Psychological distress and problem list among patients with advanced cancer: A comparative study of Indonesia and Taiwan

Background We assumed that patients in a country with lower economic development will have more psychological distress and problems than an economically stronger country. Therefore, the aims of this study were to determine whether advanced cancer patients in Indonesia have more psychological distress and experience more problems contributing to distress than a similar group of patients in Taiwan. We also examined the determinants of psychological distress. Methods We conducted a secondary data analysis comparing the data from 286 Indonesian and 70 Taiwanese participants, focusing on distress score and the Problem List (PL) of the Distress Thermometer. Descriptive analysis, Chi-Square test, independent t-test, One-way Anova and multiple linear regression with enter method were applied to analyse the data. Results Overall, more Indonesian respondents experienced distress and had more problems across all PL domains than Taiwanese participants. Being an early adult, having problems with childcare, housing and transportation were associated with higher distress while a higher depression score and having stage 4 cancer demonstrated lower distress among Indonesians. For Taiwanese respondents, appearance, bathing/dressing and pain determined psychological distress. Conclusions Differences in the healthcare system, economic level, culture, gender and age influenced the problems experienced by patients. Finding from our comparative study provide important insight into understanding distress and PL among ACPs in economically advanced countries compared with economically weak countries. Future collaboration to deliver interventions considering cultural and healthcare system differences between two countries should be developed

Decluttering the problem list in electronic health records

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The purpose of this study was to evaluate the current state of problem list maintenance at an academic medical center. Summary We included problem list data for patients who had at least 2 face-to-face encounters at Vanderbilt University Medical Center or its clinics between January 1, 2018, and December 31, 2019. We used the frequency of problem list additions, resolutions, deletions, duplicate problems (exact and SNOMED CT duplicates), inconsistencies (contradicting stages of disease state), and items that could be documented elsewhere in the electronic health record as surrogate markers of problem list maintenance. Descriptive statistics were used to summarize the results. A total of 546,510 patients met inclusion criteria. There were 3,762 (0.7%) patients who had the exact same active problem listed more than once. SNOMED CT code duplications occurred in the records for 56,399 (10.5%) patients. Of the patients with asthma, 2.5% (223/8,779) had contradicting asthma stages active on their problem list, and 6.4% (950/14,950) of patients with chronic kidney disease (CKD) had contradicting CKD stages. In addition, 17,205 (3.1%) patients had 20,365 active family history problems and 39,464 (7.2%) patients had an allergy documented on their problem list. On average, there were 43.7 (95% confidence interval [CI], 14-73.4) additions, 8.7 (95% CI, 0.1-17.4) resolutions, and 2.1 (95% CI, 0-4.6) deletions of problems per 100 face-to-face encounters, inpatient or outpatient. Conclusion Our study suggests areas for improvement for problem list maintenance. Further studies into semantic duplication and clinical decision support tools to encourage problem list maintenance and deduplication are needed.

Role of social deprivation on asthma care quality among a cohort of children in US community health centres

ObjectiveSocial deprivation is associated with worse asthma outcomes. The Social Deprivation Index is a composite measure of social determinants of health used to identify neighbourhood-level disadvantage in healthcare. Our objective was to determine if higher neighbourhood-level social deprivation is associated with documented asthma care quality measures among children treated at community health centres (CHCs).Methods (setting, participants, outcome measures)We used data from CHCs in 15 states in the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). The sample included 34 266 children with asthma from 2008 to 2017, aged 3–17 living in neighbourhoods with differing levels of social deprivation measured using quartiles of the Social Deprivation Index score. We conducted logistic regression to examine the odds of problem list documentation of asthma and asthma severity, and negative binomial regression for rates of albuterol, inhaled steroid and oral steroid prescription adjusted for patient-level covariates.ResultsChildren from the most deprived neighbourhoods had increased rates of albuterol (rate ratio (RR)=1.22, 95% CI 1.13 to 1.32) compared with those in the least deprived neighbourhoods, while the point estimate for inhaled steroids was higher, but fell just short of significance at the alpha=0.05 level (RR=1.16, 95% CI 0.99 to 1.34). We did not observe community-level differences in problem list documentation of asthma or asthma severity.ConclusionsHigher neighbourhood-level social deprivation was associated with more albuterol and inhaled steroid prescriptions among children with asthma, while problem list documentation of asthma and asthma severity varied little across neighbourhoods with differing deprivation scores. While the homogeneity of the CHC safety net setting studied may mitigate variation in diagnosis and documentation of asthma, enhanced clinician awareness of differences in community risk could help target paediatric patients at risk of lower quality asthma care.

openEHR Based Contextual Problem List

The problem list is a key facet of the digital patient record that has historically been difficult to curate. This paper presents an implementation of a contextual problem list using openEHR. It describes the modelling approach, key model elements, and how these are assembled to underpin a Problem Oriented Medical Record. Finally, it discusses issues associated with how problem lists may be used.

Screening for distress, related problems and perceived need for psycho-oncological support in head and neck squamous cell carcinoma (HNSCC) patients: a retrospective cohort study

Background In different cancer entities, several studies have shown the adverse effects of cancer on mental health, psychological well-being and the increased risk of high emotional distress in cancer patients. This study aims to analyze psychosocial distress levels and their relationship between sociodemographic parameters and selected items on the Distress Thermometer (DT) Problem List in head and neck squamous cell carcinoma (HNSCC) patients. Patients and methods We assessed a total of 120 HNSCC patients using the Distress Thermometer (DT) Problem List. Distress scores (DTS) of 90 patients were available. A DTS of ≥ 5 on the visual analogue scale represents clinically relevant distress. Data analysis consisted of descriptive statistics, comparison of mean values for different DTS subcategories and correlation between DTS scores and parameters of tumor classification, sociodemographic variables and selected problems. Results Distress was present in 57.7% of the sample, with a total of 52 patients with a DTS ≥ 5. The mean DTS was 4.7 (SD 2.4). Patients with newly diagnosed HNSCC had significantly higher DTS. Distress levels were significantly associated with sadness, general worries, anxiety, nervousness, sleeping disorders, mouth sores and fever. Out of the total sample, 6 patients and out of these 6 individuals, 5 patients with a DTS ≥ 5 requested referrals to psycho-oncological service. Conclusion High distress levels were common in HNSCC patients but only few patients desired psycho-oncological care. Addressing patients’ supportive care needs in routine clinical practice is essential to meet unmet needs of HNSCC patients and thus improve cancer care.

One list to rule them all and many semantics to bind them: Building a shared, scalable and sustainable source for the problem oriented medical record (Preprint)

BACKGROUND Since the creation of the Problem Oriented Medical Record, the building of problem lists has been the focus of many researches. To this day, this issue is not well resolved, and building an appropriate contextualized problem list is still a challenge. OBJECTIVE This paper presents the process of building a shared multi-purpose common problem list at the University Hospitals of Geneva, a consortium of all public hospitals and 30 outpatient clinics of the state of Geneva. This list aims at bridging the gap between clinicians’ language expressed in free text and secondary usages requiring structured information. METHODS The strategy focuses on the needs of clinicians by building a list of uniquely identified expressions to support their daily activities. In a second stage, these expressions are connected to additional information, building a complex graph of information. A list of 45,946 expressions manually extracted from clinical documents has been manually curated and encoded in multiple semantic dimensions, such as ICD-10, ICPC-2, SNOMED-CT or dimensions dictated by specific usages, such as identifying expressions specific to a domain, a gender, or an intervention. The list has been progressively deployed for clinicians with an iterative process of quality control, maintenance and improvements, including addition of new expressions, or dimensions for specific needs. The problem management of the electronic health record allowed to measure and correct the encoding based on real-world usage. RESULTS The list was deployed in production in January 2017 and was regularly updated and deployed in new divisions of the hospital. In 4 years, 684,102 problems were created using the list. The proportion of free text entries reduced progressively from 37.47% (8,321/22,206) in December 2017 to 18.38% (4,547/24,738) in December 2020. In the last version of the list, over 14 dimensions were mapped to expressions, among them 5 international classifications and 8 other classifications for specific usages. The list became a central axis in the EHR, being used for many different purposes linked to care such as surgical planning or emergency wards, or in research, for various predictions using machine learning techniques. CONCLUSIONS This work breaks with common approaches primarily by focusing on real clinicians’ language when expressing patient’s problems and secondly by mapping whatever is required, including controlled vocabularies to answer specific needs. This approach improves the quality of the expression of patients’ problems, while allowing to build as many structured dimensions as needed to convey semantics according to specific contexts. The method is shown to be scalable, sustainable and efficient at hiding the complexity of semantics or the burden of constraint structured problem list entry for clinicians. Ongoing work is analyzing the impact of this approach at influencing how clinicians express patient’s problems.