Cross sectional study to assess the accuracy of electronic health record data to identify patients in need of lung cancer screening

Clinical research in sepsis patients often requires gathering large amounts of longitudinal information. The electronic health record can be used to identify patients with sepsis, improve participant study recruitment, and extract data. The process of extracting data in a reliable and usable format is challenging, despite standard programming language. The aims of this project were to explore infrastructures for capturing electronic health record data and to apply criteria for identifying patients with sepsis. We conducted a prospective feasibility study to locate and capture/abstract electronic health record data for future sepsis studies. We located parameters as displayed to providers within the system and then captured data transmitted in Health Level Seven® interfaces between electronic health record systems into a prototype database. We evaluated our ability to successfully identify patients admitted with sepsis in the target intensive care unit (ICU) at two cross-sectional time points and then over a 2-month period. A majority of the selected parameters were accessible using an iterative process to locate and abstract them to the prototype database. We successfully identified patients admitted to a 20-bed ICU with sepsis using four data interfaces. Retrospectively applying similar criteria to data captured for 319 patients admitted to ICU over a 2-month period was less sensitive in identifying patients admitted directly to the ICU with sepsis. Classification into three admission categories (sepsis, no-sepsis, and other) was fair (Kappa .39) when compared with manual chart review. This project confirms reported barriers in data extraction. Data can be abstracted for future research, although more work is needed to refine and create customizable reports. We recommend that researchers engage their information technology department to electronically apply research criteria for improved research screening at the point of ICU admission. Using clinical electronic health records data to classify patients with sepsis over time is complex and challenging.

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When Is a Harm a Harm? Discordance between Patient and Medical Experts’ Evaluation of Lung Cancer Screening Attributes

Medical Decision Making ◽

10.1177/0272989x20987221 ◽

2021 ◽

Vol 41 (3) ◽

pp. 317-328

Author(s):

Marilyn M. Schapira ◽

Keri L. Rodriguez ◽

Sumedha Chhatre ◽

Liana Fraenkel ◽

Lori A. Bastian ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Radiation Exposure ◽

Incidental Findings ◽

Medical Center ◽

Indirect Costs ◽

Lung Cancer Screening ◽

Cross Sectional Study ◽

Cross Sectional ◽

Semistructured Interviews

Background A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms. Objective To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies. Design Cross-sectional study with semistructured interviews and a card-sort activity. Participants Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female. Approach Semistructured interviews with thematic coding. Main Measures The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization. Key Results In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty. Conclusions Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.

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Cardiovascular Health Trends in Electronic Health Record Data (2012–2015): A Cross-Sectional Analysis of The Guideline Advantage™

eGEMs (Generating Evidence & Methods to improve patient outcomes) ◽

10.5334/egems.268 ◽

2019 ◽

Vol 7 (1) ◽

pp. 30

Author(s):

Joyce E. Rudy ◽

Yosef Khan ◽

Julie K. Bower ◽

Sejal Patel ◽

Randi E. Foraker

Keyword(s):

Electronic Health Record ◽

Cardiovascular Health ◽

Health Record ◽

Electronic Health Record Data ◽

Cross Sectional ◽

Health Trends ◽

Cross Sectional Analysis ◽

Record Data ◽

Electronic Health ◽

Sectional Analysis

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Lifetime risk assessment in cholesterol management among hypertensive patients: Observational cross-sectional study based on electronic health record data.

10.21203/rs.2.15336/v2 ◽

2020 ◽

Author(s):

Aapo Tahkola ◽

Päivi Korhonen ◽

Hannu Kautiainen ◽

Teemu Niiranen ◽

Pekka Mäntyselkä

Keyword(s):

Primary Care ◽

Electronic Health Record ◽

Cross Sectional Study ◽

Lifetime Risk ◽

Health Record ◽

Sectional Study ◽

Cvd Risk ◽

Cross Sectional ◽

Hypertensive Patients ◽

Electronic Health

Abstract Background In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control. Methods In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting. Results More than half (54% of women and 53 % of men) of untreated patients did not meet the LDL-C target of <3 mmol/l and one third (35% of women and 33 % of men) of patients did not reach the target even with the lipid-lowering medication (LLM). Furthermore, higher age was strongly associated with better LDL-C control (p<0.001) and lower LDL-C level (p<0.001) in individuals with and without LLM. Higher age was also strongly associated with LLM prescription (p<0.001). In total, about half of the patients were on LLM (53% of women and 51 % of men). Conclusions Our findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.

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