclusion: Our results demonstrate the feasibility of developing automated data extraction scripts using structured data from EHRs, and successfully implementing these to identify and measure the periodontal documentation completeness within and across different dental institutions.

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Quality assessment of systematic reviews and meta-analyses that examine preventive antibiotic uses and management practices designed to prevent disease in livestock

Animal Health Research Reviews ◽

10.1017/s146625231900029x ◽

2019 ◽

Vol 20 (2) ◽

pp. 305-318

Author(s):

Rachael Vriezen ◽

Jan M. Sargeant ◽

Ellen Vriezen ◽

Charlotte B. Winder ◽

Annette M. O'Connor

Keyword(s):

Quality Assessment ◽

Systematic Reviews ◽

Management Practices ◽

Disease Risk ◽

Data Extraction ◽

A Priori ◽

Antibiotic Use ◽

Study Selection ◽

Meta Analyses

AbstractTo implement effective stewardship in food animal production, it is essential that producers and veterinarians are aware of preventive interventions to reduce illness in livestock. Systematic reviews and meta-analyses (SR/MA) provide transparent, replicable, and quality-assessed overviews. At present, it is unknown how many SR/MA evaluate preventive antibiotic use or management practices aimed at reducing disease risk in animal agriculture. Further, the quality of existing reviews is unknown. Our aim was to identify reviews investigating these topics and to provide an assessment of their quality. Thirty-eight relevant reviews were identified. Quality assessment was based on the AMSTAR 2 framework for the critical appraisal of systematic reviews. The quality of most of the reviews captured was classified as critically low (84.2%, n = 32/38), and only a small percentage of the evaluated reviews did not contain critical weaknesses (7.9%, n = 3/38). Particularly, a small number of reviews reported the development of an a priori protocol (15.8%, n = 6/38), and few reviews stated that key review steps were conducted in duplicate (study selection/screening: 26.3%, n = 10/38; data extraction: 15.8%, n = 6/38). The development of high-quality reviews summarizing evidence on approaches to antibiotic reduction is essential, and thus greater adherence to quality conduct guidelines for synthesis research is crucial.

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The Content and Quality of Information About Hyperacusis Presented Online

American Journal of Audiology ◽

10.1044/2020_aja-19-00074 ◽

2020 ◽

Vol 29 (3S) ◽

pp. 623-630

Author(s):

Sandra N. Smith ◽

Ethan Smallwood ◽

Magdalena Sereda ◽

Bethany Adams ◽

Derek J. Hoare

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Data Extraction ◽

The Internet ◽

Search Term ◽

Related Information ◽

Data Extraction Form ◽

Source Of Information ◽

Complete Account

Purpose Hyperacusis is a disorder characterized by reduced sound tolerance leading to ear pain, emotional distress, and reduced quality of life. Many people with hyperacusis turn to the Internet for information and support from online communities to discuss their condition. The purpose of this study was to assess the content and quality of hyperacusis information presented online. Method The three most used Internet search engines were used to identify relevant websites using the single search term hyperacusis . Fifteen websites were selected for analysis. Details of the purpose, audience, and content of each website were extracted using a bespoke data extraction form. The quality of the information on each website was rated using the validated DISCERN questionnaire. Results There was a wide disparity in the quality and content of hyperacusis information across websites. The website Hyperacusis Focus achieved the highest overall DISCERN score. Hyperacusis Focus and U.K. National Health Service websites were the most comprehensive online resources for health care professionals and patients, respectively. Wikipedia was judged useful for both health care professionals and patients. In general, hyperacusis-related information was accurate. However, no single website provided a complete account of hyperacusis, and some were judged to be selective in the information they provided. Conclusions The Internet provides an important source of information for those who have hyperacusis and those who care for them. Revisions to the websites reviewed here are needed for each to provide a complete account of hyperacusis. Supplemental Material https://doi.org/10.23641/asha.12869717

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Comparison of Three Information Sources for Smoking Information in Electronic Health Records

Cancer Informatics ◽

10.4137/cin.s40604 ◽

2016 ◽

Vol 15 ◽

pp. CIN.S40604 ◽

Cited By ~ 4

Author(s):

Liwei Wang ◽

Xiaoyang Ruan ◽

Ping Yang ◽

Hongfang Liu

Keyword(s):

Language Processing ◽

Smoking Status ◽

International Classification Of Diseases ◽

Structured Data ◽

Narrative Text ◽

Data Sources ◽

Related Information ◽

Diagnosis Codes ◽

Classification Of Diseases ◽

Sensitivity Specificity

Objective The primary aim was to compare independent and joint performance of retrieving smoking status through different sources, including narrative text processed by natural language processing (NLP), patient-provided information (PPI), and diagnosis codes (ie, International Classification of Diseases, Ninth Revision [ICD-9]). We also compared the performance of retrieving smoking strength information (ie, heavy/light smoker) from narrative text and PPL Materials and Methods Our study leveraged an existing lung cancer cohort for smoking status, amount, and strength information, which was manually chart-reviewed. On the NLP side, smoking-related electronic medical record (EMR) data were retrieved first. A pattern-based smoking information extraction module was then implemented to extract smoking-related information. After that, heuristic rules were used to obtain smoking status-related information. Smoking information was also obtained from structured data sources based on diagnosis codes and PPI. Sensitivity, specificity, and accuracy were measured using patients with coverage (ie, the proportion of patients whose smoking status/strength can be effectively determined). Results NLP alone has the best overall performance for smoking status extraction (patient coverage: 0.88; sensitivity: 0.97; specificity: 0.70; accuracy: 0.88); combining PPI with NLP further improved patient coverage to 0.96. ICD-9 does not provide additional improvement to NLP and its combination with PPI. For smoking strength, combining NLP with PPI has slight improvement over NLP alone. Conclusion These findings suggest that narrative text could serve as a more reliable and comprehensive source for obtaining smoking-related information than structured data sources. PPI, the readily available structured data, could be used as a complementary source for more comprehensive patient coverage.

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Restaging of patients with lymphoma

Nuklearmedizin ◽

10.3413/nukmed-0114 ◽

2008 ◽

Vol 47 (01) ◽

pp. 37-42 ◽

Cited By ~ 12

Author(s):

T. Pfluger ◽

V. Schneider ◽

M. Hacker ◽

N. Bröckel ◽

D. Morhard ◽

...

Keyword(s):

Low Dose ◽

Non Hodgkin Lymphoma ◽

Contrast Enhanced ◽

Pet Ct ◽

Significant Difference ◽

18F Fdg ◽

Sensitivity Specificity ◽

Fdg Pet Ct

SummaryAim: Assessment of the clinical benefit of i.v. contrast enhanced diagnostic CT (CE-CT) compared to low dose CT with 20 mAs (LD-CT) without contrast medium in combined [18F]-FDG PET/CT examinations in restaging of patients with lymphoma. Patients, methods: 45 patients with non-Hodgkin lymphoma (n = 35) and Hodgkin's disease (n = 10) were included into this study. PET, LD-CT and CECT were analyzed separately as well as side-by-side. Lymphoma involvement was evaluated separately for seven regions. Indeterminate diagnoses were accepted whenever there was a discrepancy between PET and CT findings. Results for combined reading were calculated by rating indeterminate diagnoses according the suggestions of either CT or PET. Each patient had a clinical follow-up evaluation for >6 months. Results: Region-based evaluation suggested a sensitivity/specificity of 66/93% for LD-CT, 87%/91% for CE-CT, 95%/96% for PET, 94%/99% for PET/LD-CT and 96%/99% for PET/CE-CT. The data for PET/CT were obtained by rating indeterminate results according to the suggestions of PET, which turned out to be superior to CT. Lymphoma staging was changed in two patients using PET/ CE-CT as compared to PET/LD-CT. Conclusion: Overall, there was no significant difference between PET/LD-CT and PET/CE-CT. However, PET/CE-CT yielded a more precise lesion delineation than PET/LD-CT. This was due to the improved image quality of CE-CT and might lead to a more accurate investigation of lymphoma.

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Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person

Medical Sciences ◽

10.3390/medsci9020031 ◽

2021 ◽

Vol 9 (2) ◽

pp. 31

Author(s):

Christine E. Mc Carthy

Keyword(s):

Sleep Disturbance ◽

Sleep Disorders ◽

Older Patients ◽

Disease Risk ◽

Medication Management ◽

Sleep Complaints ◽

Co Morbidity ◽

Sleep Assessment ◽

Form Part

Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson’s disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.

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Novel Methodology to Measure Preprocedure Antimicrobial Prophylaxis: Integrating Text Mining With Structured Data

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.485 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s12-s13

Author(s):

Hillary Mull ◽

Kelly Stolzmann ◽

Emily Kalver ◽

Marlena Shin ◽

Marin Schweizer ◽

...

Keyword(s):

Antimicrobial Prophylaxis ◽

High Sensitivity ◽

Structured Data ◽

Fiscal Year ◽

Veterans Health ◽

Health Administration ◽

Implementation Barriers ◽

Cardiac Device ◽

Device Infection ◽

Manual Review

Background: Antimicrobial prophylaxis is an evidence-proven strategy for reducing procedure-related infections; however, measuring this key quality metric typically requires manual review, due to the way antimicrobial prophylaxis is documented in the electronic medical record (EMR). Our objective was to combine structured and unstructured data from the Veterans’ Health Administration (VA) EMR to create an electronic tool for measuring preincisional antimicrobial prophylaxis. We assessed this methodology in cardiac device implantation procedures. Methods: With clinician input and review of clinical guidelines, we developed a list of antimicrobial names recommended for the prevention of cardiac device infection. Next, we iteratively combined positive flags for an antimicrobial order or drug fill from structured data fields in the EMR and hits on text string searches of antimicrobial names documented in electronic clinical notes to optimize an algorithm to flag preincisional antimicrobial use with high sensitivity and specificity. We trained the algorithm using existing fiscal year (FY) 2008-15 data from the VA Clinical Assessment Reporting and Tracking-Electrophysiology (CART-EP), which contains manually determined information about antimicrobial prophylaxis. We then validated the performance of the final version of the algorithm using a national cohort of VA patients who underwent cardiac device procedures in FY 2016 or 2017. Discordant cases underwent expert manual review to identify reasons for algorithm misclassification and to identify potential future implementation barriers. Results: The CART-EP dataset included 2,102 procedures at 38 VA facilities with manually identified antimicrobial prophylaxis in 2,056 cases (97.8%). The final algorithm combining structured EMR fields and text-note search results flagged 2,048 of the CART-EP cases (97.4%). Algorithm validation identified antimicrobial prophylaxis in 16,334 of 19,212 cardiac device procedures (87.9%). Misclassifications occurred due to EMR documentation issues. Conclusions: We developed a methodology with high accuracy to measure guideline-concordant use of antimicrobial prophylaxis before cardiac device procedures using data fields present in modern EMRs that does not rely on manual review. In addition to broad applicability in the VA and other healthcare systems with EMRs, this method could be adapted for other procedural areas in which antimicrobial prophylaxis is recommended but comprehensive measurement has been limited to resource-intense manual review.Funding: NoneDisclosures: None

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PARE0023 ORAL HEALTH IN RHEUMATOID ARTHRITIS: LISTENING TO PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.612 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1297.2-1297

Author(s):

J. Protudjer ◽

C. Billedeau ◽

C. Stavropoulou ◽

A. Cholakis ◽

R. Schroth ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Oral Health ◽

Periodontal Disease ◽

Oral Care ◽

Structured Interviews ◽

Face To Face ◽

Oral Health Education ◽

To Receive ◽

Latent Content

Background:Rates of periodontal disease and tooth loss are increased in rheumatoid arthritis (RA). Periodontal disease may exacerbate RA inflammation and complicate RA care. Understanding factors that contribute to the increased burden of periodontal disease in RA is critical to improving oral health and possibly arthritis outcomes. People with RA may have unique needs and/or barriers to maintain oral health.Objectives:To determine from people with RA what are their experiences and perceptions about their oral health, their most important questions relating to oral health, and how they wish to receive oral health information.Methods:Semi-structured interviews were conducted with RA patients. Recorded interview transcripts underwent iterative content analysis. Transcripts were initially reviewed to develop a coding guide. Latent content, or larger themes, were then applied to the transcripts. Constructs were considered saturated when no new themes were identified with subsequent interviews. We report identified themes with representative quotes.Results:Interviews with 11 RA (10[91%] female; all on RA medication) averaged 19 minutes (range 8-31 minutes) and were mostly conducted face-to-face. Many believed RA medication contributed to dry mouth. Most participants had not previously considered other links between oral health and RA. Themes identified included the need for complicated oral health routines, barriers of cost and access to dental care, and shame relating to oral health (Table 1). Participants preferred to receive oral health education from their rheumatologists or dentists over printed or online resources.Conclusion:RA patients have unique needs relating to oral health and report poor oral quality of life. Strategies to optimize oral health in RA may include educational tools for optimizing oral self-care appropriate for RA, and improved access to oral care professionals who are aware of the needs of arthritis patients.Disclosure of Interests:Jennifer Protudjer: None declared, Corrie Billedeau: None declared, Chrysi Stavropoulou: None declared, Anastasia Cholakis: None declared, Robert Schroth: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada

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The contribution of French patient and consumer groups to health technology assessments over a 2-year period: an observational retrospective study

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321000180 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Cedric Gesbert ◽

Joëlle André-Vert ◽

Marc Guerrier ◽

Margaret Galbraith ◽

Christine Devaud ◽

...

Keyword(s):

Retrospective Study ◽

Human Resources ◽

Data Extraction ◽

Health Technology ◽

Family Impact ◽

National Authority ◽

Public Authorities ◽

Pricing Decision ◽

Open Question

Abstract Background In 2017, The French National Authority for Health (HAS) created an open, online, systematic contribution process to enable patient and consumer groups (PCGs) to contribute to health technology assessment (HTA) carried out to aid public authorities in reimbursement and pricing decision making. Objectives This retrospective study analyzes how French PCGs contributed to the HTA process within the HAS for the first 2 years of this new mechanism. Methods PCG contributions received between 01 January 2017 and 31 December 2018 and the recording of deliberations leading to reports of the corresponding HTAs were included. Analysis grids were designed by the investigators with 5 rounds of refinement tests on 10 random PCG contributions and the reports. Systematic data extraction was then performed separately by two investigators. PCG answers to the open-question templates and the related final HTA report published by the HAS were analyzed. Results Seventy-nine contributions from 44 PCGs were received and analyzed by the HAS for 78 out of the 592 HTAs performed for drugs or medical devices during the 2-year period. Twenty-five percent of the HTAs performed for drugs received at least one contribution. The contributions covered quality-of-life aspects, access to care, and personal and family impact. Membership and budget of the contributing PCGs varied greatly. Conclusions The experience gained in the first 2 years demonstrates the feasibility of the process and the fact that PCG contribution actually provides relevant input on the patient perspective for HTAs used for reimbursement decisions. The challenges identified on the side of PCGs were time constraints and human resources.

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Effectiveness of Antalgic Therapies in Patients with Vertebral Bone Metastasis: A Protocol for a Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083991 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3991

Author(s):

Antonio Jose Martin-Perez ◽

María Fernández-González ◽

Paula Postigo-Martin ◽

Marc Sampedro Pilegaard ◽

Carolina Fernández-Lao ◽

...

Keyword(s):

Systematic Review ◽

Bone Metastasis ◽

Data Extraction ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Pharmacological Intervention ◽

Vertebral Metastasis ◽

Randomized Controlled Clinical Trials

There is no systematic review that has identified existing studies evaluating the pharmacological and non-pharmacological intervention for pain management in patients with bone metastasis. To fill this gap in the literature, this systematic review with meta-analysis aims to evaluate the effectiveness of different antalgic therapies (pharmacological and non-pharmacological) in the improvement of pain of these patients. To this end, this protocol has been written according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) and registered in PROSPERO (CRD42020135762). A systematic search will be carried out in four international databases: Medline (Via PubMed), Web of Science, Cochrane Library and SCOPUS, to select the randomized controlled clinical trials. The Risk of Bias Tool developed by Cochrane will be used to assess the risk of bias and the quality of the identified studies. A narrative synthesis will be used to describe and compare the studies, and after the data extraction, random effects model and a subgroup analyses will be performed according to the type of intervention, if possible. This protocol aims to generate a systematic review that compiles and synthesizes the best and most recent evidence on the treatment of pain derived from vertebral metastasis.

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