Physician inter-annotator agreement in the Quality Oncology Practice Initiative (QOPI) manual abstraction task.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 226-226
Author(s):  
Jeremy Warner ◽  
Reed Drews
Keyword(s):  
Research Training ◽  
Medical Center ◽  
Human Subjects ◽  
Data Entry ◽  
Interquartile Range ◽  
Accuracy Measurement ◽  
Non Hodgkin Lymphoma ◽  
Oncology Practice ◽  
Data Elements ◽  
No Gold Standard

226 Background: The Quality Oncology Practice Initiative (QOPI) relies upon the accuracy of manual abstraction of clinical data from paper-based and electronic medical records (EMR’s). While there is no “gold standard” to measure manual abstraction accuracy, measurement of inter-annotator agreement (IAA) is a commonly agreed-upon surrogate. We quantified the IAA of QOPI abstractions on a cohort of cancer patients treated at Beth Israel Deaconess Medical Center. Methods: The EMR charts of 49 patients (20 colorectal cancer; 18 breast cancer; 11 non-Hodgkin lymphoma) were abstracted by separate physician abstractors in the Fall 2010 and Fall 2011 QOPI abstraction rounds. The Fall 2011 abstractors were unaware that the charts had been previously abstracted. We analyzed data elements that were common to both rounds, had data entry for both rounds, and did not contain information expected to change after the Fall 2010 round. Cohen’s kappa (κ) was calculated for encoded data; raw levels of agreement and magnitude of discrepancies were calculated for numeric and dated data. IRB approval was obtained and all investigators completed appropriate human subjects research training. Results: 109 data elements with 2,035 paired entries met the above criteria; four narrative elements were not analyzed. Overall IAA for 1,496 coded entries was κ=0.75; median IAA for n=85 individual coded elements was κ=0.84 (interquartile range 0.30-1.00). Overall IAA for 421 dated entries was 73%; median IAA for n=17 individual dated elements was 67% (interquartile range 61-86%). The median discrepancy for the 113 discrepant dated entries was +6 days (range -217 to +391 days). Conclusions: This study establishes a baseline level of accuracy for a complex medical abstraction task with clear relevance for the oncology community. Despite the fact that all information was available in the EMR, there was disagreement for objective elements (e.g. cancer stage) as well as subjective elements (e.g. patient wellbeing). Given that the observed κ is considered only fair IAA, and that the rate of date discrepancy is high, caution is necessary in interpreting the results of QOPI and other manual abstractions of clinical oncology data.

scholarly journals Implementing and Improving Automated Electronic Tumor Molecular Profiling

2016 ◽  
Vol 12 (3) ◽  
pp. e332-e337 ◽  
Author(s):  
Matthew J. Rioth ◽  
David B. Staggs ◽  
Lauren Hackett ◽  
Erich Haberman ◽  
Mike Tod ◽  
...  
Keyword(s):  
Medical Center ◽  
Data Entry ◽  
Molecular Profiling ◽  
Third Party ◽  
Genomic Testing ◽  
Transmission Errors ◽  
Electronic Reporting ◽  
Plain Paper ◽  
Oncology Practice ◽  
Direct Feedback

Oncology practice increasingly requires the use of molecular profiling of tumors to inform the use of targeted therapeutics. However, many oncologists use third-party laboratories to perform tumor genomic testing, and these laboratories may not have electronic interfaces with the provider’s electronic medical record (EMR) system. The resultant reporting mechanisms, such as plain-paper faxing, can reduce report fidelity, slow down reporting procedures for a physician’s practice, and make reports less accessible. Vanderbilt University Medical Center and its genomic laboratory testing partner have collaborated to create an automated electronic reporting system that incorporates genetic testing results directly into the clinical EMR. This system was iteratively tested, and causes of failure were discovered and addressed. Most errors were attributable to data entry or typographical errors that made reports unable to be linked to the correct patient in the EMR. By providing direct feedback to providers, we were able to significantly decrease the rate of transmission errors (from 6.29% to 3.84%; P < .001). The results and lessons of 1 year of using the system and transmitting 832 tumor genomic testing reports are reported.

Characteristics and risk factors associated with stroke subtypes among adult patients admitted to stroke unit of JUMC

2019 ◽  
Vol 15 ◽  
Author(s):  
Bekalu Getachew Gebreegziabher ◽  
Tesema Etefa Birhanu ◽  
Diriba Dereje Olana ◽  
Behailu Terefe Tesfaye
Keyword(s):  
Risk Factors ◽  
Stroke Unit ◽  
Medical Center ◽  
Data Entry ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Factors Associated ◽  
Stroke Subtypes

Background: Stroke is a great public health problem in Ethiopia. According to reports, in-hospital stroke mortality was estimated to be 14.7% in Ethiopia. Despite this, in this country researches done on factors associated with stroke sub-types were inadequate. Objective: To assess the Characteristics and risk factors associated with stroke sub-types among patients admitted to JUMC. Methods and materials: A retrospective cross sectional study was conducted from May 2017 to May 2018 in stroke unit of Jimma University Medical Center. A total of 106 medical charts of patients diagnosed with stroke were reviewed. Checklist comprising of relevant variables was used to collect data. SPSS version 21 was employed for data entry and analysis. Chi-square test was used to point-out association and difference among stroke sub-types. The data was presented using text, tables and figures. Result: From a total of 106 patients, 67(63.2%) were men. The mean ± SD of age was 52.67±12.46 years, and no significant association was found. Of all the patients, 59(55.6%) had ischemic strokes and 47(44.4%) had hemorrhagic strokes. The most common risk factor in the patients was alcohol use with a prevalence of 69.9%. Of all the risk factors, only sex, cigarettes smoking and dyslipidemia were significantly associated to sub-types of stroke. Conclusion: Ischemic stroke was the most common subtype of stroke. Sex of patient, cigarette smoking and dyslipidemia are significantly associated with the two stroke subtypes.

Acute Schistosomiasis in Paediatric Travellers and Comparison with Their Companion Adults

2021 ◽  
Author(s):  
Shira Rabinowicz ◽  
Eyal Leshem ◽  
Eli Schwartz
Keyword(s):  
Medical Center ◽  
Acute Illness ◽  
Steroid Treatment ◽  
Interquartile Range ◽  
Short Exposure ◽  
High Infection Rate ◽  
Travel History ◽  
Asymptomatic Children ◽  
High Infection ◽  
Systemic Hypersensitivity

Abstract Background Schistosomiasis in non-immune travellers can cause acute schistosomiasis, a multi-systemic hypersensitivity reaction. Little is known regarding acute schistosomiasis in children. We describe acute schistosomiasis in paediatric travellers and compare them with adult travellers. Methods A retrospective study of paediatric travellers (0–18 years old) diagnosed with schistosomiasis at Sheba Medical Center. Patients’ findings are compared with those of adult travellers from the same travel groups. Results 18 children and 24 adults from five different trips to Tanzania, Uganda, Nigeria and Laos were infected (90% of the exposed travellers). The median bathing time of the infected children was 30 minutes (interquartile range 15–30 minutes). The most common presentations were respiratory symptoms in 13 (72%), eosinophilia in 13 (72%) and fever in 11 (61%). Acute illness included a median of 2.5 symptoms. Three children required hospitalization and three were asymptomatic. Fatigue was significantly less common in children compared with similarly exposed adults (33% vs 71%, p = 0.03). Rates of hospitalization and steroid treatment were similar. The median eosinophil count in children was 1045 cells/μL (interquartile range 625–2575), lower than adults [2900 cells/μL (interquartile range 1170-4584)], p = 0.02. Conclusions Children may develop acute schistosomiasis following a short exposure to contaminated freshwater, demonstrating a high infection rate. Severity seems to be similar to adults, although children report fatigue less commonly and show lower eosinophil counts. Disease should be suspected in children with multi-systemic illness and in asymptomatic children with a relevant travel history.

PRIMARY MEDICAL CARE AND MEDICAL RESEARCH TRAINING

PEDIATRICS ◽  
1973 ◽  
Vol 52 (6) ◽  
pp. 768-772
Author(s):  
David G. Nathan
Keyword(s):  
Child Health ◽  
Medical Research ◽  
Medical Care ◽  
Maternal And Child Health ◽  
Medical Literature ◽  
Research Training ◽  
Medical Center ◽  
Academic Programs ◽  
Primary Medical Care ◽  
And Child Health

Dr. Cicely Williams delivered a challenging Blackfan Lecture, reproduced elsewhere in this issue of the Journal,1 at the Children's Hospital Medical Center on May 30, 1973. It should be carefully studied by all pediatricians, and particularly by pediatricians involved in academic programs. Dr. Williams speaks with the experience and wisdom gathered during more than 50 years of service to the field of maternal and child health and with unimpeachable academic credentials. She first described kwashiorkor in the Western medical literature in 1931. Dr. Williams' message to academic pediatrics is loud and clear. It may be paraphrased in the following manner: "Be off," she states, "with your ultrascience, your superspecialists and your rapt attention to the few with so called interesting illnesses.

Abstract 244: Real World Evaluation of Implementing a Mock Cardiac Arrest Program

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Brad Trumpower ◽  
Lee A Kamphuis ◽  
Joseph McEvoy ◽  
Pamela J Weber ◽  
Sarah Krein ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Training Program ◽  
Program Implementation ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Response Team ◽  
Study Team ◽  
National Initiative ◽  
Data Elements

Introduction: In 2019, the Veterans Health Administration (VHA) began rolling out a national initiative to create a standardized mock code training program through the Resuscitation Education Initiative (REdI). We partnered with REdI and the local REdI Mock Code Program team at a Midwestern VA medical center to evaluate the launch of this mock cardiac arrest training program using a mixed methods approach. Methods: The REdI mock cardiac arrest program provided training to VA medical center clinical and non-clinical staff using didactic, small group, and hands-on simulation activities over a 2-day site visit in January 2019 where all facets of the resuscitation team were reviewed. Following this training visit at one VA medical center, 10 mock cardiac arrests were conducted between March 2019 and December 2019. One mock cardiac arrest included a hospital-wide activation and nine were conducted on individual units without activation of the cardiac arrest response team. The research team was composed of clinical and methodological experts who observed 8 of the mock cardiac arrests. We used an observation template to record structured data elements and take field notes during the mock code (e.g., how participants made decisions, assigned roles and quality of communication between the participants). At the end of the mock code, facilitators and the study team collected oral and written feedback from the participants. Results: In the 8 mock cardiac arrests observed, we identified 54 participants. Participants overwhelmingly rated the mock cardiac arrests as positive (83.3%, 45/54). Debriefing-feedback after the mock cardiac arrest was identified as the most helpful aspect (42.6%, 23/54). Areas for improving implementation of the mock cardiac arrest training program focused primarily on the need for a better introduction to the exercise. This included understanding the manikin’s functionality (9.3%, 5/54) and the expectation that participants should perform CPR just as they would in an actual cardiac arrest event (7.4%, 4/54). Two critical takeaways frequently cited by participants related to performance during the mock cardiac arrest were a need for better communication (20.4%, 11/54) and defined roles (18.5%, 10/54). Conclusions: Implementation of a mock cardiac arrest program was positively received by participants at a VA medical center. Moreover, participants identified both opportunities for improving resuscitation performance and optimizing learning experiences as part of program implementation.

scholarly journals Outcome of children and adolescents with lymphoblastic lymphoma

2015 ◽  
Vol 61 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Maria Christina Lopes Araújo Oliveira ◽  
Keyla Christy Sampaio ◽  
Aline Carneiro Oliveira ◽  
Aieska Dantas Santos ◽  
Lúcia Porto Castro ◽  
...  
Keyword(s):  
T Cell ◽  
Children And Adolescents ◽  
De Novo ◽  
Lymphoblastic Lymphoma ◽  
Interquartile Range ◽  
Abdominal Tumor ◽  
Probability Of Survival ◽  
Non Hodgkin Lymphoma ◽  
Tertiary Center ◽  
Mediastinal Involvement

Summary Introduction: lymphoblastic lymphoma (LBL) is the second most common subtype of non-Hodgkin lymphoma in children. The aim of this study was to characterize the clinical course of children and adolescents with LBL treated at a tertiary center. Methods: this is a retrospective cohort study of 27 patients aged 16 years or younger with LBL admitted between January 1981 and December 2013. Patients were treated according to the therapy protocol used for acute lymphoblastic leucemia. Diagnosis was based on biopsy of tumor and/or cytological examination of pleural effusions. The overall survival was analyzed using the Kaplan-Meier method. Results: the median age at diagnosis was 11.6 years (interquartile range, 4.6- 13.8). LBL had T-cell origin in 16 patients (59%). The most common primary manifestation in T-cell LBL was mediastinal involvement, in 9 patients (56%). Intra-abdominal tumor was the major site of involvement in patients with precursor B-LBL. Most patients had advanced disease (18 patients – 67%) at diagnosis. Twenty-four patients (89%) achieved complete clinical remission. After a median follow-up of 43 months (interquartile range, 6.4-95), 22 patients (81%) were alive in first complete remission. Five children (18.5%) died, three of them soon after admission and two after relapsing. The probability of survival at five years for 20 patients with de novo LBL was 78% (SD 9.4). Conclusion: our findings confirm the favorable prognosis of children with LBL with an intensive chemotherapy regimen derived from ALL therapy.

A cost analysis of practicing oncology via telemedicine

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6143-6143
Author(s):  
G. C. Doolittle ◽  
A. O. Spaulding ◽  
A. R. Williams
Keyword(s):  
Average Cost ◽  
Administrative Support ◽  
Medical Center ◽  
Substantial Reduction ◽  
Fiscal Year ◽  
Traditional Practice ◽  
Efficient Alternative ◽  
Cost Efficient ◽  
Oncology Practice ◽  
The University

6143 Background: The University of Kansas Medical Center (KUMC) has offered oncology services via interactive tele-video (ITV) to patients in rural Kansas for over a decade. A KUMC oncologist utilizes ITV technology to connect with patients at Hays Medical Center (HMC), which is approximately 265 west of KUMC. The technology enables the oncologist to conduct a complete patient visit without being in physical proximity to the patient. To date, two cost-tracking studies have been conducted to determine expenses associated with the tele-oncology practice. A third study recently analyzed costs incurred during fiscal year 2005 (FY05). Methods: In order to determine the costs of the practice during FY05, HMC and KUMC expenses were monitored for oncology services rendered via telemedicine. An analysis revealed expenses common to a traditional oncology practice and additional expenses unique to a telemedicine practice. Administrative support staff salaries, the oncologist’s contract fees, and nursing staff salaries made up the majority of the traditional practice-related expenses. Costs unique to a tele-oncology practice were those associated with technology including expenses for telemedicine equipment, telecommunication charges, and technician time. Results: Expenses for the tele-oncology practice on the KUMC side totaled $22,848, with $7,331 attributed to technology-related costs and $15,517 attributed to practice-related costs. For HMC, $5,803 in technology-related costs and $30,430 in practice-related costs totaled $36,233. At 235 tele-oncology consults and a combined total expense of $59,081 between KUMC and HMC, the FY05 analysis resulted in an average cost of $251 per consult. When compared to prior studies, this shows a substantial reduction in costs related to the practice of telemedicine. Conclusions: The average cost of a tele-oncology visit in Kansas has consistently decreased significantly since the practice’s 1995 inception. Analyses have revealed that the costs of providing oncology services via telemedicine are closely tied to utilization, as the majority of the expenses are related to personnel rather than technology. Telemedicine has proven itself to be a cost-efficient alternative to offering regular outreach clinics. No significant financial relationships to disclose.

Electronic but overly eclectic: Disciplined EHR data management is needed to automate MIPS reporting.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18074-e18074
Author(s):  
Anna E. Schorer ◽  
Jacob Koskimaki ◽  
Robert S. Miller ◽  
Wendy S. Rubinstein ◽  
Elmer Victor Bernstam ◽  
...  
Keyword(s):  
Data Exchange ◽  
Smoking Status ◽  
Vital Signs ◽  
Structured Data ◽  
Mandated Reporting ◽  
Incentive Payment ◽  
Care Plans ◽  
Report Quality ◽  
Oncology Practice ◽  
Data Elements

e18074 Background: Physician reimbursement for care delivered to Medicare beneficiaries fundamentally changed with the 2015 MACRA legislation, requiring eligible clinicians to report quality measures in the Merit-Based Incentive Payment System (MIPS). To determine whether structured data in electronic health records (EHRs) were adequate to report MIPS results, EHR data ingested by ASCO’s CancerLinQ (CLQ) was analyzed. Methods: Nineteen MIPS measures specified for medical oncology, including 8 shared by other specialties, were retrieved from qpp.cms.gov and systematically evaluated to determine data elements necessary to satisfy each measure. The existence of corresponding data fields and completion of these fields with clinical data was analyzed according to EHR implementation in de-identified and aggregated CLQ data. Results: Five clinician informaticists reviewed the 19 oncology MIPS measures, and identified a consensus list of 52 discrete EHR data elements (DEs) that would be needed. CLQ-processed data from 4 commercial EHR systems implemented at 47 CLQ practices found structured data fields for 84% (43 of 52) of the DE, but fewer than half (46%) of these fields were ever populated and only 32% (17 of 52) of DE were recorded for > 20% of cases. Only 3-5 of 19 MIPS measures could be reliably reported based on data element availability by most practices in this sample set. There were minimal differences between the EHRs ability to encode MIPS DE. Elements most likely to be encoded were those for registration (birthdate, gender), billing (diagnosis, meds), vital signs and smoking status, while those seldom or never encoded related to care plans (tobacco, alcohol, pain management). Other DE rarely encoded were patient events occurring outside the oncology practice (receipt/completion of consultations, dates of hospice enrollment and death), which would be dependent on data exchange between work units and practice entities or, more likely, re-entry by oncology practices. Conclusions: Only a minority of DE required to satisfy MIPS criteria are available as discrete data fields in current EHRs, limiting automated reporting efforts. Improved data quality and completeness is needed to satisfy mandated reporting.

Oral chemotherapy education: Hitting the mark?

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 221-221
Author(s):  
Jonathan L Berry ◽  
Jim W Doolin ◽  
Garrett Diltz ◽  
Tenzin Dechen ◽  
Natalia Forbath ◽  
...  
Keyword(s):  
Formal Education ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hematologic Malignancies ◽  
Oral Chemotherapy ◽  
Community Practice ◽  
Medication Persistence ◽  
Process Measures ◽  
Education Group ◽  
Oncology Practice

221 Background: ASCO’s Quality Oncology Practice Initiative (QOPI) includes process measures on oral chemotherapy education. Whether achievement of these measures has an impact on clinical outcomes and if an intervention to improve these measures can improve outcomes is not yet known. Methods: A retrospective analysis was conducted of patients initiated on oral chemotherapy in an academic medical center site and a community oncology practice between January 2016 and October 2019. The primary aim was to compare the time to emergency department (ED) within 90 days from initiation of oral chemotherapy of patients who met the QOPI process measure through an intervention of pharmacist-driven education with a comparison group of patients who had not received formal education. A secondary aim was to assess for a difference in oral chemotherapy medication persistence. Data were also analyzed by demographics, concurrent parenteral therapy, intent of therapy, and disease group. Results: 285 patients in the education group and 284 patients in the non-education group were analyzed. The education group had a higher proportion of patients with gastrointestinal and gynecologic cancers, and a lower proportion of patients with hematologic malignancies, compared to the non-education group. The education group also had a higher proportion of patients treated at the community practice compared to the non-education group. There was no statistical difference in median time-to-ED, with 49 days (IQR 37-74) in the education group and 59 days (IQR 41-60) in the non-education group (p=0.15). Conclusions: In patients receiving oral chemotherapy, pharmacist-driven education with improvement in QOPI process measures did not result in an improvement in time to ED. One factor contributing to this result may be that only 20% of patients required ED-level care within 90 days of starting oral We continue to collect data regarding medication persistence, which may be a more sensitive outcome measure. At this point, further work is needed to determine if achievement or modification of the QOPI oral chemotherapy process measures results in a clinically significant change in outcome. [Table: see text]

Translating Traditional Principles of System Development into a Process for Designing Clinical Information Systems

1994 ◽  
Vol 10 (2) ◽  
pp. 235-248 ◽  
Author(s):  
Pamela A. Gillis ◽  
Holly Booth ◽  
Judith R. Graves ◽  
Charles Steven Fehlauer ◽  
Jerome Soller
Keyword(s):  
Information Systems ◽  
Assessment Tool ◽  
Salt Lake ◽  
System Development ◽  
Medical Center ◽  
Data Entry ◽  
Clinical Information ◽  
Mobile Computer ◽  
Geriatric Unit ◽  
Software Development Methodologies

AbstractTraditional software development methodologies enhanced by a clinical component result in information systems that support the practice of nursing. This paper describes the clinical informatics model used to develop and evaluate a mobile computer assessment tool. Data entry of atomic-level elements, with storage in a relational database, allows the synthesis and analysis by multiple disciplines to aid in real-time decision making. The system is designed to improve the recording and accessibility of patient data and nursing observations on a geriatric unit at the Salt Lake VA Medical Center.

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