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Kenneth W Scully - One of the best experts on this subject based on the ideXlab platform.
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using a Clinical Data Repository to estimate the frequency and costs of adverse drug events
Journal of the American Medical Informatics Association, 2002Co-Authors: Jonathan S Einbinder, Kenneth W ScullyAbstract:As a result of increased attention to medical errors, many institutions are contemplating increased use of information technology and Clinical decision support. We conducted a retrospective analysis to estimate the frequency and cost of adverse drug events (ADEs) for inpatients at the University of Virginia. Applying published criteria for the detection of potential adverse events, we used a Clinical Data warehouse to identify patients and cases with potential ADEs. Again using published criteria, we then estimated the actual number of adverse drug events and preventable adverse drug events, as well as their attributable costs and excess length of stay. Our results showed a higher estimate (10.4–11.5 events per 100 admissions) for ADEs than seen in the ADE Prevention Study, highlighting the importance of considering the generalizability of published ADE studies to other settings. Our analysis demonstrates that retrospective analysis can be an efficient and powerful technique to evaluate rules and criteria used to detect ADEs and to assess their impact.
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enhancement of Clinical Data Repository by linkage to state mortality files
American Medical Informatics Association Annual Symposium, 2001Co-Authors: Robert D Pates, Kenneth W Scully, Jonathan S Einbinder, George J Stukenborg, Thomas A Spraggins, Bruce P DemblingAbstract:We report a method and preliminary results for merging state mortality Data into a hospital Clinical Data Repository (CDR). A broadly inclusive set of potential matches for our CDR patient population was obtained from the state Death Registry at the Virginia Center for Health Statistics (VCHS). For each possible match, a total weighted score was calculated according to the level of agreement between seven identifiers. The scoring method was validated by consideration of that population of CDR patients known to have died in the hospital. We conclude that the method represents a practical way to enhance hospital Data with important outcomes information.
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development of an enterprise wide Clinical Data Repository merging multiple legacy Databases
Conference of American Medical Informatics Association, 1997Co-Authors: Kenneth W Scully, Robert D Pates, George S Desper, Alfred F Connors, Frank E Harrell, Karen S Pieper, Robert L Hannan, Robert E ReynoldsAbstract:We describe the development of a Clinical Data Repository whose core consists of four years of inpatient administrative and billing Data from the mainframe legacy systems of the University of Virginia Health System (UVAHS). To these Data we have linked a cardiac surgery Clinical Database and our physician billing Data (inpatient and outpatient). Other Databases will be merged in the future. A relational Database management system (Sybase) running on a dedicated IBM RS/6000 minicomputer was employed to assemble 2.5 Gigabytes of core Data describing approximately 100,000 hospital admissions over the four year period. To enable convenient Data queries, the system has been equipped with a custom-built WWW user interface, which generates Structured Query Language (SQL) automatically. We illustrate the rapid reporting capabilities of the resulting system with reference to patients undergoing coronary artery bypass graft surgery (CABG). We conclude that this information system: a) constitutes a convenient and low-cost method to increase Data availability across the UVAHS; b) provides clinicians with a tool for surveillance of patient care and outcomes; c) forms the core of a comprehensive Database from which Clinical research may proceed; d) provides a flexible interface empowering a wide variety of Clinical departments to share and enrich their own Clinical Data.
Jonathan S Einbinder - One of the best experts on this subject based on the ideXlab platform.
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using a Clinical Data Repository to estimate the frequency and costs of adverse drug events
Journal of the American Medical Informatics Association, 2002Co-Authors: Jonathan S Einbinder, Kenneth W ScullyAbstract:As a result of increased attention to medical errors, many institutions are contemplating increased use of information technology and Clinical decision support. We conducted a retrospective analysis to estimate the frequency and cost of adverse drug events (ADEs) for inpatients at the University of Virginia. Applying published criteria for the detection of potential adverse events, we used a Clinical Data warehouse to identify patients and cases with potential ADEs. Again using published criteria, we then estimated the actual number of adverse drug events and preventable adverse drug events, as well as their attributable costs and excess length of stay. Our results showed a higher estimate (10.4–11.5 events per 100 admissions) for ADEs than seen in the ADE Prevention Study, highlighting the importance of considering the generalizability of published ADE studies to other settings. Our analysis demonstrates that retrospective analysis can be an efficient and powerful technique to evaluate rules and criteria used to detect ADEs and to assess their impact.
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enhancement of Clinical Data Repository by linkage to state mortality files
American Medical Informatics Association Annual Symposium, 2001Co-Authors: Robert D Pates, Kenneth W Scully, Jonathan S Einbinder, George J Stukenborg, Thomas A Spraggins, Bruce P DemblingAbstract:We report a method and preliminary results for merging state mortality Data into a hospital Clinical Data Repository (CDR). A broadly inclusive set of potential matches for our CDR patient population was obtained from the state Death Registry at the Virginia Center for Health Statistics (VCHS). For each possible match, a total weighted score was calculated according to the level of agreement between seven identifiers. The scoring method was validated by consideration of that population of CDR patients known to have died in the hospital. We conclude that the method represents a practical way to enhance hospital Data with important outcomes information.
Lemuel R Waitman - One of the best experts on this subject based on the ideXlab platform.
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the prevalence of type 2 diabetes and associated risk factors with generalized osteoarthritis a retrospective study using icd codes for Clinical Data Repository system
Clinical Rheumatology, 2019Co-Authors: Aqeel M Alenazi, Lemuel R Waitman, Shaima Alothman, Mohammed M Alshehri, Jason Rucker, Jo Wick, Neena K Sharma, Patricia M KludingAbstract:Type 2 diabetes mellitus (T2DM) has been associated with osteoarthritis (OA). T2DM may be associated with generalized OA (GOA ≥ 3 joints) rather than localized OA (LOA < 3 joints). The purpose of this study was to examine the prevalence of T2DM in people with GOA compared with LOA and to investigate the association between demographic risk factors and chronic diseases (i.e., T2DM, hypertension, dyslipidemia, neuropathy, and body mass index (BMI)) with GOA compared with LOA. A retrospective review of Data was performed, and patients with diagnostic codes for OA were selected. Identified codes included primary GOA, primary LOA, T2DM, hypertension, dyslipidemia, neuropathy, depression, anxiety, and sleep disorders. Information about BMI and medication list was obtained. Chi-square and logistic regression were performed to examine the prevalence and risk factors, respectively. Data from 3855 patients (mean age = 66.43 ± 11.02, 60.9% women) included patients with GOA (n = 1265) and LOA (n = 2590). The prevalence of T2DM was significantly greater among patients with GOA (25.8%) compared with those with LOA (12.0%); however, the GOA group were older. Based on age groups, T2DM was prevalent in 17.8% of GOA compared with 7.2% in LOA for younger adults (aged 45–64 years) and was prevalent in 28.8% of GOA compared with 15.7% in LOA for older adults (aged 65 years or older). The odds ratio of GOA increased in people with chronic diseases compared with those without including T2DM (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.05–1.78, p = 0.02), hypertension (OR 1.99, CI 1.63–2.43, p < 0.001), and dyslipidemia (OR 3.46, CI 2.86–4.19, p < 0.001), adjusting for covariates. Higher prevalence of T2DM was found in people with GOA when compared with LOA across both age groups. T2DM, hypertension, and dyslipidemia were associated with GOA. Future research with longitudinal designs is needed to test the causality of this association.
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integrating medication alert Data into a Clinical Data Repository to enable retrospective study of drug interaction alerts in Clinical practice
AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science, 2017Co-Authors: Mei Liu, Brittany L Melton, Gregory A Ator, Lemuel R WaitmanAbstract:Current Clinical Data repositories primarily extract Data from multiple administrative and electronic medical record (EMR) Data resources (e.g., hospital and physician billing records) containing specific patient-level Data including demographics, medications, laboratory results, diagnoses, and procedure codes. It overlooks the importance of EMR system-level Data (e.g., medication alerts that are routinely used by physicians, nurses, and pharmacists for decision support) for the surveillance of EMR decision support tools. These medication alerts are a significant source of information for providers, to minimize avoidable adverse drug events. This study describes the integration of medication alert Data into an i2b2-based Clinical Data Repository to support the investigation of Clinical events occurring around patients with anticoagulation treatment that triggered drug-drug interaction alerts. The integration of medication alerts allows us to repurpose the Clinical and translational research infrastructure to conduct retrospective effectiveness surveillance of Clinical decision support tools.
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expressing observations from electronic medical record flowsheets in an i2b2 based Clinical Data Repository to support research and quality improvement
American Medical Informatics Association Annual Symposium, 2011Co-Authors: Lemuel R Waitman, Judith J Warren, E L Manos, Dan ConnollyAbstract:While nursing documentation in electronic medical record (EMR) flowsheets may represent the largest investment of clinician time with information systems, organizations lack tools to visualize and repurpose this Data for research and quality improvement. Incorporating flowsheet documentation into a Clinical Data Repository and methods to reduce the flowsheet ontology’s redundancy are described. 411 million flowsheet observations, derived from an EMR predominantly used in inpatient, outpatient oncology, and emergency room settings, were incorporated into a Repository using the i2b2 framework. The local flowsheet ontology contained 720 “templates” employing 5,379 groups (2,678 distinct), 37,836 measures (13,659 distinct) containing 226,666 choices for a total size of 270,641. Aggressive pruning and clustering resulted in 150 templates, 743 groups (615 distinct), 6,950 measures (4,066 distinct) with 22,497 choices, and size of 30,371. Making nursing Data accessible within i2b2 provides a new perspective for contributing Clinical organizations and heightens collaboration between the academic and Clinical activities.
Eunja Chung - One of the best experts on this subject based on the ideXlab platform.
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exploring use of a Clinical Data Repository containing international classification for nursing practice based nursing practice Data
Cin-computers Informatics Nursing, 2011Co-Authors: Hyeounae Park, Insook Cho, Eunja ChungAbstract:To determine the usefulness of a Clinical Data Repository for nursing, we conducted two studies (1) investigating the gaps between required nursing care time based on patient classification and actual nursing care time based on nurse staffing level and (2) exploring the practice variations of nurses by comparing nursing interventions documented to prevent and treat pressure ulcers. We reviewed the nursing records of 124,416 patients discharged from 2005 to 2007 to identify the gaps in nursing care time. We also reviewed records of 41,891 patients discharged in 2007 to identify those who had pressure ulcers or were at risk of pressure ulcers and analyzed the nursing interventions documented to prevent and treat pressure ulcers. The pediatric and geriatric units showed relatively high staffing needs and the trends of understaffing over time. For pressure ulcer care, nursing interventions vary by nursing unit. Position change was the most common nursing intervention documented except in the maternity unit, followed by ulcer wound care, use of devices, and nutritional assessment. This study showed that Data in a Clinical Data Repository can provide nurse managers and nurses with valuable information about nurse staffing and patient care.
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exploring practice variation in preventive pressure ulcer care using Data from a Clinical Data Repository
International Journal of Medical Informatics, 2011Co-Authors: Insook Cho, Hyeounae Park, Eunja ChungAbstract:Abstract Objective The aims of this study were to explore pressure ulcer incidences and practice variations in the nursing intervention provided for preventive pressure-ulcer care to patients either with pressure ulcers or at risk of pressure ulcers, and to examine them in relation to the patients’ medical problems and the characteristics of the nurses who cared for them. Methods The narrative nursing notes of 427 intensive-care patients who were discharged in 2007 that were documented at the point-of-care using standardized nursing statements were extracted from a Clinical Data Repository at a teaching hospital in Korea and analyzed. The frequencies of five nursing interventions for pressure-ulcer prevention were compared between pressure-ulcer and pressure-ulcer risk groups, as were the characteristics of the nurses who were treating the patients in these two groups. Nursing interventions for pressure-ulcer prevention were also assessed relative to the patients’ medical problems. Results The overall incidence of pressure ulcers was 15.0%. Position change was the most popular nursing intervention provided for pressure-ulcer prevention in both the pressure-ulcer and at-risk groups, followed by skin care. There was a statistically significant tendency toward a greater frequency of providing skin care and nutritional care in the at-risk group than in the pressure-ulcer group. There was no statistically significant difference in the mean frequencies of nursing interventions relative to the patients’ medical problems in the pressure-ulcer group. However, frequencies of nursing interventions did differ significantly between patients with neurological problems and those with other medical problems in the at-risk group. Analysis of the nurses’ characteristics revealed that more nursing interventions were documented by those who were younger, less experienced, and more educated. Conclusion A standardized nursing-terminology-based electronic nursing record system allowed us to monitor the variations in nursing practice with regard to preventive pressure-ulcer care in intensive-care patients with and at risk of pressure ulcers. We found that pressure-ulcer prevention care was provided at frequencies much lower than the recommended guidelines. Further studies on identifying the factors affecting pressure-ulcer prevention care and ways to improve the quality of that care are needed.
Declan G Murphy - One of the best experts on this subject based on the ideXlab platform.
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error rates in a Clinical Data Repository lessons from the transition to electronic Data transfer a descriptive study
BMJ Open, 2013Co-Authors: Matthew K H Hong, John Pedersen, Justin S Peters, Anthony J Costello, Declan G MurphyAbstract:Objective Data errors are a well-documented part of Clinical Datasets as is their potential to confound downstream analysis. In this study, we explore the reliability of manually transcribed Data across different pathology fields in a prostate cancer Database and also measure error rates attributable to the source Data. Design Descriptive study. Setting Specialist urology service at a single centre in metropolitan Victoria in Australia. Participants Between 2004 and 2011, 1471 patients underwent radical prostatectomy at our institution. In a large proportion of these cases, clinicopathological variables were recorded by manual Data-entry. In 2011, we obtained electronic versions of the same printed pathology reports for our cohort. The Data were electronically imported in parallel to any existing manual entry record enabling direct comparison between them. Outcome measures Error rates of manually entered Data compared with electronically imported Data across clinicopathological fields. Results 421 patients had at least 10 comparable pathology fields between the electronic import and manual records and were selected for study. 320 patients had concordant Data between manually entered and electronically populated fields in a median of 12 pathology fields (range 10–13), indicating an outright accuracy in manually entered pathology Data in 76% of patients. Across all fields, the error rate was 2.8%, while individual field error ranges from 0.5% to 6.4%. Fields in text formats were significantly more error-prone than those with direct measurements or involving numerical figures (p Conclusions While the overall rate of error was low in manually entered Data, individual pathology fields were variably prone to error. High-quality pathology Data can be obtained for both prospective and retrospective parts of our Data Repository and the electronic checking of source pathology Data for error is feasible.