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Hundt A.S.,University of Wisconsin - Madison | Adams J.A.,United Information Technology | Schmid J.A.,Clinical Innovations | Musser L.M.,United Information Technology | And 5 more authors.
International Journal of Medical Informatics

Purpose: To develop, conduct, and evaluate a proactive risk assessment (PRA) of the design and implementation of CPOE in an ICU. Methods: We developed a PRA method based on issues identified from documented experience with conventional PRA methods and the constraints of an organization about to implement CPOE in an intensive care unit. The PRA method consists of three phases: planning (three months), team (one five-hour meeting), and evaluation (short- and long-term). Results: Sixteen unique relevant vulnerabilities were identified as a result of the PRA team's efforts. Negative consequences resulting from the vulnerabilities included potential patient safety and quality of care issues, non-compliance with regulatory requirements, increases in cognitive burden on CPOE users, and/or worker inconvenience or distress. Actions taken to address the vulnerabilities included redesign of the technology, process (workflow) redesign, user training, and/or ongoing monitoring. Verbal and written evaluation by the team members indicated that the PRA method was useful and that participants were willing to participate in future PRAs. Long-term evaluation was accomplished by monitoring an ongoing "issues list" of CPOE problems identified by or reported to IT staff. Vulnerabilities identified by the team were either resolved prior to CPOE implementation (n= 7) or shortly thereafter (n= 9). No other issues were identified beside those identified by the team. Conclusions: Generally positive results from the various evaluations including a long-term evaluation demonstrate the value of developing an efficient PRA method that meets organizational and contextual requirements and constraints. © 2012 Elsevier Ireland Ltd. Source

Fonseca E.,Healthcare Informatics | Sander S.D.,Boehringer Ingelheim Pharmaceuticals | Hess G.P.,University of Pennsylvania | Ghosh S.,Boehringer Ingelheim Pharmaceuticals
Journal of Managed Care Pharmacy

BACKGROUND: Oral anticoagulation such as warfarin and dabigatran is indicated for atrial fibrillation (AF) patients at risk of ischemic stroke. Dabigatran etexilate was developed to address the limitations of warfarin, including the need for regular blood monitoring, which has the potential to lead to higher health care resource use, particularly in hospitalized patients. OBJECTIVE: To evaluate whether hospitalization cost, length of hospital stay (LOS), likelihood of readmission within 30 days, and cost of readmissions differed across inpatient encounters among nonvalvular atrial fibrillation (NVAF) patients that were newly diagnosed and newly treated with either dabigatran or warfarin. METHODS: A retrospective cohort study was conducted using IMS Health's Charge Detail Master (CDM) database. Hospitalizations were identified based on a primary or secondary AF diagnosis, dabigatran or warfarin use, and a discharge date from January 2011 through March 2012. The identified patients without valvular procedures and transient AF were required to have a minimum of 12 months of pharmacy and private practitioner records prior to the inpatient encounter to ensure that they were newly treated on dabigatran or warfarin. Propensity score matching was used to balance baseline characteristics between treatment cohorts. Outcomes assessed were LOS, 30-day readmissions, and costs. Because individual patients could have more than 1 hospital observation, generalized estimating equations (GEE) with a gamma distribution (log link) were used for the analysis of continuous outcome measures (e.g., LOS and costs) and a binominal distribution for dichotomous outcomes (hospital readmissions). RESULTS: Two cohorts were propensity score matched (1:2) on demographic and clinical characteristics. The dabigatran cohort included 646 hospitalizations, and the warfarin cohort included 1,292 hospitalizations. Hospitalizations were on average 13% shorter (4.8 vs. 5.5 days, P < 0.001) and cost 12% less ($14,794 vs. $16,826, P = 0.007) when dabigatran was used versus warfarin. No differences in 30-day readmissions were observed. CONCLUSIONS: Hospital encounters among newly diagnosed NVAF patients during which warfarin was initiated had longer lengths of stay and incurred higher costs than those during which dabigatran was initiated. © 2015, Academy of Managed Care Pharmacy. Source

Hakonsen S.J.,University of Aarhus | Madsen I.,Healthcare Informatics | Madsen I.,University of Aarhus | Bjerrum M.,University of Aarhus | Pedersen P.U.,University of Aarhus
Online Journal of Nursing Informatics

In Denmark the national guidelines for nursing documentation outlines twelve areas in which nurses have to systematically document in daily care. Nutrition is one of these areas. However, the guidelines are frameworks that do not specify exactly what data nurses have to collect and which areas nurses need to document about nutrition in order to make a nursing specific documentation. This present study set out to identify a nursing minimum data set for nutrition in a clinical setting. Data used was validated and available tools to screen or assess patients' nutritional risk. A systematic literature search was undertaken identifying 42 eligible instruments. An inductive content analysis identified eighteen subcategories that were divided into five main categories: 1 Anthropometry such as weight, height, biochemistry, muscle mass and fat etc., 2 Ability to eat, 3 Intake, 4 Factors which indirectly affect intake and needs and 5 Stress factors. The five main categories are intended to help clinical staff make a complete nursing assessment of patients' nutritional status in order to guide nurses to make a relevant and complete nursing documentation. © 2012 OJNI. Source

Muehlenbein C.E.,Eli Lilly and Company | Hoverman J.R.,Texas Oncology | Gruschkus S.K.,Healthcare Informatics | Forsyth M.,Healthcare Informatics | And 5 more authors.
Journal of Cancer Epidemiology

Background. Traditional methods for identifying comorbidity data in EMRs have relied primarily on costly and time-consuming manual chart review. The purpose of this study was to validate a strategy of electronically searching EMR data to identify comorbidities among cancer patients. Methods. Advanced stage NSCLC patients (N=2,513) who received chemotherapy from 7/1/2006 to 6/30/2008 were identified using iKnowMed, US Oncology's proprietary oncology-specific EMR system. EMR data were searched for documentation of comorbidities common to advanced stage cancer patients. The search was conducted by a series of programmatic queries on standardized information including concomitant illnesses, patient history, review of systems, and diagnoses other than cancer. The validity of the comorbidity information that we derived from the EMR search was compared to the chart review gold standard in a random sample of 450 patients for whom the EMR search yielded no indication of comorbidities. Negative predictive values were calculated. Results. The overall prevalence of comorbidities of 22. Overall negative predictive value was 0.92 in the 450 patients randomly sampled patients (36 of 450 were found to have evidence of comorbidities on chart review). Conclusion. Results of this study suggest that efficient queries/text searches of EMR data may provide reliable data on comorbid conditions among cancer patients. Copyright © 2011 Catherine E. Muehlenbein et al. Source

Beveridge R.,Healthcare Informatics | Satram-Hoang S.,Genentech | Sail K.,Healthcare Informatics | Darragh J.,Healthcare Informatics | And 3 more authors.
Leukemia and Lymphoma

Using a retrospective claims database, we estimated the economic costs of progression among patients with follicular non-Hodgkin lymphoma (f-NHL) treated in an outpatient community-based setting. Patients with f-NHL who received care between 1 July 2006 and 31 December 2009 were categorized into two cohorts based on whether they experienced progressive disease (PD) or not. Costs per patient per month (PPPM) were compared between patients with PD versus non-PD. Follow-up time was censored at the last entry for disease status or 6 months after the date of remission/stable disease or progression. Of the 1002 patients with f-NHL identified, 268 progressed and 734 did not. The mean overall costs PPPM over the 6-month follow-up period were significantly higher for patients with PD versus non-PD ($3527 vs. $860; difference = $2667; p < 0.001). This cost difference persisted within all resource categories evaluated. Results of this study indicate that therapies which delay progression for patients with f-NHL may result in potential cost savings. © 2011 Informa UK, Ltd. Source

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