Billing Data May Not Accurately Represent In-Hospital Cardiac Arrests

MedicalResearch.com Interview with:

Rohan Khera MD Division of Cardiology University of Texas Southwestern Medical Center Texas 

Dr. Khera

Rohan Khera MD
Division of Cardiology
University of Texas Southwestern Medical Center
Texas 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: An increasing number of studies have used administrative claims (or billing) data to study in-hospital cardiac arrest with the goal of understanding differences in incidence and outcomes at hospitals that are not part of quality improvement initiatives like the American Heart Association’s Get With The Guidelines-Resuscitation (AHA’s GWTG-Resuscitation). These studies have important implications for health policies and determining targets for interventions for improving the care of patients with this cardiac arrest, where only in 1 in 5 patient survive the hospitalization.

Therefore, in our study, we evaluated the validity of such an approach. We used data from 56,678 patients in AHA’s GWTG-Resuscitation with a confirmed in-hospital cardiac arrest, which were linked to Medicare claims data. We found:

(1)  While most prior studies have used a diagnosis or procedure code alone to identify cases of in-hospital cardiac arrest, we found that the majority of confirmed cases in a national registry (AHA’s GWTG-Resuscitation) would not be captured using either administrative data strategy.

(2)  Survival rates using administrative data to identify cases from the same reference population varied markedly and were 52% higher (28.4% vs. 18.7%) when using diagnosis codes alone to identify in-hospital cardiac arrest.

(3)  There was large hospital variation in documenting diagnosis or procedure codes for patients with in-hospital cardiac arrest, which would have consequences for using administrative data to examine hospital-level variation in cardiac arrest incidence or survival, or conducting single-center studies to validate this administrative approach.

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What Do Patients Value About Reading Their Electronic Medical Record Notes?

MedicalResearch.com Interview with:
Macda Gerard
M.D. Candidate | Class of 2021
Wayne State University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: As electronic health records proliferate, patients are increasingly asking for their health information but little is known about how patients use that information or whether they encounter errors in their records. This comes at a time when we’re learning that understanding the patient and family experience, especially what is most valued in exchanges between doctors and patients is important and has many benefits. To learn more, we developed a formal mechanism for patients to provide feedback on what they like about accessing the information in their health records and to inform their clinical team about things like inaccuracies and perceived errors. So that’s the gap we tried to fill.

The patient feedback tool is linked to the visit note in the electronic health record (EHR), and it’s part of a quality improvement initiative aimed at improving safety and learning what motivates patients to engage with their health information on the patient portal. Over the 12-month pilot period, 260 patients and care partners provided feedback using the OpenNotes patient feedback tool. Nearly all respondents found the tool to be valuable and about 70 percent provided additional information regarding what they liked about their notes and the feedback process.

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Clinicians Multitask on Electronic Health Records 30% of Visit Time with Patients

MedicalResearch.com Interview with:

Neda Ratanawongsa, MD, MPH Associate Chief Health Informatics Officer for Ambulatory Services, San Francisco Health Network Associate Professor, Division of General Internal Medicine UCSF Center for Vulnerable Populations Physician, Richard H. Fine People's Clinic (RHPC) Zuckerberg San Francisco General Hospital San Francisco, CA 94110 

Dr. Ratanawongsa

Neda Ratanawongsa, MD, MPH
Associate Chief Health Informatics Officer for Ambulatory Services, San Francisco Health Network
Associate Professor, Division of General Internal Medicine
UCSF Center for Vulnerable Populations
Physician, Richard H. Fine People’s Clinic (RHPC)
Zuckerberg San Francisco General Hospital
San Francisco, CA 94110

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: U.S. federal incentives allowed many safety net healthcare systems to afford fully functional electronic health record systems (EHRs). Although EHRs can help clinicians provide care to vulnerable populations, clinicians may struggle with managing the EHR workload, particularly in resource-limited settings. In addition, clinicians’ use of EHRs during clinic visits may affect how they communicate with patients.

There are two forms of EHR use during clinic visits.  Clinicians can multitask, for example, by ordering laboratory tests while chatting with a patient about baseball.  However, like distracted driving, using EHRs while talking with increases risks – in this case, the risk of errors in patient-provider communication or in the EHR task. Alternatively, clinicians can use EHRs in complete silence, which may be appropriate for high-risk tasks like prescribing insulin. However, silence during visits has been associated with lower patient satisfaction and less patient-centered communication.

So we studied how primary and specialty care clinicians used EHRs during visits with English- and Spanish-speaking patients in a safety net system with an EHR certified for Centers for Medicare & Medicaid Services meaningful use incentive programs. We found that multitasking EHR use was more common than silent EHR use (median of 30.5% vs. 4.6% of visit time). Focused patient-clinician talk comprised one-third of visit time.

We also examined the transitions into and out of silent EHR use. Sometimes clinicians explicitly stated a need to focus on the EHR, but at times, clinicians drifted into silence without warning. Patients played a role in breaking silent EHR use, either by introducing small talk or by bringing up their health concerns.

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EHRs Can Facilitate Rapid Detection and Treatment of Sepsis

MedicalResearch.com Interview with:

Faheem Guirgis MD  Assistant Professor of Emergency Medicine Department of Emergency Medicine Division of Research UF Health Jacksonville

Dr. Guirgis

Faheem Guirgis MD
Assistant Professor of Emergency Medicine
Department of Emergency Medicine
Division of Research
UF Health Jacksonville

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sepsis is quite prevalent among hospitals and the incidence is increasing. It is a life-threatening disease that can lead to poor outcomes if patients are not recognized and treated promptly. We recognized that our institution needed a strategic approach to the problem of sepsis, therefore the Sepsis Committee was created with the goal of creating a comprehensive sepsis program.

We developed a system for sepsis recognition and rapid care delivery that would work in any area of the hospital. We found that we reduced overall mortality from sepsis, the number of patients requiring mechanical ventilation, intensive care unit length and overall hospital length of stay, and the charges to the patient by approximately $7000 per patient.

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Large Teaching Hospitals Face Greater Risk of Data Breaches

MedicalResearch.com Interview with:

Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036

Dr. Ge Bai

Ge Bai, PhD, CPA
Assistant Professor
The Johns Hopkins Carey Business School
Washington, DC 20036


MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We examined the hospital data breaches between 2009 and 2016 and found that larger hospitals and hospitals that have a major teaching mission have a higher risk of data breaches.

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Computerized Clinical Decision Support Systems Can Reduce Rate of Venous Thromboembolism

MedicalResearch.com Interview with:
Zachary Borabm, Research fellow

Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent studies have shown that health care providers perform poorly in risk stratifying their patients for venous thromboembolism (VTE) which leads to inadequate VTE prophylaxis delivery, especially in surgical patients. Computerized Clinical Decision Support Systems (CCDSSs) are programs integrated into an electronic health record that have the power to aid health care providers. Using a meta-analysis study technique we were able to pool data from 11 studies, including 156,366 patients that either had CCDSSs intervention or routine care without CCDSSs.

Our main outcome measures were the rate of prophylaxis for VTE and the rate of actual VTE events. We found that CCDSSs increased the rate of VTE prophylaxis (odds ratio 2.35, p<0.001) and decreased the risk of VTE events (risk ratio 0.78, p<0.001).

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Loopback Analytics Uses Predictive Analytics To Close The Loop In Health Care Data

MedicalResearch.com Interview with: Neil Smiley CEO of Loopback Analytics

Neil Smiley

MedicalResearch.com Interview with:
Neil Smiley
CEO of Loopback Analytics

MedicalResearch.com: What is the background for Loopback Analytics? What are the problems Loopback Analytics is attempting to mitigate?

Response: Loopback Analytics (Loopback) is a Software-as-a-Service company that provides event-driven population health management. Founded in 2009, Loopback integrates and manages diverse data sources to support predictive analytics and intervention solutions to address health reform reimbursement challenges with the goal of achieving the Triple Aim – better care, better health and lower costs.

Loopback enabled intervention solutions address key challenges associated with value-based care, such as reducing avoidable hospitalizations, high emergency department utilization, medication adherence and optimization of post-acute care networks.

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Drop in Adverse Drug Events Linked to Meaningful Use of Electronic Records

MedicalResearch.com Interview with:
Michael Furukawa, Ph.D.

Senior Economist
Agency for Healthcare Research and Quality 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Despite some progress, patient safety remains a serious concern in U.S. health care delivery, particularly in acute care hospitals. In part to support safety improvement, the Health Information Technology for Economic and Clinical Health (HITECH) Act promoted widespread adoption and use of certified electronic health record technology. To meet Meaningful Use (MU) requirements in the law, hospitals are required to adopt specific capabilities, such as computerized physician order entry, which are expected to reduce errors and promote safer care.

We found that, after the HITECH Act was made law, the occurrence of in-hospital adverse drug events (ADEs) declined significantly from 2010 to 2013, a decline of 19%. Hospital adoption of medication-related MU capabilities was associated with 11% lower odds of ADEs occurring, but the effects did not vary by the number of years of experience with these capabilities. Interoperability capability was associated with 19% lower odds of adverse drug events occurring. Greater exposure to MU capabilities explained about one-fifth of the observed reduction in ADEs.

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Cedars-Sinai Study Will Address How Doctors Communicate With Patients About Chronic Pain

MedicalResearch.com Interview with:
Michelle S. Keller, MPH, PhD Candidate

Health Policy and Management
Cedars-Sinai
Los Angeles CA 90048

MedicalResearch.com: What is the background for this new funding award?

Response: Research shows that treating and managing chronic pain is tough, and it can be hard for patients and their physicians to be on the same page. Chronic pain touches so many facets of people’s lives—relationships, mental health, sleep, work—that treating it in a 15-minute visit can lead to a lot of frustration and disappointment.

Our hope is that by arming patients and clinicians with evidence-based tools, we can help foster a better dialogue about what is ultimately important to patients, how to achieve fully functional lives while managing chronic pain. We’re testing two different types of communication tools: electronic health record alerts pointing physicians to guidelines when they write opioid prescriptions and patient portal-based tools that can help patients prepare for visits and become active, engaged partners in their care.

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Is Trust in Mental Health Clinicians Affected Among Patients Who Access Clinical Notes Online?

MedicalResearch.com Interview with:

Steven K. Dobscha, M.D. Professor, Department of Psychiatry, OHSU Director, VAPORHCS Center to Improve Veteran Involvement in Care Oregon Health & Science University

Dr. Dobscha

Steven K. Dobscha, M.D.
Professor, Department of Psychiatry, OHSU
Director, VAPORHCS Center to Improve Veteran Involvement in Care
Oregon Health & Science University

MedicalResearch.com: What is the background for this study? 

Response: Several health care systems across the United States now offer patients online access to all of their clinical notes (sometimes referred to as progress notes) through electronic health record portals; this type of access has been referred to as OpenNotes (see www.opennotes.org for more information on the national OpenNotes initiative). Veterans have been able to use OpenNotes in the Veterans Health Care (VHA) system since 2013. However, some individuals have expressed concern that online access to clinical notes related to mental health could cause some patient harms.

We are conducting a VA-funded research project with several objectives:
1) to examine benefits and unintended negative consequences of OpenNotes use as perceived by veterans receiving VHA mental health care and by VHA mental health clinicians, and
2) to develop and evaluate brief web-based courses designed to help veterans and clinicians use OpenNotes in ways that optimize Veteran-clinician collaboration and minimize unintended consequences.

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