scholarly journals Investigating the quality and completeness of medication data available within the Indiana Network for Patient Care

2020 ◽  
Vol 3 ◽  
Author(s):  
Jaibir Khera ◽  
Shaun Grannis ◽  
Suranga Kasthurirathne
Keyword(s):  
Data Quality ◽  
Patient Care ◽  
Claims Data ◽  
Phase 1 ◽  
Healthcare Services ◽  
Current Status ◽  
Venn Diagram ◽  
Local Health ◽  
Current State ◽  
Number Of Patients

Background and Hypothesis: Healthcare data is increasingly fragmented across multiple points of care due to increased specialization of healthcare services and mobility of patient populations [1]. The Indiana Network for Patient Care (INPC) plays a pivotal role in capturing, standardizing, and integrating comprehensive datasets[2]. Currently, the INPC receives medication data from a variety of sources. However, some of these sources are costly and may be incomplete and/or inaccurate. We aim to characterize the degree to which additional claims data can augment or replace existing INPC medication data. Our hypothesis is that the new claims datasets will provide additional medication information for patients in the INPC.  Methods: Data analysts extracted and formatted a claims data sample for analysis. Individuals from the sample dataset were then mapped to INPC data using global person identifiers. The resulting analysis was split into two phases.   Phase 1: To provide an initial high-level assessment of overlap and complementarity between INPC and new claims data, we computed the number of patients captured in each data source. Patients were classified into five groups as illustrated in Figure 1. To investigate Medicare usage, we also stratified datasets by patient age: less than 65 and 65 and older.   Figure 1: Venn diagram illustrating medication claims data analysis approach. Several subgroups  among the INPC will be compared to existing pharmacy claims and new claims data sources.  Phase 2: Investigation of data quality on a clinical use case. These datasets will be used to investigate the current state of the opioid epidemic in Indiana.   Results: With the completion of phase 1, we expect to characterize the current state of claims data across each of the patient groups, and how they influence data quality within the INPC.  Discussion. The quality and completeness of medication data currently available via the INPC in unclear. Our efforts add clarity to the current status of these datasets, and how they can be augmented for increased research and clinical productivity.    Citations  [1] Stange, K.C., The problem of fragmentation and the need for integrative solutions. The Annals of Family Medicine. 7(2):100-103, 2009.  [2] McDonald, C. J., Overhage, J. M., Barnes, M., Schadow, G., Blevins, L., Dexter, P. R., ... & INPC Management Committee. (2005). The Indiana network for patient care: a working local health information infrastructure. Health affairs, 24(5), 1214-1220. 

scholarly journals Current status and issues of medical demand in Japan

2020 ◽  
pp. 1
Keyword(s):  
Medical Care ◽  
Hospital Stay ◽  
Statistical Data ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Current Status ◽  
Current State ◽  
Important Measure ◽  
Number Of Patients

The purpose of this study is to analyze the transition of population and the number of patients in Japan based on official statistical data, and to examine the current state and issues of medical care. In Japan's medical care, it will be an important measure to improve the quality and shorten the length of hospital stay by clarifying, sharing and coordinating service functions to meet the ongoing demand for the elderly.

CONCEPTUAL POSITIONS OF MODERNIZATION OF EXISTING INEFFICIENT DISTRICT HEATING SYSTEMS

2017 ◽  
pp. 11-21
Author(s):  
Ye.Ye. Nikitin
Keyword(s):  
Energy Efficient ◽  
Mutual Influence ◽  
District Heating ◽  
Current Status ◽  
Cognitive Approach ◽  
Heating Systems ◽  
Energy Management Systems ◽  
Current State ◽  
Self Sufficiency ◽  
District Heating Systems

The current situation in the sphere of district heating is analysed on the basis of use of the cognitive approach. The presence of closed chains of cause-effect relationships of negative factors and conflicts of target settings of the subjects in the field of district heating is shown. The conceptual model of energy efficient modernization of district heating systems is proposed. This model includes indicators of the current status of heat sources, networks and heat consumers, energetic and economic models, restrictions, procedure of forming and analysis of the mutual influence of the recommended projects. The quantitative data on indicators of the current state of district heating systems of the cities of Ukraine are presented. The interrelation between indicators of the current state and projects of energy efficient modernization of district heating systems is shown. Assessment of energy self-sufficiency of municipal district heating systems on condition of thermal modernization of buildings is carried out. The creation of energy management systems at the district heating enterprises is proposed. Bib. 6, Fig. 7, Tab. 5.

Survey of Cloud Computing in Healthcare Sector

2017 ◽  
Vol 7 (7) ◽  
pp. 337
Author(s):  
S. Karthiga Devi ◽  
B. Arputhamary
Keyword(s):  
Cloud Computing ◽  
Healthcare Providers ◽  
High Volume ◽  
Healthcare Services ◽  
Healthcare Sector ◽  
Cloud Infrastructure ◽  
Healthcare Organizations ◽  
Privacy And Security ◽  
Healthcare Data ◽  
Number Of Patients

Today the volume of healthcare data generated increased rapidly because of the number of patients in each hospital increasing.  These data are most important for decision making and delivering the best care for patients. Healthcare providers are now faced with collecting, managing, storing and securing huge amounts of sensitive protected health information. As a result, an increasing number of healthcare organizations are turning to cloud based services. Cloud computing offers a viable, secure alternative to premise based healthcare solutions. The infrastructure of Cloud is characterized by a high volume storage and a high throughput. The privacy and security are the two most important concerns in cloud-based healthcare services. Healthcare organization should have electronic medical records in order to use the cloud infrastructure. This paper surveys the challenges of cloud in healthcare and benefits of cloud techniques in health care industries.

Geobotanical studies at the Caucasus: a review of materials of the International Conference “Flora and conservation in the Caucasus: history and current state of knowledge” (Pyatigorsk, May 22–25, 2019)

2019 ◽  
pp. 91-94
Author(s):  
T. M. Lysenko ◽  
V. Yu. Neshatayeva ◽  
Z. V. Dutova
Keyword(s):  
Plant Communities ◽  
Aquatic Vegetation ◽  
Plant Cover ◽  
Floristic Composition ◽  
Current Status ◽  
Wide Field ◽  
The Caucasus ◽  
International Conference ◽  
Rare And Endangered Species ◽  
Current State

The International conference “Flora and conservation in the Caucasus: history and current state of knowledge” dedicated to the 130-year anniversary of the Perkalsky Arboretum took place at 22–25 of May 2019 in Pyatigorsk (Stavropol Territory) on the base of the Pyatigorsk Museum of local lore and natural history. The participants were from 11 cities of Russia and 7 Republics of the Caucasus and represented 14 institutions. Proceedings of the conference were published by the beginning of the meeting the book of abstracts includes 49 papers on the study of vascular plants, bryophytes, lichens and fungi, plant communities, as well as the protection of rare and endangered species, unique plant communities, and ecological problems in the Caucasus. The following geobotanical topics were highlighted in 13 papers: forest communities (3 reports), meadow and steppe vegetation (2), xeric open forests (2), communities of ecotone areas (1), structure of populations of rare plant species (3), as well as the history and current status of nature protected areas (2). The great emphasis has been focused on the study of floristic composition and plant populations. Thus, the conference showed that very few studies от vegetation are currently carried out in the Caucasus, and a lot of districts are not affected by the research. The greatest attention is paid to forest vegetation while meadow, steppe, alpine heath and xerophytic communities are studied rather poorly. Besides, there are “white spots” — mire, floodplain and aquatic vegetation. In nowadays, when the anthropogenic impact on the plant cover of the Caucasus is intensively increasing, it is especially important to study natural undisturbed communities preserved in protected natural areas. Another important issue is the conservation of the unique vegetation cover of the whole Caucasus. Thus, the study of vegetation of this region opens a wide field for researchers using various methods of modern plant science.

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

2020 ◽  
Vol 51 (4) ◽  
pp. 550-570
Author(s):  
Cindy Luu ◽  
Thomas B. Talbot ◽  
Cha Chi Fung ◽  
Eyal Ben-Isaac ◽  
Juan Espinoza ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Patient Care ◽  
Skill Acquisition ◽  
Video Game ◽  
Rank Correlation ◽  
Fixed Time ◽  
Serious Game ◽  
Cross Sectional ◽  
Number Of Patients

Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.

scholarly journals Current status of vascular access in Japan—from Dialysis Access Symposium 2017

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 38-44
Author(s):  
Mizuya Fukasawa
Keyword(s):  
Vascular Access ◽  
Current Status ◽  
Good Survival ◽  
Chronic Glomerulonephritis ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Survival Prognosis ◽  
Access Methods ◽  
Number Of Patients ◽  
Wide Range

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.

Experience of an Interdisciplinary Pediatric Pain Service

PEDIATRICS ◽  
1991 ◽  
Vol 88 (6) ◽  
pp. 1226-1232
Author(s):  
Barbara S. Shapiro ◽  
David E. Cohen ◽  
Kenneth W. Covelman ◽  
Carol J. Howe ◽  
Sam M. Scott
Keyword(s):  
Sickle Cell Disease ◽  
Patient Care ◽  
Sickle Cell ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Direct Patient Care ◽  
Team Approach ◽  
Cell Disease ◽  
Number Of Patients ◽  
Physician Time

This article is a report of our experience with an interdisciplinary pain service in a large tertiary care pediatric hospital. During the first 2 years of operation, we received 869 consultations and referrals from more than 19 hospital divisions. Postoperative pain was the most frequent reason for consultation (56% of patients). Patients with pain related to cancer and sickle cell disease comprised 25% of the consultations. The remaining patients had a wide variety of primary diagnoses and causes of pain. We calculated the time spent by pain service physicians in direct patient care. The majority (63%) of physician time was spent with a small number of patients (17%). Most of these patients had pain that was unrelated to surgery, cancer, or sickle cell disease, and many posed dilemmas in diagnosis and treatment. Physician time was correlated directly to the use of psychologic and physical therapies for the pain, involving multiple team members. This experience supports the demand for an interdisciplinary pain service in a tertiary care children's hospital. A significant amount of physician time is necessary to provide patient care and to maintain a team approach, however, and pediatricians and other health care professionals who aim to implement such services should be cognizant of the time required.

Linking Provider Specialty and Outpatient Diagnoses in Medicare Claims Data: Data Quality Implications

2021 ◽  
Vol 12 (04) ◽  
pp. 729-736
Author(s):  
Vojtech Huser ◽  
Nick D. Williams ◽  
Craig S. Mayer
Keyword(s):  
Data Quality ◽  
Claims Data ◽  
Medical Toxicology ◽  
Health Care Research ◽  
Real World Data ◽  
Full Spectrum ◽  
Data Completeness ◽  
Medicare Claims ◽  
Diagnosis Codes ◽  
Medicare Claims Data

Abstract Background With increasing use of real world data in observational health care research, data quality assessment of these data is equally gaining in importance. Electronic health record (EHR) or claims datasets can differ significantly in the spectrum of care covered by the data. Objective In our study, we link provider specialty with diagnoses (encoded in International Classification of Diseases) with a motivation to characterize data completeness. Methods We develop a set of measures that determine diagnostic span of a specialty (how many distinct diagnosis codes are generated by a specialty) and specialty span of a diagnosis (how many specialties diagnose a given condition). We also analyze ranked lists for both measures. As use case, we apply these measures to outpatient Medicare claims data from 2016 (3.5 billion diagnosis–specialty pairs). We analyze 82 distinct specialties present in Medicare claims (using Medicare list of specialties derived from level III Healthcare Provider Taxonomy Codes). Results A typical specialty diagnoses on average 4,046 distinct diagnosis codes. It can range from 33 codes for medical toxicology to 25,475 codes for internal medicine. Specialties with large visit volume tend to have large diagnostic span. Median specialty span of a diagnosis code is 8 specialties with a range from 1 to 82 specialties. In total, 13.5% of all observed diagnoses are generated exclusively by a single specialty. Quantitative cumulative rankings reveal that some diagnosis codes can be dominated by few specialties. Using such diagnoses in cohort or outcome definitions may thus be vulnerable to incomplete specialty coverage of a given dataset. Conclusion We propose specialty fingerprinting as a method to assess data completeness component of data quality. Datasets covering a full spectrum of care can be used to generate reference benchmark data that can quantify relative importance of a specialty in constructing diagnostic history elements of computable phenotype definitions.

Abstract 047: Using Geospatial Data To Eliminate Disparities In Covid-19 Testing

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Gregory W Heath ◽  
Tim Moreland ◽  
Shannon Stephenson ◽  
Jesse A Houser ◽  
Colleen Schmitt
Keyword(s):  
Community Health Centers ◽  
Effective Means ◽  
Age Distribution ◽  
Healthcare Services ◽  
Health Concern ◽  
Behavioral Risk ◽  
Local Health ◽  
Social Vulnerability Index ◽  
First Case ◽  
Black Residents

Introduction: The first case of COVID-19 in Chattanooga/Hamilton County, Tennessee (CHC) was identified on March 13, 2020. By early April, 51 RT-PCR confirmed cases were identified, with white, non-Hispanic males and females representing 82% (41/51) of positive cases and remaining cases representing black residents (18%; 9/51). That few people from racial/ethnic minorities were being tested became a key public health concern. We hypothesized that local mapping of health-related data would identify regions where individuals at greater risk for COVID-19 live and work and have limited access to testing and healthcare services. Methods: The CDC 500 Cities data was used to generate layered maps of prevalence estimates for cardiovascular disease, type 2 diabetes mellitus, chronic lung disease, and the behavioral risk factors of physical inactivity and obesity. Layers also included the CDC Social Vulnerability Index, age distribution, gender, race, ethnicity, and zip codes. Maps were shared with intersectoral collaborators representing the black and Hispanic/Latinx communities who provided specific neighborhood information to the maps. Collaborators included hospital systems, the local health department, community health centers, the private sector, and non-profit organizations. Maps were used to identify geographic sites for mobile and strategic testing within communities at higher risk for the spread of the coronavirus. Specific diverse neighborhoods along with worksites were then provided with testing beginning in early May and ongoing. Results: Strategic and mobile testing beginning in early May increased three-fold the number of identified new cases of COVID-19. Seventy percent (652/932) of these positive tests were among ethnically Hispanic/Latinx and 16% (149/932) among black residents. Positive tests continued to increase at a greater rate among Hispanic/Latinx and black residents compared with white residents through the months of May-July (68/10K vs. 2.6/10K, OR = 4.85, 95% CI 2.66, 9.02). Conclusions: This example of inter-sectoral collaboration, data sharing, and data use through strategic mapping of vulnerable populations for COVID-19 was an effective means to enhance COVID-19 testing and identification of positive cases throughout CHC. This expanded partnering resulting in targeted testing may be a useful approach among similar communities and subsequent outbreaks.

scholarly journals Status Quo and Trends of Intra-Arterial Therapy for Brain Tumors: A Bibliometric and Clinical Trials Analysis

Pharmaceutics ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 1885
Author(s):  
Julian S. Rechberger ◽  
Frederic Thiele ◽  
David J. Daniels
Keyword(s):  
Drug Delivery ◽  
Clinical Trials ◽  
Brain Tumors ◽  
Phase 1 ◽  
Citation Count ◽  
Tumor Therapy ◽  
The United States ◽  
Blood Brain Barrier Disruption ◽  
Current State ◽  
Brain Barrier Disruption

Intra-arterial drug delivery circumvents the first-pass effect and is believed to increase both efficacy and tolerability of primary and metastatic brain tumor therapy. The aim of this update is to report on pertinent articles and clinical trials to better understand the research landscape to date and future directions. Elsevier’s Scopus and ClinicalTrials.gov databases were reviewed in August 2021 for all possible articles and clinical trials of intra-arterial drug injection as a treatment strategy for brain tumors. Entries were screened against predefined selection criteria and various parameters were summarized. Twenty clinical trials and 271 articles satisfied all inclusion criteria. In terms of articles, 201 (74%) were primarily clinical and 70 (26%) were basic science, published in a total of 120 different journals. Median values were: publication year, 1986 (range, 1962–2021); citation count, 15 (range, 0–607); number of authors, 5 (range, 1–18). Pertaining to clinical trials, 9 (45%) were phase 1 trials, with median expected start and completion years in 2011 (range, 1998–2019) and 2022 (range, 2008–2025), respectively. Only one (5%) trial has reported results to date. Glioma was the most common tumor indication reported in both articles (68%) and trials (75%). There were 215 (79%) articles investigating chemotherapy, while 13 (65%) trials evaluated targeted therapy. Transient blood–brain barrier disruption was the commonest strategy for articles (27%) and trials (60%) to optimize intra-arterial therapy. Articles and trials predominately originated in the United States (50% and 90%, respectively). In this bibliometric and clinical trials analysis, we discuss the current state and trends of intra-arterial therapy for brain tumors. Most articles were clinical, and traditional anti-cancer agents and drug delivery strategies were commonly studied. This was reflected in clinical trials, of which only a single study had reported outcomes. We anticipate future efforts to involve novel therapeutic and procedural strategies based on recent advances in the field.

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