Administrative Record Research Articles

Feasibility of introducing a smartphone navigation application into the care of breast cancer patients (The FIONA Study)

PurposePatients with breast cancer (BC) face complex medical information and decisions. The Outcomes4Me mobile app provides evidence-based BC education, symptom management tracking and clinical trial matching. This study sought to evaluate the feasibility of introducing this app into routine BC care.MethodsIn this pilot study among BC patients undergoing therapy at an academic cancer center, patients were followed for 12 weeks with survey administration and electronic health record (EHR) abstraction at baseline and completion. Feasibility was defined as 40% of patients engaging with the app 3 or more times during the study. Additional endpoints included app usability (system usability scale), patient care experience, symptom evaluation, and clinical trial matching.ResultsThe study enrolled 107 patients from 6/01/2020 to 3/31/2021. Utilization of the app was deemed feasible with 60% of patients engaging with the app at least 3 times. SUS score of 70 indicated above average usability. New diagnosis and higher education level was associated with greater app engagement, with usability similar across all age groups. 41% of patients found the app helped track symptoms. Cognitive and sexual symptoms were infrequently reported, but were more frequently captured in the app than in the EHR. After using the app, 33% of patients reported increased interest in clinical trial enrollment.ConclusionIntroducing the Outcomes4Me patient navigation app into routine BC care is feasible and may improve the patient experience. These results support further evaluation of this mobile technology platform to improve BC education, symptom management, and decision making.Clinical trial registryClinicaltrials.gov registration #: NCT04262518

Incidence and between-center heterogeneity of anesthesia-related complications in pediatric populations documented in administrative data: A retrospective study.

Incidence and between-center heterogeneity of anesthesia-related complications in pediatric populations documented in administrative data: A retrospective study.

Mortality Modeling of Partially Observed Cohorts Using Administrative Death Records

New advances in data linkage provide mortality researchers with access to administrative datasets with millions of mortality records and rich demographic covariates. Although these new datasets allow for high-resolution mortality research, administrative mortality records often have technical limitations, such as limited mortality coverage windows and incomplete observation of survivors. We describe a method for fitting truncated distributions that can be used for estimating mortality differentials in administrative data. We apply this method to the CenSoc datasets, which link the United States 1940 Census records to Social Security administrative mortality records. Our approach may be useful in other contexts where administrative data on deaths are available. As a companion to the paper, we release the R package gompertztrunc, which implements the methods introduced in this paper.

Antecedents of fatal overdose in an adult cohort identified through administrative record linkage in Indiana, 2015–2022

BackgroundThe United States continues to experience unprecedented rates of overdose mortality and need to identify effective policies or practices that can be implemented. This study aims to measure the prevalence, frequency, timing, and rate of touchpoints that occurred prior to a fatal overdose where communities might intervene. MethodsIn collaboration with Indiana state government, we conducted record-linkage of statewide administrative datasets to vital records (January 1, 2015, through August 26, 2022) to identify touchpoints (jail booking, prison release, prescription medication dispensation, emergency department visits, and emergency medical services). We examined touchpoints within 12-months prior to a fatal overdose among an adult cohort and explored variation over time and by demographic characteristics. ResultsOver the 92-month study period there were 13,882 overdose deaths (89.3% accidental poisonings, X40-X44) in our adult cohort that were record-linked to multiple administrative datasets and revealed nearly two-thirds (64.7%; n=8980) experienced an emergency department visit, the most prevalent touchpoint followed by prescription medication dispensation, emergency medical services responses, jail booking, and prison release. However, with approximately 1 out of every 100 returning citizens dying from drug overdose within 12-months of release, prison release had the highest touchpoint rate followed by emergency medical services responses, jail booking, emergency department visits, and prescription medication dispensation. ConclusionRecord-linking administrative data from routine practice to vital records from overdose mortality is a viable means of identifying where resources should be situated to reduce fatal overdose, with potential to evaluate the effectiveness of overdose prevention efforts.

Comparing Dementia Classification by Self-Report and Administrative Records in the National Core Indicators-Aging and Disability Survey: A Predictive Modeling Approach.

Policymakers are interested in the long-term services and supports (LTSS) needs of people living with dementia. The National Core Indicators-Aging and Disability (NCI-AD) survey is conducted to evaluate LTSS care needs. However, dementia reporting in NCI-AD varies across states, and is either obtained from state administrative records or self-reported during the survey. We explored the implications of identifying dementia from administrative records versus self-report. We analyzed 24,569 NCI-AD respondents age 65+, of which 22.4% had dementia. To assess dementia accuracy by data source, we fit separate logistic regression models using the administrative and self-reported subsamples. We applied model coefficients to the population whose dementia status came from the opposite source. Using the administrative model to predict self-reported dementia resulted in higher sensitivity than using the self-report model to predict administrative dementia (43.8% vs. 37.9%). The self-report model's diminished sensitivity suggests administrative records may capture cases of dementia missed by self-report.

Gender, race and class at work: enlisting African health labour into the Gold Coast Medical Service, 1860–1957

From the mid-nineteenth century, the people of the Gold Coast formed an essential component of the missionary and early colonial medical services (CMS). The labour of the people was mainly...

Collaboration, not Confrontation: Understanding General Practitioners’ Attitudes Towards Natural Language and Text Automation in Clinical Practice

General Practitioners are among the primary users and curators of textual electronic health records, highlighting the need for technologies supporting record access and administration. Recent advancements in natural language processing facilitate the development of clinical systems, automating some time-consuming record-keeping tasks. However, it remains unclear what automation tasks would benefit clinicians most, what features such automation should exhibit, and how clinicians will interact with the automation. We conducted semi-structured interviews with General Practitioners uncovering their views and attitudes toward text automation. The main emerging theme was doctor-AI collaboration, addressing a reciprocal clinician-technology relationship that does not threaten to substitute clinicians, but rather establishes a constructive synergistic relationship. Other themes included: (i) desired features for clinical text automation; (ii) concerns around clinical text automation; and (iii) the consultation of the future. Our findings will inform the design of future natural language processing systems, to be implemented in general practice.

2023 National Teaching Institute Evidence-Based Solutions Abstracts

NTI Abstracts| April 01 2023 2023 National Teaching Institute Evidence-Based Solutions Abstracts Crit Care Nurse (2023) 43 (2): e1–e42. https://doi.org/10.4037/ccn2023361 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Cite Icon Cite Get Permissions Citation 2023 National Teaching Institute Evidence-Based Solutions Abstracts. Crit Care Nurse 1 April 2023; 43 (2): e1–e42. doi: https://doi.org/10.4037/ccn2023361 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentCritical Care Nurse Search Advanced Search Stephanie Williams, Christine Humphrey; Cleveland Clinic Hillcrest Hospital, Mayfield Heights, OH The purpose of this Clinical Scene Investigator project was to increase patient safety, patient-centered care, communication of correct dosage of loading dose (LD), and timely administration of maintenance dose (MD) of antiplatelet therapy after cardiac catheterization to decrease the risk of stent occlusion and/or myocardial reinfarction. Patients in the coronary care unit at Cleveland Clinic Hillcrest Hospital who are undergoing a cardiac catheterization receive an LD of antiplatelet therapy and an MD after a percutaneous coronary intervention (PCI) such as a stent or angioplasty. Of those patients, 13.6% were not receiving their first MD according to therapeutic guidelines, because of inconsistency with LD administration and/or documentation, MD administration and/or documentation, and multiple methods of communicating the LD. There were also several areas in which the LD was documented, including: (1) medication administration record (MAR); (2) catheterization laboratory (cath lab)... Article PDF first page preview Close Modal You do not currently have access to this content.

Evaluation of Inpatients Medication Prescribing Practice at Ibrahim Malik Teaching Hospital: A Descriptive Cross-sectional Study

Introduction: Prescribing errors account for almost 50% of medication errors and represent the eighth leading cause of death in the US. The current study aimed to evaluate inpatient prescribing practice by assessing adherence to prescription-writing guidelines and identifying the frequency and severity of drug-drug interactions (DDIs) and drug-disease interactions (DDSIs). Methods: An observational-descriptive cross-sectional study was conducted among inpatient wards in Ibrahim Malik teaching hospital, Khartoum, Sudan. Total coverage sampling was performed and the sample size consisted of 132 prescriptions containing a total of 700 prescribed drugs. The data were collected from patients’ files, and the completeness of prescriptions was assessed according to national and international guidelines. Drug interactions were checked by the interaction checker of www.drug.com. Results: The overall prescription completeness was 0%, and the completeness of both prescriber data and medication data were 1.5%, (0.4% for Intravenous [IV] and 0.6% for non-IV drugs), respectively. The most missing elements of the prescription were duration and qualification. Moreover, only 25% of the prescribed drugs were written in the Prescription and Medication Administration Record or drug chart, but the rest were written elsewhere within the patient’s file. The prescriptions containing DDIs and DDSIs were 49.2% and 46.2%, respectively, ranging from major (9.1%), moderate, (40.9%), and minor (28%) for DDIs, major (30.3%), moderate (33.3%), and minor (0.8%) for DDSIs. The highest percentage of drug interactions was found in the internal medicine ward. Diabetes was significantly associated with both DDIs (P = 0.003) and DDSIs (P = 0.031). Conclusion: The findings of this study reflect a real problem in prescribing practice, as no prescription was considered to be complete, and nearly half of the patients were exposed to DDIs and/or DDSIs.

Using Electronic Patient Record Systems to Enhance Spiritual Care for Patients

There is a significant minority of the hospital population for whom hospitalization raises profound existential questions: the meaning and purpose of a dramatic life change or the realization of one’s own mortality. This can impact on the spirit – the sense of inner well-being and contentment of the individual. The realization of mortality impacts more widely, both on the patient and those in their wider circle. The opportunity to receive care which permits the exploration of existential questions and unconditionally embraces the anguish they evoke can be of real benefit. Nervecentre is an electronic patient care record administration system, which has been recognized for its benefits in improving access to and provision of spiritual care. The implementation of Nervecentre has increased the visibility of chaplains, strengthening the relationships supporting the delivery of spiritual care at the end of life.

Magnitude of depression and associated risk factors among patients with musculoskeletal disorder treated in physiotherapy outpatient department in Amhara region comprehensive specialized hospital in Ethiopia: a prospective cross-sectional study

BackgroundThe state of depression that can lead to substance and drug abuse, as well as an increased risk of suicide. Without a doubt, the link between musculoskeletal pain and depression compromises a person’s health and drastically lowers their quality of life, resulting in increased incapacity. Depression and musculoskeletal discomfort are two well-known risk factors for long-term sickness absence, which is defined as a period of sickness lasting more than a week, which means chronic musculoskeletal pains, particularly multiple pains, are linked to depression. And early diagnosis and care of depression in musculoskeletal disorder are critical to patients’ physical, functional, and occupational results. This study aimed to assess the magnitude of depression and associated risk factors among patients with musculoskeletal disorder.MethodMulti-institution cross-sectional study conducted in Amhara region Comprehensive specialized Hospitals from April 1st to May 30th, 2021. The data was collected from 217 participants through interview administrative questioner and patient medical record review. Binary logistic regression was used to identify associated risk factors of depression. The strength of the association was detected by the adjusted odds ratio.ResultA total of 217 participate in this study with the age range of 18–80 years. Among the study participants, 57.1% (n = 124) (AOR: 95% CI: 50.7–63.6) were had depression. Treatment duration, and social support were significantly association with depression among patient with musculoskeletal disorder with P < 0.05.ConclusionThe magnitude of depression was relatively high among musculoskeletal disorder patients treated in physiotherapy out-patient department. The length of treatment duration (hospital stay) and the status of social support from families and friends were significantly associated with depression among patients with musculoskeletal disorders. A multidisciplinary strategy is required for diagnosing and treating depression in patients with musculoskeletal disorder.

"Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses.

(1) Characterize persistent hazards and inefficiencies in inpatient medication administration; (2) Explore cognitive attributes of medication administration tasks; and (3) Discuss strategies to reduce medication administration technology-related hazards. Interviews were conducted with 32 nurses practicing at 2 urban, eastern and western US health systems. Qualitative analysis using inductive and deductive coding included consensus discussion, iterative review, and coding structure revision. We abstracted hazards and inefficiencies through the lens of risks to patient safety and the cognitive perception-action cycle (PAC). Persistent safety hazards and inefficiencies related to MAT organized around the PAC cycle included: (1) Compatibility constraints create information silos; (2) Missing action cues; (3) Intermittent communication flow between safety monitoring systems and nurses; (4) Occlusion of important alerts by other, less helpful alerts; (5) Dispersed information: Information required for tasks is not collocated; (6) Inconsistent data organization: Mismatch of the display and the user's mental model; (7) Hidden medication administration technologies (MAT) limitations: Inaccurate beliefs about MAT functionality contribute to overreliance on the technology; (8) Software rigidity causes workarounds; (9) Cumbersome dependencies between technology and the physical environment; and (10) Technology breakdowns require adaptive actions. Errors might persist in medication administration despite successful Bar Code Medication Administration and Electronic Medication Administration Record deployment for reducing errors. Opportunities to improve MAT require a deeper understanding of high-level reasoning in medication administration, including control over the information space, collaboration tools, and decision support. Future medication administration technology should consider a deeper understanding of nursing knowledge work for medication administration.

Hierarchical approaches to Text-based Offense Classification.

Researchers working with administrative crime data often must classify offense narratives into a common scheme for analysis purposes. No comprehensive standard currently exists, nor is there a mapping tool to transform raw descriptions into offense types. This paper introduces a new schema, the Uniform Crime Classification Standard (UCCS), and the Text-based Offense Classification (TOC) tool to address these shortcomings. The UCCS schema draws from existing efforts, aiming to better reflect offense severity and improve type disambiguation. The TOC tool is a machine learning algorithm that uses a hierarchical, multilayer perceptron classification framework, built on 313,209 hand-coded offense descriptions from 24 states, to translate raw descriptions into UCCS codes. We test how variations in data processing and modeling approaches affect recall, precision, and F1 scores to assess their relative influence on model performance. The code scheme and classification tool are collaborations between Measures for Justice and the Criminal Justice Administrative Records System.

Accuracy of antibacterial indication documentation in an electronic medicines management system.

Electronic medicines management (EMM) systems are relatively new in the Australian healthcare system. This tertiary hospital network implemented an EMM in 2018, with mandatory documentation of antimicrobial indication when prescribing. Free-text (unrestricted) and pre-defined dropdown (restricted) indications are utilized according to antimicrobial restriction. To determine accuracy of antibacterial indication documentation on the medication administration record (MAR) when prescribing and to evaluate factors influencing accuracy of documentation. A random sample of 400 inpatient admissions of ≥24 h, between March and September 2019, with the first antibacterial prescription per encounter reviewed retrospectively. Demographic and prescription details were extracted. Indication accuracy was assessed by comparing MAR documentation with the medical notes (gold standard). Statistical analysis compared factors associated with accuracy of indication using chi-squared and Fisher's exact tests. Antibacterials were prescribed in 9708 admissions. Of the 400 patients included (60% male; median age 60 years, IQR 40-73), 225 prescriptions were unrestricted and 175 were restricted. Patients were managed by emergency (118), surgical (178) and medical (104) teams. Overall accuracy of antibacterial indication documentation on the MAR was 86%. A higher accuracy rate was found for the unrestricted proportion compared with the restricted proportion (94.2% versus 75.2%; P < 0.0001). Surgical teams had higher accuracy compared with medical and emergency teams (94.4% versus 78.8% versus 79.7%; P < 0.0001). Antibacterial indication documentation on the MAR when prescribing demonstrated a high rate of accuracy. Multiple factors influenced this accuracy, which requires further study to determine the impact on accuracy, with a view to improve future EMM builds.

National population-based survival estimates after definitive radiation therapy for prostate cancer.

395 Background: Understanding contemporary radiation therapy outcomes for prostate cancer (i.e., metastasis, death) is important for shared decision-making and setting expectations for patients and providers. Unfortunately, long-term outcome estimates are often derived from meta-analyses of outdated prospective clinical trials or population-based data lacking reliable clinical details (e.g., incident metastatic disease). For these reasons, we used a recently validated, natural language processing algorithm to identify incident metastatic prostate cancer within the electronic medical records of men treated with radiation therapy for localized prostate cancer in order to conduct an innovative and contemporary population-based survival outcomes study. Methods: We used national administrative, cancer registry, and electronic health record data for patients undergoing definitive radiation therapy with or without concurrent androgen deprivation therapy (ADT) within the Veterans Health Administration from 2005 to 2015. We used National Death Index data through 2019 for overall and prostate cancer-specific survival, and identified the date of incident metastatic prostate cancer using a validated natural language processing algorithm. We estimated metastasis-free, prostate cancer-specific, and overall survival using Kaplan-Meier methods. Results: We identified 41,876 patients treated with definitive radiation therapy for prostate cancer from 2005 through 2015, and followed them for over 8 years (follow up, median, 8.7 years, age at diagnosis, median, 65 years). Most patients had intermediate (42%) and high risk (33%) disease, with nearly half treated with ADT as part of initial therapy (44%). Unadjusted 10-year metastasis-free survival was 96%, 92%, and 80% for low, intermediate, and high risk disease. Similarly, unadjusted 10-year prostate cancer-specific survival was 98%, 97%, and 90% for low, intermediate, and high risk disease. Unadjusted overall survival was lower across disease risk categories at 77%, 71%, and 62% for low, intermediate, and high risk disease. Conclusions: These data provide population-based benchmarks for clinically relevant endpoints, including metastasis-free survival, among patients with low, intermediate, and high risk prostate cancer undergoing radiation therapy using contemporary techniques. The survival rates for high risk disease, in particular, compare favorably with historical outcomes.

Improving medication safety in a paediatric hospital: a mixed-methods evaluation of a newly implemented computerised provider order entry system

ObjectivesComputerised provider order entry (CPOE) systems have been implemented around the world as a solution to reduce ordering and transcription errors. However, previous literature documented many challenges to attain this...

Implementation of CYP2D6-guided opioid therapy at Cincinnati Children's Hospital Medical Center.

We describe the implementation of CYP2D6-focused pharmacogenetic testing to guide opioid prescribing in a quaternary care, nonprofit pediatric academic medical center. Children are often prescribed oral opioids after surgeries, for cancer pain, and occasionally for chronic pain. In 2004, Cincinnati Children's Hospital Medical Center implemented pharmacogenetic testing for CYP2D6 metabolism phenotype to inform codeine prescribing. The test and reports were updated to align with changes over time in the testing platform, the interpretation of genotype to phenotype, the electronic health record, and Food and Drug Administration (FDA) guidance. The use of the test increased when a research project required testing and decreased as prescribing of oxycodone increased due to FDA warnings about codeine. Education about the opioid-focused pharmacogenetic test was provided to prescribers (eg, the pain and sickle cell teams) as well as patients and families. Education and electronic health record capability increased provider compliance with genotype-guided postsurgical prescribing of oxycodone, although there was a perceived lack of utility for oxycodone prescribing. The implementation of pharmacogenetic testing to inform opioid prescribing for children has evolved with accumulating evidence and guidelines, requiring changes in reporting of results and recommendations.

Profile of Prescribing Chemotherapy Regimens for High-Risk Acute Leukemia in Children

Cancer is one of the non-communicable diseases but is a health problem in the world, including in Indonesia. The results of the 2018 Basic Health Research showed that the prevalence of cancer rose from 1.4% in 2013 to 1.8% in 2018. Acute Lymphoblastic Leukemia (ALL) is a malignant disease characterized by progressive infiltration of immature lymphoid cells in the bone marrow and lymphatic organs. , with leukocyte cells proliferating irregularly and uncontrollably. This study aims to analyze the descriptive profile of prescribing high-risk ALL chemotherapy regimens in children at a hospital in East Surabaya. This study was conducted on inpatients, chemotherapy regimens using the 2018 ALL National Protocol. The protocol consists of 4 phases of chemotherapy, namely the induction, consolidation, intensification and maintenance phases. The results of the study from the drug administration record data, there were 143 pediatric patients with a diagnosis of ALL. high risk from the period July to August 2022. The most widely used drug classification is the glucocorticoid group with use in the induction phase 38,17%, intensification 43,2%, and maintenance 50%. Dexamethasone was the most used generic name 38,17% was used in the induction phase and 43,2% for the intensification phase. The use of ALL chemotherapy doses is Dexamethasone with doses based on the age of the child, the most being 1 mg (97,62%) and 12 mg (88,10%).

Lazy Data? Using Administrative Records in Research on Judicial Systems

Lazy Data? Using Administrative Records in Research on Judicial Systems

Rationalizing the Administrative Record for Equitable Constitutional Claims

Rationalizing the Administrative Record for Equitable Constitutional Claims