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AMIA ... Annual Symposium Proceedings.... 2017Information technologies have transformed healthcare delivery and promise to improve efficiency and quality of care. However, in-depth analysis of EHR-mediated workflows...
Information technologies have transformed healthcare delivery and promise to improve efficiency and quality of care. However, in-depth analysis of EHR-mediated workflows is challenging. Our goal was to apply process mining, in combination with observational techniques, to understand EHR-based workflows. We reviewed nearly 76,000 event logs from 15 providers and supporting staff, and 142 patients in a pre-operative setting and we inspected 3 weeks of interviews and video observations. We found that on average 44 minutes were spent per patient interacting with the EHR, 55% of the time of the patient visit was spent by personnel interacting with the EHR and for over 5% of the time personnel used or reviewed paper-based artifacts. We also discovered the handover-of-care network and compared frequency of interactions between personnel. This study suggests that applying process mining in combination with observational techniques has vast potential for informing Mayo Clinic in the forthcoming EHR conversion.
Topics: Data Mining; Electronic Health Records; Hospital Administration; Humans; Interviews as Topic; Observation; Patient Handoff; Preoperative Care; Surgery Department, Hospital; Time Factors; Workflow; Workload
PubMed: 29854145
DOI: No ID Found -
Clinical Trials (London, England) Jun 2019Pragmatic clinical trials often use automated data sources such as electronic health records, claims, or registries to identify eligible individuals and collect outcome...
BACKGROUND
Pragmatic clinical trials often use automated data sources such as electronic health records, claims, or registries to identify eligible individuals and collect outcome information. A specific advantage that this automated data collection often yields is having data on potential participants when design decisions are being made. We outline how this data can be used to inform trial design.
METHODS
Our work is motivated by a pragmatic clinical trial evaluating the impact of suicide-prevention outreach interventions on fatal and non-fatal suicide attempts in the 18 months after randomization. We illustrate our recommended approaches for designing pragmatic clinical trials using historical data from the health systems participating in this study. Specifically, we illustrate how electronic health record data can be used to inform the selection of trial eligibility requirements, to estimate the distribution of participant characteristics over the course of the trial, and to conduct power and sample size calculations.
RESULTS
Data from 122,873 people with patient health questionnaire (PHQ) responses, recorded in their electronic health records between 1 July 2010 and 31 March 2012, were used to show that the suicide attempt rate in the 18 months following completion of the questionnaire varies by response to item nine of the PHQ. We estimated that the proportion of individuals with a prior recorded elevated PHQ (i.e. history of suicidal ideation) would decrease from approximately 50% at the beginning of a trial to about 5%, 50 weeks later. Using electronic health record data, we conducted simulations to estimate the power to detect a 25% reduction in suicide attempts. Simulation-based power calculations estimated that randomizing 8000 participants per randomization arm would allow 90% power to detect a 25% reduction in the suicide attempt rate in the intervention arm compared to usual care at an alpha rate of 0.05.
CONCLUSIONS
Historical data can be used to inform the design of pragmatic clinical trials, a strength of trials that use automated data collection for randomizing participants and assessing outcomes. In particular, realistic sample size calculations can be conducted using real-world data from the health systems in which the trial will be conducted. Data-informed trial design should yield more realistic estimates of statistical power and maximize efficiency of trial recruitment.
Topics: Computer Simulation; Electronic Health Records; Humans; Mental Health; Randomized Controlled Trials as Topic; Research Design; Sample Size; United States; Suicide Prevention
PubMed: 30866672
DOI: 10.1177/1740774519833679 -
Nephrology (Carlton, Vic.) Dec 2021Over the past few years, a large number of prediction models have been published, often of poor methodological quality. Seemingly objective and straightforward,... (Meta-Analysis)
Meta-Analysis Review
Over the past few years, a large number of prediction models have been published, often of poor methodological quality. Seemingly objective and straightforward, prediction models provide a risk estimate for the outcome of interest, usually based on readily available clinical information. Yet, using models of substandard methodological rigour, especially without external validation, may result in incorrect risk estimates and consequently misclassification. To assess and combat bias in prediction research the prediction model risk of bias assessment tool (PROBAST) was published in 2019. This risk of bias (ROB) tool includes four domains and 20 signalling questions highlighting methodological flaws, and provides guidance in assessing the applicability of the model. In this paper, the PROBAST will be discussed, along with an in-depth review of two commonly encountered pitfalls in prediction modelling that may induce bias: overfitting and composite endpoints. We illustrate the prevalence of potential bias in prediction models with a meta-review of 50 systematic reviews that used the PROBAST to appraise their included studies, thus including 1510 different studies on 2104 prediction models. All domains showed an unclear or high ROB; these results were markedly stable over time, highlighting the urgent need for attention on bias in prediction research. This article aims to do just that by providing (1) the clinician with tools to evaluate the (methodological) quality of a clinical prediction model, (2) the researcher working on a review with methods to appraise the included models, and (3) the researcher developing a model with suggestions to improve model quality.
Topics: Humans; Models, Statistical; Nephrology; Prognosis; Research Design; Risk Assessment
PubMed: 34138495
DOI: 10.1111/nep.13913 -
Journal of Medical Internet Research Dec 2010This theme issue on e-mental health presents 16 articles from leading researchers working on systems and theories related to supporting and improving mental health...
This theme issue on e-mental health presents 16 articles from leading researchers working on systems and theories related to supporting and improving mental health conditions and mental health care using information and communication technologies. In this editorial, we present the background of this theme issue, and highlight the content of this issue.
Topics: Computer User Training; Humans; Internet; Mental Disorders; Mental Health Services; Remote Consultation; Research Design; Therapy, Computer-Assisted
PubMed: 21169177
DOI: 10.2196/jmir.1713 -
Clinical Medicine (London, England) Feb 2018Ambulatory emergency care (AEC) has been developed by clinicians as a means of providing emergency care without the traditional bed base of a hospital. Given that AEC is...
Ambulatory emergency care (AEC) has been developed by clinicians as a means of providing emergency care without the traditional bed base of a hospital. Given that AEC is provided in a clinic-style setting, it can continue to operate during periods of high bed occupancy, alleviating bed pressures and continuing to provide timely care for selected patients. Although different models of AEC have developed according to local context, there are common principles that apply to AEC services, including early access to senior decision-makers, opening hours matching demand, access to diagnostics, close collaboration with other clinical services, a mixed workforce and patient selection processes. Some of the key AEC developments have been related to technology, including high-sensitivity troponin, low-molecular-weight heparins and computer tomography (CT) pulmonary angiography. Risk stratification tools are useful for assessing the appropriateness of using AEC as a care model for patients.
Topics: Ambulatory Care; Early Medical Intervention; Emergencies; Emergency Medical Services; Humans; Models, Organizational; Patient Selection; Quality Improvement; Risk Assessment; United Kingdom
PubMed: 29436442
DOI: 10.7861/clinmedicine.18-1-69 -
Systematic Reviews Dec 2013Quality circles (QCs) are commonly used in primary health care in Europe to consider and improve standard practice over time. They represent a complex social...
BACKGROUND
Quality circles (QCs) are commonly used in primary health care in Europe to consider and improve standard practice over time. They represent a complex social intervention that occurs within the fast-changing system of primary health care. Numerous controlled trials, reviews, and studies have shown small but unpredictable positive effect sizes on behavior change. Although QCs seem to be effective, stakeholders have difficulty understanding how the results are achieved and in generalizing the results with confidence. They also lack understanding of the active components of QCs which result in changes in the behavior of health care professionals. This protocol for a realist synthesis will examine how configurations of components and the contextual features of QCs influence their performance.
METHODS/DESIGN
Stakeholder interviews and a scoping search revealed the processes of QCs and helped to describe their core components and underlying theories. After clarifying their historical and geographical distribution, a purposive and systematic search was developed to identify relevant papers to answer the research questions, which are: understanding why, how, and when QCs work, over what time frame, and in what circumstances. After selecting and abstracting appropriate data, configurations of contexts and mechanisms which influence the outcome of QCs within each study will be identified. Studies will be grouped by similar propositional statements in order to identify patterns and validation from stakeholders sought. Finally, theories will be explored in order to explain these patterns and to help stakeholders maintain and improve QC performance.
DISCUSSION
Analyzing context-mechanism-outcome (CMO) patterns will reveal how QCs work and how contextual factors interact to influence their outcome. The aim is to investigate unique configurations that enable them to improve the performance of health care professionals. Using a standardized reporting system, this realist review will allow the research questions to be answered to the satisfaction of key stakeholders and enable on-going critical examination and dissemination of the findings.
STUDY REGISTRATION
PROSPERO registration number: CRD42013004826.
Topics: Group Processes; Humans; Management Quality Circles; Primary Health Care; Quality Improvement; Research Design; Review Literature as Topic
PubMed: 24321626
DOI: 10.1186/2046-4053-2-110 -
Health Services Research Dec 1999
Review
Topics: Causality; Health Maintenance Organizations; Humans; Organizational Case Studies; Personnel Turnover; Quality Assurance, Health Care; Research Design
PubMed: 10591281
DOI: No ID Found -
BMC Public Health Aug 2018The working environment should be a naturally integrated part of business development. Provisions are in place that address the employer's obligations to investigate,...
Study protocol of an effect and process evaluation of the Stamina model; a Structured and Time-effective Approach through Methods for an Inclusive and Active working life.
BACKGROUND
The working environment should be a naturally integrated part of business development. Provisions are in place that address the employer's obligations to investigate, carry out and follow up activities in such a way that ill health and accidents at work are prevented and a satisfactory working environment is achieved. Still, there are organizations that not properly perform systematic work environment management. In order to improve adherence, interventions and models focused on these issues need to be easy to understand and provide rapid feedback of results in order to be implemented. The Stamina model has recently been implemented in Sweden. The model is a participatory organizational systematic model facilitating the work environment, productivity and quality. It is a support model that provides structured and recurrent feedback in the systematic work environment management. The aim of the present paper is to thoroughly describe the Stamina model and the studies that are designed to investigate the effect, to increase the understanding of how and why the model was or was not effective, and to identify factors that facilitate implementation.
METHODS
The paper presents a project consisting of two related evaluation parts. Part one is an effect evaluation with an active group applying the Stamina model and a control group. This part investigate effects on proxy outcomes that are relevant for health and productivity. Part two is a process evaluation with a qualitative design. This part will be based on semi-structured interviews with various stakeholders, such as employees, first line managers, project managers, facilitators and representatives from the management group, in the organizations.
DISCUSSION
Many interventions found to be effective in research projects fail to translate into meaningful outcomes across multiple contexts. In this project a participatory approach will be adopted, including the possibility to modify the model according to organizational needs and preconditions. Valuable knowledge regarding the design and implementation of the model will be generated in order to develop a model that is suitable and sustainable in organizations.
Topics: Efficiency, Organizational; Humans; Models, Organizational; Qualitative Research; Research Design; Sweden; Workplace
PubMed: 30157812
DOI: 10.1186/s12889-018-5807-9 -
Progress in Biophysics and Molecular... 2004The IUPS Physiome Project is an internationally collaborative open-source project to provide a public domain framework for computational physiology, including the... (Review)
Review
The IUPS Physiome Project is an internationally collaborative open-source project to provide a public domain framework for computational physiology, including the development of modelling standards, computational tools and web-accessible databases of models of structure and function at all spatial scales. A number of papers in this volume deal with the development of specific mathematical models of physiological processes. This paper stands back from the detail of individual models and reviews the current state of the IUPS Physiome Project including organ and organ system continuum models, the interpretation of constitutive law parameters in terms of micro-structural models, and markup languages for standardizing cellular processes. Some current practical applications of the physiome models are given and some of the challenges for the next 5 years of the Physiome Project at the level of organs, cells and proteins are proposed.
Topics: Cell Physiological Phenomena; Computational Biology; Computer Simulation; Database Management Systems; Information Storage and Retrieval; International Cooperation; Models, Biological; Research; Research Design; Systems Integration; Viscera
PubMed: 15142761
DOI: 10.1016/j.pbiomolbio.2004.02.006 -
Annali Dell'Istituto Superiore Di Sanita 2019It is currently well accepted that in general, more than one method is necessary to allow the full replacement of an animal experimentation. These so called partial...
It is currently well accepted that in general, more than one method is necessary to allow the full replacement of an animal experimentation. These so called partial replacement methods can be used within integrated strategy approaches that combine different methods and information sources. A number of integrated strategy approaches were implemented within recent years in different areas of safety and regulatory toxicology. Moreover, latest advances in biomedical research and bioengineering provide a major opportunity to make use of in vitro human-based and/or three-dimensional complex models that can contribute to achieve more physiologically-relevant models. Examples herein describe currently existing integrated strategy frameworks aiming at full or partial replacement purposes and/or at gaining mechanistic insights. Furthermore, a general concept is provided on how 3R methods might be integrated in a strategy approach in order to ensure that animal experimentation is conducted only as a last resort.
Topics: Adverse Outcome Pathways; Animal Testing Alternatives; Animals; Consumer Product Safety; Eye; Guidelines as Topic; Humans; Irritants; Research Design; Skin
PubMed: 31850870
DOI: 10.4415/ANN_19_04_16