MedicalResearch.com Interview with:
Hardeep Singh, MD MPH
Chief, Health Policy, Quality and Informatics Program,
Houston Veterans Affairs Health Services Research Center for Innovations
Michael E. DeBakey Veterans Affairs Medical Center and
Baylor College of Medicine
Houston TX 77030
Medical Research: What is the background for this study? What are the main findings?
Dr. Singh: Missed or delayed diagnoses are among the most common patient safety concerns in outpatient settings, and measuring and reducing them is a high priority. Our computerized triggers scanned huge amounts of patient data in the electronic health record and flagged individuals at risk for delays in follow-up of cancer-related abnormal clinical findings. Records of all patients flagged by the computerized trigger algorithm in the intervention group were reviewed to determine the presence of delay and if delay was confirmed, we communicated this information to their clinicians. We found that patients seeing clinicians who were notified of potential delays had more timely diagnostic evaluation for both prostate and colon cancer and more patients in the intervention part of the study had received diagnostic evaluation by the time we completed our final review.
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MedicalResearch.com Interview with:
Dr. Kristin Kostick PhD on behalf of the authors
Research Associate - Decision Making and Ethics Research Program
Center for Medical Ethics and Health Policy
Baylor College of Medicine
Houston, TX
Medical Research: What is the background for this study? What are the main findings?
Response: The idea of this study came from a larger research study we’re doing to develop and test a decision aid for patients and caregivers considering LVAD treatment. As part of that study, we interviewed LVAD patients, candidates, caregivers and decliners of LVAD treatment to explore their decisional needs. One of the things that kept coming up in these interviews was the need for “support,” which everyone, including clinicians, identified as a crucial aspect of post-implant recovery. There is an excellent clinical support team at our partnering hospital in Houston, as well as a community of LVAD recipients and caregivers where people can get together to share their stories and resources face-to-face. But for other people who find it difficult to get to the hospital, either because they have transportation barriers or they simply live too far away, we began to wonder whether support services might be available to them in virtual settings. So we decided to do this analysis to see what social media sites exist for the LVAD community. What is the content of these sites? Are there different kinds for different support needs? What are patients getting from them? How might they be used in the future for improving patient care and support?
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MedicalResearch.com Interview with:
Barbara W. Trautner, MD, PhD
Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center
Section of Infectious Diseases
Department of Medicine
Baylor College of Medicine, Houston, Texas
Medical Research: What is the background for this study? What are the main findings?
Dr. Trautner: Reducing antimicrobial overuse, or antimicrobial stewardship, is a national imperative. If we fail to optimize and limit use of these precious resources, we may lose effective antimicrobial therapy in the future. CDC estimates that more than $1 billion is spent on unnecessary antibiotics annually, and that drug-resistant pathogens cause 2 million illnesses and 23,000 deaths in the U.S. each year. The use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized and nursing home patients, especially among patients with urinary catheters. In catheterized patients, ASB is very often misdiagnosed and treated as catheter-associated urinary tract infection (CAUTI). Therefore, we designed the “Kicking CAUTI: The No Knee-Jerk Antibiotics Campaign intervention” to reduce overtreatment of ASB and to reduce the confusion about distinguishing CAUTI from asymptomatic bacteriuria.
This study evaluated the effectiveness of the Kicking CAUTI intervention in two VAMCs between July 2010 and June 2013. The primary outcomes were urine cultures ordered per 1,000 bed-days (inappropriate screening for ASB) and cases of ASB receiving antibiotics (overtreatment). The study included 289,754 total bed days, with 170,345 at the intervention site and 119,409 at the comparison site. Through this campaign, researchers were able to dramatically decrease the number of urine cultures ordered. At the intervention site, the total number of urine cultures ordered decreased by 71 percent over the course of the intervention. Antibiotic treatment of asymptomatic bacteriuria decreased by more than 75 percent during the study. No significant changes occurred at the comparison site over the same time period. Failure to treat catheter-associated urinary tract infection when indicated did not increase at either site. (more…)
MedicalResearch.com Interview with:
Aaron P. Thrift, Ph.D.
Assistant Professor, Department of Medicine
Dan L. Duncan Cancer Center
Baylor College of Medicine
Houston, TX 77030-3498
Medical Research: What is the background for this study? What are the main findings?
Dr. Thrift: Greater attained adult height is associated with increased risk of all cancers combined; however, the association may differ by cancer site and between women and men. For colorectal cancer, epidemiological studies suggest that the association with height may be stronger for women than for men. We used data from over 10,000 patients with colorectal cancer and over 10,000 population-based controls and conducted multiple analyses, including using Mendelian randomization (which incorporates genomic data with traditional approaches) to overcome potential issues of confounding and bias in observational studies, to further examine the association between height and risk of colorectal cancer. Overall, we found that taller height was associated with increased risk of colorectal cancer (8% increased risk per 10cm increase in height). When we examined women and men separately, our results strongly suggest that height is causally associated with colorectal cancer risk for women, whereas there was weaker evidence for a causal association between height and colorectal cancer risk for men.
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MedicalResearch.com Interview with:
Alexander W. Pastuszak, MD, PhD
Male Reproductive Medicine and Surgery
Scott Department of Urology
Jason Malcolm Scovell
Medical Student, Ofc SA-BCM StudentsBaylor College of MedicineHouston, TX
Medical Research: What is the background for this study? What are the main findings?
Response: Sleep quality is an important component of overall health, and can both exacerbate health issues and be impaired by health problems. Shift workers, primarily those who do not work standard daylight shifts, are prone to sleep problems, a significant concern in light of the fact that up to 25% of the U.S. workforce is comprised of shift workers. As men age, the prevalence of Lower Urinary Tract Symptoms (LUTS), which include urgency, frequency, waking up at night to urinate, and difficulties with urination, increases. Unsurprisingly, men with LUTS report poor sleep in part due to awakening repeatedly during the night. We studied a group of male shift workers, who we believe to be an ‘at-risk’ population, and found that not only do the men who report worse sleep quality have worse Lower Urinary Tract Symptoms, but also men who report difficulty falling asleep have more severe LUTS than those who do not. This latter point is significant, given that most men with LUTS can fall asleep without difficulty, but then awaken repeatedly throughout the night, and suggests that sleep difficulties in this population may be resulting in Lower Urinary Tract Symptoms rather than LUTS exclusively resulting in sleep difficulties.
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MedicalResearch.com Interview with:
Alexander W. Pastuszak, MD, PhDMale Reproductive Medicine and Surgery
Scott Department of Urology
Baylor College of Medicine Houston, TX
Medical Research: What is the background for this study?
Dr. Pastuszak: The link between erectile dysfunction (ED) and cardiovascular disease (CVD) has been growing stronger in recent years, and recommendations have recently been made to screen men with ED for CVD risk factors. The arteries in the penis are much smaller than those in the heart, and if vascular disease contributes to ED, which we know it does, then ED should be detected before CVD in affected men. We also know that treating men with CVD risk factors results in improvement in their risk of having acute cardiovascular events (i.e. heart attack, stroke, etc.). Because of these relationships, we wanted to assess the economic impact of screening men with erectile dysfunction for CVD, identifying men with CVD risk factors, and treating these men on the incidence of cardiovascular events and new cases of ED. Specifically, we wanted to look at the costs associated with screening and treatment of CVD and erectile dysfunction, and the cost savings resulting from screening and treating men with CVD risk factors and ED when preventing acute cardiovascular events.
Medical Research: What are the main findings?
Dr. Pastuszak: We modeled the reduction in acute cardiovascular events and the associated cost savings over 20 years. We predicted that approximately 5.8 million men with both CVD and ED would be identified over 20 years if we screened men with ED for CVD risk factors, and the cost of this screening would be $2.7 billion. We assumed that if we treated these at-risk men, there would be an approximately 20% decrease in cardiovascular events, which would prevent 1.1 million cardiovascular events over 20 years, saving $21.3 billion that would otherwise be put to treatment of these acute events. Since ED and CVD arise from the same pathology, we predicted that in treating the CVD risk factors, a similar decrease in ED cases would be seen as well, which would save $9.7 billion that would otherwise be put to ED treatment. In screening these men, a combined $28.5 billion would be saved over 20 years.
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MedicalResearch.com Interview with:
Dr. Xiang (Shawn) Zhang PhD
Assistant Professor
Department of Molecular and Cellular Biology
Lester and Sue Smith Breast Center
Baylor College of Medicine Houston, Texas
Medical Research: What is the background for this study? What are the main findings?
Response: Bone metastases present a major clinical problem for oncologists. They are very painful and unpleasant due to the ability of metastatic cells to dissolve bones, and if they spread to the spine or vertebrate bone they the spinal cord compression could cause paralysis. There is a gap in our knowledge about bone metastasis in breast cancer. We know a lot about when they are fully established and already dissolving the bone, but little about what happens early on, right after the cancer cells get there but before they start the bone-dissolving process.
In the study, we revealed that in the early stages, when there are only a few cancer cells, these cells tend to locate themselves in a microenvironment that is enriched in bone making cells called osteoblasts whose normal job is to help make new bones. The cancer cells appear to be surrounded by these bone-making cells before they acquire the ability to dissolve bones.
We also uncovered the pathway that gets activated when the cancer cells lodge into the bone-making cells, and helps them progress to more malignant metastases. The action is mediated by a class of proteins that helps bind the cancer cells to the bone tissue called heterotypic adherens junctions (hAJs) involving the adherens proteins E-cadherin (cancer-derived) and N-cadherin (bone-promoting). This then activates the mTOR pathway in cancer cells, which drives the progression from single cells to metastases.
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MedicalResearch.com Interview with:
Michael K. Scullin, Ph.D.
Principal Investigator of the Sleep Neuroscience & Cognition (SNaC) Laboratory and an Assistant Professor of Psychology & Neuroscience Director Sleep Neuroscience and Cognition Laboratory Baylor University
Medical Research: What is the background for this study? What are the main findings?
Dr. Scullin: One of the purposes of sleep in healthy adults is to optimize cognitive functioning. When we lose out on a few hours of sleep we tend not to be able to focus or think as well as when we get enough sleep (typically 8 hours). Even more interesting is that particular aspects of sleep physiology—our deepest levels of sleep known as slow wave sleep and rapid eye movement sleep—are essential to our brain’s ability to take the information that we learn during the day and stabilize those memories so that we can use them in the future.
Sleep quantity and quality change markedly across the lifespan, though there are individual differences in how much one’s sleep changes. Our work was concerned with the possible long-term repercussions of cutting back on sleep and getting lower quality sleep (less slow wave sleep and rapid eye movement sleep). We reviewed approximately 200 scientific articles on this topic and we found that the amount of total sleep and the quality of that sleep is important to cognitive and memory functioning in young adults and middle-aged adults and can even predict how well someone’s cognitive functioning will be decades later. Thus, if you’re sleeping well when you are 40 then you are investing in preserving your mental functioning at age 50.
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MedicalResearch.com Interview with:M. Justin Coffey MD
Associate Professor
Menninger Department of Psychiatry & Behavioral Sciences
Baylor College of Medicine
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Coffey: Although both the US Surgeon General and the Institute of Medicine have called on health care systems to reduce suicide, the few assessments of suicide in such systems have examined only specific patient groups and not the entire population of health plan members. Our study reports the first information on suicide for the entire membership of a large health maintenance organization (HMO). The findings provide a previously unavailable baseline data for health care systems who are engaged in important efforts to measure and prevent suicide.
We identified all suicides among the entire membership of our HMO network between 1999 and 2010, determining the date and cause of death using official state mortality records. In our sample, the annual suicide rate among all HMO members (including non-patient members) did not change over time, whereas the annual suicide rate in the general population of the state of Michigan increased significantly. Importantly, suicides actually decreased among HMO members who received specialty mental health services, whereas suicides increased among HMO members who accessed general medical services but not specialty mental health services. (more…)
MedicalResearch.com Interview with:
Aymer Al-Mutairi, MD
Primary Care Research fellow
Dept. Family and Community Medicine
Baylor College of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Al-Mutairi: Previous studies indicate that 8% of abnormal imaging results did not receive follow-up actions by referring providers within 4 weeks. In addition, abnormal imaging results often state recommendations for further testing and radiology reports occasionally contain language that conveys doubt regarding the results.
We hypothesized that recommendations for further imaging, and expressions of doubt or uncertainty in the radiology report, are more likely to be associated with lack of timely follow-up. We found that patients with abnormal imaging results where radiologists recommended further imaging were less likely to be followed-up by a treating clinician within 4 weeks compared with patients without such recommendations. Expression of “doubt” in the radiology reports did not affect follow-up actions.
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MedicalResearch.com Interview with:
Dr. Grace Hsiao-Wei Lo
Baylor College of Medicine
Assistant Professor, Section of Immunology, Allergy and Rheumatology, Department of Medicine, Baylor College of Medicine
Faculty, Immunology, Allergy, and Rheumatology Section,Michael E. DeBakey VA Medical Center
Medical Research:What is the background for this study? What are the main findings?Dr. Hsiao-Wei Lo: Controversy exists regarding whether running is harmful versus beneficial to the knee. There is concern that chronic repetitive loading of the knee could physically damage structures within the knee. Alternatively, runners have a lower body mass index, which we know is protective of knee osteoarthritis. Limitations of prior studies evaluating the relationship between running and osteoarthritis include that they have been small studies and they have focused on those participating in a high level or an elite level of running which may not be very generalizable. Addressing the question of whether running is associated with osteoarthritis is of particular relevance given that recent CDC guidelines recommend that all adults participate in regular physical activity, as there is definitive evidence that increased physical activity is associated with reduced cardiovascular events and mortality.
To address this question, we used data from a multicenter observational study, the Osteoarthritis Initiative (OAI). Of 2,683 participants, 56 percent were female, the mean age was 64.5 and the mean BMI was 28.6. Twenty-nine percent of the participants reported that they ran at some time in their lives.
Patients had knee X-rays, were given symptom assessments, and were asked to complete the Lifetime Physical Activity Questionnaire (LPAQ), identifying the top three most frequently performed physical activities (≥ 10 times in life) they performed at different age ranges throughout their life. Age ranges included 12-18, 19-34, 35-49, and 50 years or older.
Knee X-rays were taken and then scored for evidence of radiographic OA using the Kellgren-Lawrence (KL) grade scale. Participants with KL grades of two or higher were considered as having radiographic OA (ROA). The researchers also measured if participants had frequent knee pain. Researchers considered a participant to have symptomatic OA (SOA) if they had at least one knee with both ROA and frequent knee pain. Anyone with a total knee replacement was classified as having frequent knee pain, ROA and SOA.
After collecting all the data, the researchers reported that runners, regardless of the age when they ran, had a lower prevalence of knee pain, ROA and SOA than non-runners. For people who had run at any time in their lives, 22.8 percent had SOA compared to 29.8 percent of non-runners. People with the lowest BMI scores were the most likely to report being habitual runners. Regular running, even at a non-elite level, not only does not increase the risk of developing knee osteoarthritis but may protect against it, the researchers concluded. (more…)
MedicalResearch.com Interview with: Dr. Hardeep Singh MD, MPH
Chief the Health Policy, Quality & Informatics Program
Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety
Michael E. DeBakey VA Medical Center in Houston, Texas
Associate professor at Baylor College of Medicine
MedicalResearch: What are the main findings of the study?Dr. Singh: EHRs use can prompt new patient safety concerns, and many of these problems are complex and difficult to detect. We sought to better understand the nature of these patient safety concerns and reviewed 100 closed investigations involving 344 technology-related incidents arising between 2009 and 2013 at the Department of Veterans Affairs (VA).
We evaluated safety concerns related to technology itself as well as human and operational factors such as user behaviors, clinical workflow demands, and organizational policies and procedures involving technology. Three quarters of the investigations involved unsafe technology while the remainder involved unsafe use of technology. Most (70%) investigations identified a mix of 2 or more technical and/or non-technical underlying factors.
The most common types of safety concerns were related to the display of information in the EHR; software upgrades or modifications; and transmission of data between different components of the EHR system.
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Medicalresearch.com Interview with: Robert S. Tan MD, MBA, AGSF
Clinical Director & Chief Geriatrics, Michael DeBakey VAMC
Director, Opal Medical, LLC
Clinical Professor of Family & Community Medicine, UTHSC-Houston
Associate Professor of Medicine (Geriatrics), Baylor College Medicine
Medicalresearch: What are the main findings of the study?Dr. Tan:Our findings¹ are similar to that of an early study by Shores et al ² and other studies on endogenous testosterone that found testosterone lowered mortality. In the analysis of 39,937 patients at the Low T Centers up to 5 years, the rate ratios of new MI and strokes on testosterone as compared to general community based data sets (3,4) was 0.12 (C.I. 0.08-0.18, p<0.0001) and 0.05 (C.I 0.02-0.13, p<0.0001) respectively. Thus, there appears to be a lower risk of heart attacks and strokes with patients on testosterone. While the compared population sets are not identical or real controls; our study does suggest that rates of MI and strokes in real life practice with testosterone treated patients are even lower than the general population registries (which may include older patients).
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MedicalResearch.com Interview with:Flor M. Munoz, MDDepartment of Pediatrics
Department of Molecular Virology and Microbiology
Baylor College of Medicine, Houston, Texas
MedicalResearch.com: What are the main findings of the study?Dr. Munoz:
1. Tdap vaccine was safe and well tolerated during pregnancy
2. Women who are pregnant have adequate responses to the Tdap vaccine, similar to those of women who are not pregnant.
3. Antibodies to pertussis are efficiently transferred to the fetus through the placenta so that babies of mothers who were vaccinated during pregnancy had significantly higher concentrations of antibody at birth and up to 2 months of age, when compared to infants of mothers who were vaccinated post-partum.
4. Higher antibody concentrations in the first two months of life are likely to provide protection against pertussis during this period of high vulnerability
5. Infants of mothers who were vaccinated during pregnancy had adequate responses to their routine pertussis vaccines at 2, 4, and 6 months of age, and had expected and adequate responses to their 4th dose of vaccine at 1 year of age. The absolute concentration of antibodies to some of the pertussis antigens might be modestly lower after the primary series of vaccines in some infants of mothers who were vaccinated during pregnancy, but this difference does not persist after the 4th dose.
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MedicalResearch.com Interview with: Dr Hardeep Singh MD MPH
Chief of the health policy, quality & informatics program at the Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, based at the Michael E. DeBakey VA Medical Center in Houston, Texas
Associate professor at Baylor College of Medicine in Houston
MedicalResearch.com: What are the main findings of the study?Dr Singh: We built estimates of diagnostic error by compiling and analyzing data from three previous studies. These studies evaluated situations such as unexpected return visits and lack of timely follow up and provided researchers with an estimated frequency of diagnostic error. This frequency was then applied to the general adult population. Diagnostic errors, which we defined as missed opportunities to make a correct or timely diagnosis based on available evidence—occur in about 5 percent of adults in the United States.
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MedicalResearch.com Interview with: Rachelle S. Doody, M.D.,Ph.D.
Effie Marie Cain Chair in Alzheimer's Disease Research
Director, Alzheimer's Disease and Memory Disorders Center
Baylor College of Medicine-Department of Neurology
Houston, Texas 77030: MedicalResearch.com
MedicalResearch.com: What are the main findings of the study? Dr. Doody: The study set out to see whether the antibody infusion treatment, Solanezumab, would improve the course of mild to moderate Alzheimer's disease in the ways necessary to gain drug approval. Unfortunately, the results did not support an approvable treatment for this purpose.
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MedicalResearch.com Interview with:Daniel A. Anaya, MD, FACS
Associate Professor of Surgery - Surgical Oncology
Michael E. DeBakey Department of Surgery
Baylor College of Medicine
Chief, General Surgery & Surgical Oncology SectionDirector, Liver Tumor Program
Michael E. DeBakey VA Medical Center Houston, TX 77030
and
Dr. Courtney J. Balentine, MD
First author and surgical resident at Baylor College of Medicine
MedicalResearch.com: What are the main findings of the study?Dr. Anaya: That a good proportion of patients having colorectal operations will need additional assistance to recover during the postoperative period, resulting in being discharged to other facilities (nursing facilities, skilled care, etc) after surgery, and that hospitals where a higher-volume of colorectal operations are performed are more likely to discharge patients back to home after surgery.
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MedicalResearch.com Interview with:Faisal G. Bakaeen, MD FACS
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TexasThe Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas
MedicalResearch.com: What are the main findings of the study?Dr. Bakaeen: The relative use of off-pump CABG peaked at 24% in 2003, followed by a slow decline after that to about 19%. In addition, the conversion rate from off- to on-pump decreased with time and has stayed below 3.5% in recent years. Perioperative mortality rates decreased over time for both on- and off-pump CABG and have stayed below 2% since 2006. The mortality associated with converted cases was high regardless of the surgery year.
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MedicalResearch.com Interview with:
Laura A. Petersen, MD, MPH
MEDVAMC Associate Chief of Staff, Research
Director, VA HSR&D Center of Excellence (152)
Houston TX 77030
Professor of Medicine
Chief, Section of Health Services Research
Baylor College of Medicine
HSR&D Center of Excellence
Michael E. DeBakey Veterans Affairs Medical Center
Houston, Texas 77030
MedicalResearch.com: What are the main findings of the study?Dr. Petersen: VA physicians randomized to the individual incentive group were more likely than controls to improve their treatment of hypertension. The adjusted changes over the study period in Veterans meeting the combined BP/appropriate response measure were 8.8 percentage points for the individual-level, 3.7 for the practice-level, 5.5 for the combined, and 0.47 for the control groups. Therefore, a physician in the individual group caring for 1000 patients with hypertension would have about 84 additional patients achieving blood pressure control or appropriate response after 1 year. The effect of the incentive was not sustained after the washout period. Although performance did not decline to pre-intervention levels, the decline was significant. None of the incentives resulted in increased incidence of hypotension compared with controls. While the use of guideline-recommended medications increased significantly over the course of the study in the intervention groups, there was no significant change compared to the control group. The mean individual incentive earnings over the study represented approximately 1.6% of a physician’s salary, assuming a mean salary of $168,000.
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MedicalResearch.com Interview with Salim S. Virani, MD, PhD
Health Policy and Quality Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine,
Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
MedicalResearch.com: What are the main findings of the study?Dr. Virani: The main findings of the study are that despite having cholesterol levels at goal (LDL cholesterol <100 mg/dL), about one-third of patients (9200 out of 27947) with coronary heart disease had repeat cholesterol testing in 11 months from their last lipid panel. As expected, no intervention was performed as a response to these lipid panels. Collectively, 12686 additional lipid panels were performed in these patients. Among 13,114 patients who met the optional treatment target of LDL-C<70 mg/dL, repeat lipid testing was performed in 8,177 (62.3% of those with LDL-C<70) during 11 months of follow-up.
Patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% CI, 1.10-1.22), a history of hypertension (OR, 1.21; 95%CI, 1.13-1.30), higher illness burden (OR, 1.39; 95%CI, 1.23-1.57), and more frequent primary care visits (OR, 1.32; 95%CI, 1.25-1.39) were more likely to undergo repeat testing, whereas patients receiving care at a teaching facility (OR, 0.74; 95%CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95%CI, 0.88-0.98) and those with a medication possession ratio of 0.8 or higher (OR, 0.75; 95%CI, 0.71-0.80) were less likely to undergo repeat testing.
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MedicalResearch.com Interview with:
Hardeep Singh, MD MPH
Chief, Health Policy, Quality and Informatics Program,
Houston Veterans Affairs Health Services Research Center for Innovations
Michael E. DeBakey Veterans Affairs Medical Center and
Baylor College of Medicine
Houston TX 77030
Medical Research: What is the background for this study? What are the main findings?
Dr. Singh: Missed or delayed diagnoses are among the most common patient safety concerns in outpatient settings, and measuring and reducing them is a high priority. Our computerized triggers scanned huge amounts of patient data in the electronic health record and flagged individuals at risk for delays in follow-up of cancer-related abnormal clinical findings. Records of all patients flagged by the computerized trigger algorithm in the intervention group were reviewed to determine the presence of delay and if delay was confirmed, we communicated this information to their clinicians. We found that patients seeing clinicians who were notified of potential delays had more timely diagnostic evaluation for both prostate and colon cancer and more patients in the intervention part of the study had received diagnostic evaluation by the time we completed our final review.
(more…)
