scholarly journals Electronic Medical Record Review as a Surrogate to Telephone Follow-up to Establish Outcome for Diagnostic Research Studies in the Emergency Department

2005 ◽  
Vol 12 (11) ◽  
pp. 1127-1133 ◽  
Author(s):  
J. A. Kline
2021 ◽  
Vol 27 (Suppl 1) ◽  
pp. i9-i12
Author(s):  
Anna Hansen ◽  
Dana Quesinberry ◽  
Peter Akpunonu ◽  
Julia Martin ◽  
Svetla Slavova

IntroductionThe purpose of this study was to estimate the positive predictive value (PPV) of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for injury, poisoning, physical or sexual assault complicating pregnancy, childbirth and the puerperium (PCP) to capture injury encounters within both hospital and emergency department claims data.MethodsA medical record review was conducted on a sample (n=157) of inpatient and emergency department claims from one Kentucky healthcare system from 2015 to 2017, with any diagnosis in the ICD-10-CM range O9A.2-O9A.4. Study clinicians reviewed medical records for the sampled cases and used an abstraction form to collect information on documented presence of injury and PCP complications. The study estimated the PPVs and the 95% CIs of O9A.2-O9A.4 codes for (1) capturing injuries and (2) capturing injuries complicating PCP.ResultsThe estimated PPV for the codes O9A.2-O9A.4 to identify injury in the full sample was 79.6% (95% CI 73.3% to 85.9%) and the PPV for capturing injuries complicating PCP was 72.0% (95% CI 65.0% to 79.0%). The estimated PPV for an inpatient principal diagnosis O9A.2-O9A.4 to capture injuries was 90.7% (95% CI 82.0% to 99.4%) and the PPV for capturing injuries complicating PCP was 88.4% (95% CI 78.4% to 98.4%). The estimated PPV for any mention of O9A.2-O9A.4 in emergency department data to capture injuries was 95.2% (95% CI 90.6% to 99.9%) and the PPV for capturing injuries complicating PCP was 81.0% (95% CI 72.4% to 89.5%).DiscussionThe O9A.2-O9A.4 codes captured high percentage true injury cases among pregnant and puerperal women.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1235-1235 ◽  
Author(s):  
Marianne Ulcickas Yood ◽  
Susan A Oliveria ◽  
Ishan Hirji ◽  
Mark Cziraky ◽  
Catherine Davis

Abstract Abstract 1235 Introduction: Over the past 10 years, oral treatment options for chronic myelogenous leukemia (CML) have provided patients autonomy over treatment administration. Low adherence to long-term maintenance therapy is a known challenge in a number of chronic diseases. The correlation between poor adherence and poor clinical outcomes has been previously demonstrated among CML patients in a clinical study setting. Few studies have evaluated adherence to CML treatments in a real-world setting and none have assessed treatment and adherence trends over time in a contemporary cohort of patients. Further, no studies have used medical record review to obtain comprehensive CML diagnosis and treatment information. Method: Medical and pharmacy claims from HealthCore Integrated Research Database™ (8.5 million covered US lives during study time period) were used to identify patients with CML (2001 – 2005). Review of medical records validated diagnosis and treatment exposure. Currently, additional data are being collected on this cohort to extend follow-up through 2010, and expand the number of CML patients to include data on the newer CML treatments. To measure adherence we used medication possession ratio (MPR) (number of days' supply of prescription divided by 365) and treatment interruptions (TI) (failure to refill prescription within 30 days of end of supply from previous prescription or clinician-directed discontinuation). For the current analysis, adherence to imatinib treatment was assessed for one year following treatment initiation. Result: In the initial study time frame (2001-2005), during which imatinib was indicated as first-line treatment, 216 CML patients treated with imatinib were identified. Mean age at imatinib initiation was 51 years and 42.6% were female. Fifty-one percent of patients had a MPR <85% for the one year period after imatinib initiation and 57% of patients experienced at least one TI during the follow up. Conclusion: Our preliminary findings indicate that adherence to imatinib treatment is low in CML patients for the time period studied. This is the first study to use medical record review to validate exposure and adherence by obtaining comprehensive imatinib treatment information on CML patients in a real-world setting and indicates that adherence may be even lower than previously reported. Adherence data from ongoing analyses which includes longer patient follow-up (up to 10 years) and second-generation tyrosine-kinase inhibitors will be presented. Disclosures: Hirji: Bristol-Myers Squibb: Employment. Davis:Bristol-Myers Squibb: Employment.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4492-4492
Author(s):  
Susan A Oliveria ◽  
Marianne Ulcickas Yood ◽  
Ishan Hirji ◽  
Mark Cziraky ◽  
Catherine Davis

Abstract Abstract 4492 Introduction: Few studies have evaluated the presence of comorbidities and the complexity of conmedication among CML patients in the real-world setting. No studies have used automated claims and medical record review to obtain comprehensive CML diagnosis, treatment, comorbidity, and conmedication information. Methods: Medical and pharmacy claims from HealthCore Integrated Research Database™ (8.5 million covered US lives during study time period) were used to identify patients with CML (2001 – 2005). Information on comorbidities and conmedications was obtained using claims data supplemented with medical record review. For the current analysis, conmedication use and the presence of comorbidities were assessed for one year following imatinib initiation. Results: Two hundred and sixteen CML patients treated with imatinib were included in this analysis. Mean age at imatinib initiation was 51 years and 42.6% were female. The mean number of unique medications for treated patients was 19 (median = 9) in the one-year follow-up. Of all medications prescribed within 1-year of CML treatment initiation, approximately 40% had dosing restrictions (i.e. administration required with/without meals) and dosing of more than once per day. The proportion of patients experiencing 1, 2, 3, and 4+ comorbidities was 22%, 16%, 17%, and 29%, respectively. Analyses were also conducted to explore the complexity (based on dosing guidelines and intake restrictions) of each medication and specific comorbidities. Thirty-four percent % of the conmedications had no intake restrictions while 11% had specific intake restrictions (e.g. take on empty stomach) and 15% had dosing guidelines of more than once per day. Forty-one percent of conmedications had both dosing restrictions and dosing of more than once per day. Conclusion: In addition to their CML diagnosis, patients experience a number of other comorbidities, some of which require complex management regimens. This is the first study to use medical record review to validate exposure and CML diagnosis and use claims and medical record review to obtain comprehensive information on comorbidities and conmedications. Additional data are being collected (and will be presented) on this cohort to extend follow-up through 2010, expand the number of CML patients included, and obtain complete information on all CML treatments and comorbidities. Disclosures: Hirji: Bristol-Myers Squibb: Employment. Davis:Bristol-Myers Squibb: Employment.


2006 ◽  
Vol 27 (7) ◽  
pp. 722-728 ◽  
Author(s):  
M. Aquino ◽  
J. M. Raboud ◽  
A. McGeer ◽  
K. Green ◽  
R. Chow ◽  
...  

Objective.To determine the validity of using healthcare worker (HCW) recall of patient interactions and medical record review for contact tracing in a critical care setting.Design.Trained observers recorded the interactions of nurses, respiratory therapists, and service assistants with study patients in a medical-surgical intensive care unit. These observers' records were used as the reference standard to test the criterion validity of using HCW recall data or medical record review data to identify exposure characteristics. We assessed the effects of previous quarantine of the HCW (because of possible exposure) and the availability of patients' medical records for use as memory aids on the accuracy of HCW recall.Setting.A 10-bed medical-surgical intensive care unit at Mount Sinai Hospital in Toronto, Ontario.Patients.Thirty-six HCWs observed caring for 16 patients, for a total of 55 healthcare worker shifts.Results.Recall accuracy was better among HCWs who were provided with patient medical records as memory aids (P<.01). However, HCWs tended to overestimate exposures when they used patient medical records as memory aids. For 6 of 26 procedures or care activities, this tendency to overestimate was statistically significant (P<.05). Most HCWs with true exposures were identified by means of this technique, despite the overestimations. Documentation of the activities of the 4 service assistants could not be found in any of the patients' medical records. Similarly, the interactions between 6 (19%) of 32 other patient–HCW pairs were not recorded in patients' medical records.Conclusions.Data collected from follow-up interviews with HCWs in which they are provided with patient medical records as memory aids should be adequate for contact tracing and for determining exposure histories. Neither follow-up interviews nor medical record review alone provide sufficient data for these purposes.


2020 ◽  
pp. 112972982097425
Author(s):  
Shawn Kache ◽  
Sunny Patel ◽  
Nai-Wei Chen ◽  
Lihua Qu ◽  
Amit Bahl

Introduction: The survivorship of peripheral intravenous catheters (PIVCs) placed in hospitalized patients is shockingly poor and leads to frequent reinsertions. We aimed to evaluate differences in failure rates and IV insertion practices for PIVCs that are placed in the emergency department (ED) compared to those placed in the inpatient (IP) setting. Methods: We conducted a retrospective electronic medical record review of PIVC survival at a single-site suburban, academic tertiary care referral center with 130,000 annual ED visits and 1100 inpatient beds. Adult patients admitted requiring at least one PIVC were included. The primary outcome was incidence of premature failure of PIVCs. Secondary outcomes included dwell time, completion of therapy, catheter diameter, and site of insertion as they relate to PIVC survival. Results: Between January 2018 and July 2019, 90,743 IV catheters were included from 47,272 unique patient encounters in which 35,798 and 54,945 catheters were placed in the ED and IP units, respectively. There was no significant difference in failure rate between the ED and IP PIVCs, with 53.1% of ED PIVCs failing and 53.4% of IP PIVCs failing ( p = 0.35). Mean dwell time for ED PIVCs was 3.4 days compared to a mean of 3.2 days for IP placed PIVCs ( p < 0.001). 48% of ED PIVCs achieved completion of therapy at the first insertion compared to 59% of IP PIVCs ( p < 0.001). The antecubital fossa and forearm had the lowest failure rate of 53% and 50%, respectively, and 22 gauge PIVCs had the highest failure rate of 60.5%. Conclusion: PIVCs have similar poor survival rates regardless of ED versus IP location of the insertion. The forearm and antecubital fossa sites should be preferentially used. Smaller diameter (22G) catheters have highest complications and poorest survival regardless of site of insertion. Larger diameter catheters (18 or 20 gauge) may offer improved outcomes.


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