Incremental Changes Research Articles

Modelling Climate Change Impacts on Location Suitability for Cultivating Avocado and Blueberry in New Zealand

Regional suitability for growing avocados and blueberries may alter with climate change. Modelling can provide insights into potential climate change impacts, thereby informing industry and government policy decisions to ameliorate future risks and capitalise on future opportunities. We developed continuous/sliding-scale models that used soil, terrain and weather data to assess location suitability for cultivating avocado and blueberry, based on physiological and phenological considerations specific to each crop. Using geographical information system (GIS) data on soil, slope and weather, we mapped cultivation suitability for avocado and blueberry across New Zealand, and, for accuracy, “ground-truthed” these maps in an iterative process of expert validation and model recalibration. We modelled the incremental changes in location suitability that could occur through climate change using “future” GIS-based weather data from climate model simulations for different greenhouse gas (GHG) pathways that ranged from stringent GHG mitigation to unabated GHG emissions. Changes in maps over time showed where suitability would increase or decrease and to what extent. These results indicate where avocado and blueberry might replace other crops that become less suitable over time, and where avocado might displace blueberry. The approach and models can be applied to other countries or extended to other crops with similar growing requirements.

A Data-Driven Approach Identifies Subtypes of Caries From Dental Charting.

The objectives were to: (i) assess the accuracy of dental data for adults obtained from the Swedish Quality Register on Caries and Periodontitis (SKaPa); (ii) explore whether Latent Class Analysis (LCA) can identify groups of people based on caries data; and (iii) characterise the dental, medical and behavioural characteristics of people in the LCA-derived classes. Caries data from the SKaPa register were compared with clinical data collected by five experienced dentists in a nested subgroup of the Malmö Offspring Study (MOS), namely the Malmö Offspring Dental Study (MODS) (n = 724) for validation. Dental data from SKaPa were then used to classify 61 984 adult participants of the Västerbotten Intervention Programme (VIP) into five classes using LCA and DMFS-based quintile ranking, respectively. Dental status (including caries progression over 5 years), medical, anthropometric and behavioural characteristics were compared between the groups. Analyses were replicated in 2767 adults in the MOS. DMFS-scores and number of teeth recorded within -2 to +2 years showed excellent agreement between the SKaPa and reference data with intra-class correlations > 0.90. The five LCA classes differed in mean DMFS from 10.0 to 94.4. There were strong associations between LCA class and health, and health and behavioural measures respectively, including some associations that were not detected using DMFS-ranked quintile groups. LCA class was associated with incremental change in DMFS, DFS, and number of teeth. The results in the MOS cohort were consistent with the results in the VIP cohort. Dental data for adults from the SKaPa registry were considered accurate within 2 years of recording. The LCA approach can classify participants into caries subtypes based on dental charting. These groups differ in health and behavioural characteristics and future caries increment. The LCA approach may capture some information that is missing from DMFS-ranked quintile groups, but is also heavily influenced by total DMFS, meaning that applying LCA in cumulative, highly age-determined diseases, such as caries, is a challenge.

Relational visioning and the emerging future: Transforming towards a sustainable local society

The Earth is currently facing unprecedented anthropogenic impacts. In this context of widespread environmental degradation and climate anxiety, there is an urgent need to reimagine our approaches to sustainability. This paper explores how a relational framing of sustainability can be applied to visioning exercises to foster transformative actions in local governance. While relational approaches are increasingly recognized as important to spark transformative change, their benefits and practical applicability to visioning are still under-explored. Drawing on findings from a multi-stakeholder workshop in a Norwegian municipality, we make two main contributions to the existing literature. First, we demonstrate how a relational visioning process can be carried out, identifying three key elements for establishing a relational foundation that can catalyse effective sustainability transformations: 1) the act of listening deeply, 2) integrating values, and 3) defining direction. Second, we contribute with new insights concerning the benefits and practical application in local sustainability governance contexts, highlighting the need for facilitating incremental (yet radical) changes in existing governance frameworks that are sensitive to available bureaucratic resources.

Evaluating Sustainability in Social-ecological Systems: 50 Years of Conservation in Florianópolis, Brazil

Abstract This study examines 50 years of land use planning practices in Florianópolis, Brazil, to identify the attributes that resulted in the city’s notable and long-standing commitment to pro-conservation programmes and policies. By analysing key policies, planning strategies, and partnerships that underpin the preservation of forests and green spaces, this research contributes valuable insights to the ongoing discourse on the combined role of conservation governance and collective action in building sustainable and resilient cities. The social-ecological systems framework is applied to evaluate the interactions between multi-level laws, collective action groups, and mid-level government officials to determine the drivers that promoted incremental and accumulative change, ultimately leading to sustainable land conservation practices in Florianópolis. The findings highlight the importance of stakeholder goal alignment, managerial flexibility, and collaboration with diverse actors in achieving long-term conservation goals, particularly in cities adopting an amenity-led growth model. Growing challenges to the continued protection of conservation units in the city resulting from population growth are also raised to advance approaches to evaluating the durability of sustainability initiatives.

The long arc of learning: Perspectives and innovations from 20 years of U.S. National Professional Development Program projects

AbstractU.S. National Professional Development (NPD) grants can afford a longitudinal understanding of how teachers learn to support English learners. When NPD projects are completed successively and successfully, they can provide an even greater longitudinal arc of understanding. This article chronicles the designs and lessons learned across five NPD grants between 2002 and 2023. Each grant represents a snapshot in time, presenting a set of assumptions from the field, programmatic innovations, and insights from research outcomes. From highlighting the difference between incremental and radical pedagogical change and what it takes to move beyond individual teacher change to systemic change benefiting multilingual learners, the article outlines the succession of aspirations (capacity building, sustainability, and scalability), experiences, changing conditions, and data points framing lessons learned and new cycles of praxis. This article offers implications for theory, practice, and research. It stands as an argument for adapting, innovating, and moving beyond the status quo to inspire more innovation in teacher preparation for multilingual learners.

Capitalizing on Dementia Care Mapping in an Evaluation of a Montessori-Based Intervention for Individuals Living with Dementia.

Montessori-based interventions (MBIs) promote quality of life among older adults living with dementia. We used Dementia Care Mapping (DCM) to evaluate the impact of a small-scale MBI. DCM is a systematic observation tool that records the behavior and mood/engagement of individuals living with dementia and can be used to improve quality of care and well-being. Pre- and post-intervention data from 15 care community residents compared: 1) residents' range and types of behaviors, 2) their mood/engagement and 3) staff behaviors that facilitated and impeded residents' personhood. In this mixed-methods study, deductive qualitative content analysis of DCM field notes further explored staff behaviors. Post-intervention, a significantly higher proportion of residents' behaviors had the potential to promote their well-being, although there was little change in mood/engagement while engaging in those behaviors. Post-intervention, there was also a significant increase in staff behaviors that facilitated, and a decrease in staff behaviors that impeded, residents' personhood. Further, post-intervention, staff interactions with residents were more open-ended and inclusive. Although some staff behaviors still excluded residents, the exclusion was more benign than pre-intervention. DCM documented incremental changes toward person-centered care, and DCM field notes provided insight into missed opportunities for effective staff interactions with residents. Taken together, findings provide additional support for the use of MBIs and highlights the usefulness of DCM, especially its associated field notes, to help researchers and practitioners create environments that promote the personhood that individuals living with dementia deserve.

High Hypoperfusion Intensity Ratio Is Independently Associated with Very Poor Outcomes in Large Ischemic Core Stroke.

Recent advances have highlighted the efficacy of endovascular thrombectomy (EVT) in patients with large ischemic core stroke, yet asignificant portion still experience very poor outcomes, defined as a90-day modified Rankin Score (mRS) of 5-6. This study aims to investigate the hypoperfusion intensity ratio (HIR) as aprognostic imaging parameter for these outcomes. In amulticenter retrospective cohort study, data from consecutive patients undergoing EVT for acute ischemic stroke with large vessel occlusion (AIS-LVO) at two comprehensive stroke centers were analyzed. The study included patients with an Alberta Stroke Program Early CT Score (ASPECTS) of5 or less and utilized pretreatment perfusion imaging to calculate HIR. The primary outcome was very poor outcomes (90days mRS 5-6). Among 102 patients included, 59 (57.8%) had very poor outcome (90days mRS 5-6). Multivariable logistic regression analysis adjusting for multiple covariates including admission National Institutes of Health Stroke Scale (NIHSS) and EVT revealed that higher admission NIHSS (adjusted odds ratio [aOR] 1.224, 95% CI 1.089-1.374, p = 0.001) and HIR (aOR per 0.1 incremental change, 1.34, 95% CI 1.02-1.82, P = 0.042) were independently associated with very poor outcomes. This study demonstrates that admission NIHSS and HIR are independently associated with very poor outcome (90days mRS 5-6) in patients with large ischemic core strokes. These findings highlight the importance of collateral status and perfusion imaging in predicting outcomes in this patient population, suggesting apotential role for HIR in the triage and management of large core stroke patients.

The Effect of Stenting on Post-Stenotic Dilatation in Coarctation of The Aorta.

The effect of stenting of native aortic coarctation (CoA) on post-stenotic dilatation (PSD) has not been previously described. We hypothesized that CoA stenting may lead to positive remodeling of PSD. Retrospective analysis of patients who underwent stent implantation for native CoA from 1999 to 2021 was performed. Primary outcome was incremental change PSD diameter and the PSD/DescAo (Descending Aorta) following stent implantation and comparison between covered and bare-metal stents. 90 consecutive patients, (26 female, average age at first intervention 12.0years) were included. 35 patients (38.9%) underwent dilatation with bare-metal stents and 55 patients (61.1%) with covered stents. The covered stent subgroup was older (14.0 vs. 9.2years old, p < 0.001) and PSD was larger (17.0 vs 14.0mm, p < 0.001). Over a mean of 3.2years, mean inter-catheterization growth of the PSD was blunted [- 0.05 mm, 95% CI (- 1.5 to 1.4)]. The covered stent subgroup demonstrated a negative inter-catheterization growth compared to the bare-metal stent subgroup (- 0.7 vs 1.6mm, p < 0.001). When controlled for somatic growth, the PDS/DescAo decreased more significantly among those with covered stent vs bare metal (- 0.12 vs - 0.058, p = 0.004). Stenting of native CoA blunts the growth of PSD; covered stents were significantly associated with regression of the diameter of the PSD over time compared to bare-metal stents.

A decolonized science requires bigger, bolder, and less incremental change: Commentary on Sharpe (2024).

This commentary is written in response to Sharpe's (2024) article titled "Editor Bias and Transparency in Psychology's Open Science Era." The article clearly describes the conversation on bias, transparency, and editor accountability occurring in the field of psychology in recent years. However, in this era of public accountability, where there is a groundswell seeking a more decolonized science, we use the commentary to discuss how the article could have gone further. We used an equity model to explore whether the model of change being proposed by Sharpe is at the right level of analysis and whether it is equipped with the needed ingredients to bring about a solution to the long-standing problem of editor bias and lack of transparency. We offer an alternative to the individual model that Sharpe's article puts forth and recommend the use of a systems thinking approach to generate action items for a more decolonized science in the realm of publishing and editor bias. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adapting the GPT engine for proactive customer insight extraction in product development

Understanding the perceptions of consumers is widely recognized as a critical element in the innovation of new products. Traditional techniques used by companies to collect essential consumer insights have largely remained unchanged. Common practices like interviews and surveys have distinct limitations. Interviews may not always capture the precise needs of consumers due to communication barriers, and surveys tend to encourage incremental changes rather than radical innovations. Service industries face further complexity as they navigate customer feedback on the more intangible aspects of service quality. This study highlights the pioneering use of GPT-3.5 Turbo, a tool known for its exceptional ability to delve into the nuances of conversational context and process data in a chat-centric manner, thereby enhancing the extraction of Voice of the Customer (VoC). Its capability to handle large volumes of data in multiple languages leads to a more thorough and inclusive VoC analysis. The study links these technological advancements with Lean Six Sigma 4.0, suggesting that incorporating GPT-3.5 Turbo could significantly improve the customer-focused strategies in the current industrial landscape. This breakthrough in VoC analysis suggests possibilities for more perceptive, immediate data-driven approaches in customer service, and lays a stronger groundwork for decisions in product evolution and process enhancement. The paper concludes by urging further investigation to confirm these initial results and to explore the ethical aspects of employing such advanced natural language processing technologies.

From sectoral policy change to cross-sectoral (dis)integration? A longitudinal analysis of the EU's forest and rural development policy

Policy integration (PI) is critical to address cross-cutting challenges like climate change and biodiversity loss holistically. In the European Union, forests are confronting increasingly adverse climatic conditions and numerous stressors that impact their biodiversity. Political efforts to counteract these trends are mainly channeled through funding from the rural development policy as a pivotal part of the Common Agricultural Policy (CAP). In contrast, forest policy is hardly institutionalized at EU level. This study employs process tracing using 65 EU forest and rural development policy documents, including legal acts, preparatory documents, communications, related working documents and evaluation reports, predominantly produced over the last 25 years. By doing this, it examines the development of sectoral policy changes over time and their implications for the cross-sectoral integration of EU forest policy into rural development policy as part of agricultural policy at EU level. Results suggest that the adoption of the EU Forest Strategy for 2030 represented a provisional paradigm shift in EU forest policy. This shift is characterized by a substantial reprioritization of policy objectives, transitioning from an emphasis on economic aspects to a more climate- and biodiversity-centric approach, alterations in supported policy instruments and the introduction of various new regulatory instruments. On the other hand, the CAP and its rural development policy remain characterized by a path dependent incremental change and the latest reforms hardly reflect ambitious forest policy objectives both from budgetary and content perspectives. The findings suggest that the latest seemingly decoupled developments within both policy areas have led to an emergence of forest policy fragmentation at the EU level.

Energy evolution and damage deformation behavior of cemented broken coal specimen under triaxial compression condition

Coal is a major energy source, and deep coal mining often leads to fractured coal around roadways. Grouting is a common method used to reinforce fractured rock masses, where the slurry encases coal particles, forming a cemented broken coal (CBC) body. The content of coal particles (CP) significantly affects the energy characteristics of CBC specimens. To investigate this, a series of triaxial compression tests and triaxial unloading tests were conducted on CBC specimens with varying CP contents. The results indicate that as CP content increases, both peak strength and cohesion decrease, while the internal friction angle increases in both tests. In the triaxial unloading tests, specimens with higher CP content showed tensile-shear failure. Additionally, energy trends during damage were similar in both tests. In triaxial compression tests, dissipated energy increased with CP content, while in the triaxial unloading test, it initially rose and then fell. During the unloading phase of the triaxial unloading tests, the CBC specimen with 40 % CP content exhibited the most significant change in energy increment and its rate. Analysis of damage and deformation characteristics indicated that damage, deformation, and dilation were effectively restrained in CBC specimens with 40 % CP content during unloading.

Neonatal and Maternal Outcomes in Nulliparous Individuals according to Prepregnancy Body Mass Index.

This study aimed to examine the effect of incremental changes in body mass index (BMI, kg/m2) on the association with adverse pregnancy outcomes. This was a retrospective cohort study of U.S. vital statistics Live Birth and Infant Death linked data from 2011 to 2020. We limited analyses to nulliparas with singleton pregnancies who delivered at 20 weeks or greater. Outcomes were compared according to the prepregnancy BMI category using 5 kg/m2 increments, with each of the other BMI categories sequentially as the referent. The composite neonatal outcome was defined as any neonatal death, neonatal intensive care unit (ICU), surfactant use, ventilation use, or seizure. Severe maternal morbidity was defined as any maternal ICU, transfusion, uterine rupture, and hysterectomy. Adjusted relative risks were calculated for each BMI category as a referent group, using modified Poisson regression and adjusting for confounders. A total of 11,174,890 nulliparous individuals were included. From 2011 to 2020, the proportions of individuals with BMI 40 or greater, BMI 50 or greater, and BMI 60 or greater increased significantly (from 3.1 to 4.9%, from 0.4 to 0.6%, from 0.03 to 0.06%, respectively; all trend p-values < 0.001). As BMI deviated from normal BMI, risks of neonatal and maternal adverse outcomes increased progressively. For example, as BMI deviated from normal BMI (18.5-24.9), the risk of composite neonatal outcome increased by 2% in individuals with BMI < 18.5 and up to 2.11-fold in individuals with BMI 65-69.9. When compared with BMI 40 to 44.9, BMI 35 to 39.9 was associated with an 8% decreased risk of composite neonatal outcome, whereas BMI 45 to 49.9 was associated with an 8% increased risk of composite neonatal outcome. Incremental increases in prepregnancy BMI are linked to higher risks of adverse pregnancy outcomes, highlighting the need for effective weight management before conception. · Incremental BMI increases raise pregnancy risks.. · Higher BMI linked to adverse neonatal outcomes.. · Elevated BMI heightens severe maternal morbidity..

Athafnafólk í opinberri stefnumótun á óvissutímum: Hvernig hugmyndin um notendastýrða persónulega aðstoð varð að veruleika á Íslandi

Þessi rannsókn leitast við að útskýra tímamótaákvörðun í þjónustu við fatlað fólk á Íslandi. Opinber stefnumótun hefur löngum einkennst af hægfara breytingum, sem gerast í smáum skrefum. Stundum bregður þó svo við að meiriháttar breytingar verða og stefnumál, sem verið hefur baráttumál hagsmunahópa um margra ára skeið, ná fram að ganga. Dagskrárkenningar leitast við að útskýra meiriháttar stefnubreytingar með því m.a. að beina athyglinni að því hvernig og hvers vegna tiltekin málefni koma til kasta stjórnvalda á hverju tíma. Bandaríski stjórnmálafræðingurinn, John W. Kingdon, setti fyrst fram kenningu sína um straumana þrjá og glugga tækifæranna fyrir rúmum 30 árum. Nýlegar rannsóknir evrópskra stjórnmálafræðinga halda því nú fram að nálgun Kingdons geti varpað ljósi á það hvernig það pólitíska kerfi sem stefnumótunin fer fram í virkar og hvernig hegðun og aðferðir þátttakenda í ferlinu hafa áhrif. Í þessari eigindlegu rannsókn er skoðað hvernig hugmyndin um notendastýrða persónulega aðstoð (NPA) varð að veruleika á Íslandi. Rannsóknin byggir á fyrirliggjandi gögnum og viðtölum við lykilfólk um þá framvindu mála sem leiddi til ákvörðunar um að innleiða NPA hér á landi. Rannsóknin lýsir því hvernig og undir hvaða kringumstæðum NPA komst á dagskrá stjórnvalda. Niðurstöðurnar sýna hvernig breytingar á verkaskiptingu milli ríkis og sveitarfélaga gáfu tækifæri fyrir nýja hugmyndafræði sem nýttist bæði notendum, viðskiptahagsmunum og pólitískum hagsmunum. Niðurstöðurnar benda til þess að þar hafi ekki aðeins verið réttur maður á réttum stað á réttum tíma, heldur varpa þær fræðilegu ljósi á það hvað einkennir athafnafólk í opinberri stefnumótun og hvernig og hvers vegna það skiptir máli á óvissutímum í stjórnmálum.

Delta GUI change detection using inferred models

Recent software development methodologies emphasize iterative and incremental evolution to align with stakeholders’ needs. This perpetual and rapid software evolution demands ongoing research into verification practices and technologies that ensure swift responsiveness and effective management of software delta increments. Strategies such as code review have been widely adopted for development and verification, ensuring readability and consistency in the delta increments of software projects. However, the integration of techniques to detect and visually report delta changes within the Graphical User Interface (GUI) software applications remains an underutilized process. In this paper, we set out to achieve two objectives. First, we aim to conduct a comprehensive review of existing studies concerning GUI change detection in desktop, web, and mobile applications to recognize common practices. Second, we introduce a novel change detection tool capable of highlighting delta GUI changes for this diverse range of applications. To accomplish our first objective, we performed a systematic mapping of the literature using the Scopus database. To address the second objective, we designed and developed a GUI change detection tool. This tool simultaneously transits and compares state models inferred by a scriptless testing tool, enabling the detection and highlighting of GUI changes to detect the widgets or functionalities that have been added, removed, or modified. Our study reveals the existence of a multitude of techniques for change detection in specific GUI systems with different objectives. However, there is no widely adopted technique suitable for the diverse range of existing desktop, web, and mobile applications. Our tool and findings demonstrate the effectiveness of using inferred state models to highlight between 8 and 20 GUI changes in software delta increments containing a large number of changes over months and between 4 and 6 GUI changes in delta increments of small iterations performed over multiple weeks. Moreover, some of these changes were recognized by the software developers as GUI failures that required a fix. Finally, we expose the motivation for using this technique to help developers and testers analyze GUI changes to validate delta increments and detect potential GUI failures, thereby fostering knowledge dissemination and paving the way to standard practices.

Effect of processing conditions on the tensile properties of PLA/Jute fabric laminates: Experimental and numerical analysis

This article explores how the mechanical properties of composite polymers reinforced with jute fibers are influenced by manufacturing conditions, specifically pressure and temperature. To investigate this, a total of 45 distinct samples were created, and fabricated under nine different pressure and temperature conditions. The results demonstrate a notable linear increase in mechanical properties with incremental changes in pressure, while the impact of temperature variations remains less clearly defined. Based on these findings, a corrective factor was developed for the homogenization formula or rule of mixture that is commonly used to predict the mechanical behavior of composite polymers but does not typically consider manufacturing conditions. The newly introduced corrective factor aims to improve the accuracy of predictions and represents a significant advancement in modeling jute fiber-reinforced composite polymers. This development opens the door for more precise predictions and a better understanding of the intricate relationship between manufacturing conditions and resulting material properties.

Impacts of improved transport on regional market access

This article presents a pedagogic review and explanation of a core idea in location theory. Central to the analysis is the von Thünen model, a cornerstone of agricultural land use theory. The model is adapted to non‐uniform transport surfaces, enabling an exploration of how improved transport corridors, such as roads and canals, alter economic landscapes. The article explores the influence of enhanced transport corridors within agricultural growing regions and provides a conceptual framework for understanding the impacts of improved transport infrastructure. By examining incremental changes of varying effectiveness, we shed light on the multifaceted effects of these corridors. Using a spatial‐price equilibrium model, findings reveal and quantify how these improvements contribute to increased supply, price moderation, and cost reduction. Networks that provide full connectivity with large reductions in transport cost have the greatest effect, as might be expected, but there are subtle spatial zones displaying differential impacts.

Examining the Legality of the Use of Force in International Law

This article examines the legality of the use of force in international law. The article revealed that faith in the UN may weaken when it fails to act in contexts where its Charter requires or implies it should, or when its actions fail to achieve the intended results. As a result, it is critical for the UN’s integrity and vitality that it is willing and able to act in circumstances that warrant its intervention. If there was a successful alternative to meeting global aims, it would deter states from taking matters into their own hands. This leads to the conclusion that we can welcome illegal but clearly justified action, or what we might call ‘legitimate’ action, under certain specified circumstances. The article proposes several broad areas where the UN could rationally undergo reform. As the maintainer of peace and security, it would be unwise for the UN to engage ‘with incomplete and incremental change.’ The UNSC needs ‘greater credibility, legitimacy, representation, effectiveness, and enhanced capacity and willingness to act in defense of the common peace.’ Therefore, the article advocates for the development of a legal doctrine of humanitarian intervention. A suggested criterion is the existence of a supreme humanitarian emergency, the use of force as a last resort, and the achievement of a positive humanitarian outcome. If the UNSC can identify these criteria for lawful humanitarian intervention, it would be wiser to authorize force. The use of force would then be under central control, as opposed to unilateral state action with a potentially undefined mandate. Keywords: International law, Justification, Legitimacy, UN Charters, Use of force.

Abstract P406: Transforming Clinical Practices for Blood Pressure Management in Community Health Centers through Timely Data and Technical Support

Introduction: Blood pressure (BP) control can prevent major adverse cardiac events and is monitored through various means, including the Centers for Medicare and Medicaid Services 165 metric for BP control - an annual reporting metric for community health centers (CHCs) within the Uniform Data System framework that becomes accessible 6 months after the conclusion of the reporting period. In pursuit of more immediate indicators related to BP management, the National Hypertension Control Initiative (NHCI) initiated collaboration with a population health platform to support select CHCs with rapidly available data on 19 BP-related metrics. Hypothesis: With technical support and regular access to data, CHCs can implement timely clinical practice and process changes. Methods: To support CHCs in using the population health platform, NHCI staff provided technical assistance in a rapid cycle performance improvement (RCPI) to 10 interested CHCs. This opportunity allowed CHCs to partner with NHCI staff to review BP related metrics in the population health platform and to identify opportunities for clinical process and practice changes. Over an 8-week period from October to December 2023, 7 CHCs were actively involved in a series of 5-6 structured 30–60-minute meetings with both NHCI registered nurse and quality improvement staff. These meetings reviewed BP metrics, mapped clinical workflows for improvement, and supported data analytics. CHCs often chose 1-2 BP metrics for focus, concentrating on incremental change and short-term improvement. Results: Among participating CHCs that reported, they revealed successful or anticipated adjustments in team responsibilities and clinical processes, including leadership involvement and new methods. Limitations included CHC staff engagement, time, concerns with data reliability, and familiarity with the population health platform. Most reporting CHCs shared that their goals were greatly impacted by access to readily available performance data and that they plan to continue using the population health platform to affect performance moving forward. Conclusions: For participating CHCs, individualized guidance based on timely data may have been helpful in analyzing workflows and procedures, assessing clinical care practices, and implementing quality improvement plans. Frequent data may allow CHCs to make clinical practice and process changes to efficiently measure impact and more quickly improve BP control than standard methods.

Assessing the Effect of Electronic Health Record Data Quality on Identifying Patients With Type 2 Diabetes: Cross-Sectional Study.

Increasing and substantial reliance on electronic health records (EHRs) and data types (ie, diagnosis, medication, and laboratory data) demands assessment of their data quality as a fundamental approach, especially since there is a need to identify appropriate denominator populations with chronic conditions, such as type 2 diabetes (T2D), using commonly available computable phenotype definitions (ie, phenotypes). To bridge this gap, our study aims to assess how issues of EHR data quality and variations and robustness (or lack thereof) in phenotypes may have potential impacts in identifying denominator populations. Approximately 208,000 patients with T2D were included in our study, which used retrospective EHR data from the Johns Hopkins Medical Institution (JHMI) during 2017-2019. Our assessment included 4 published phenotypes and 1 definition from a panel of experts at Hopkins. We conducted descriptive analyses of demographics (ie, age, sex, race, and ethnicity), use of health care (inpatient and emergency room visits), and the average Charlson Comorbidity Index score of each phenotype. We then used different methods to induce or simulate data quality issues of completeness, accuracy, and timeliness separately across each phenotype. For induced data incompleteness, our model randomly dropped diagnosis, medication, and laboratory codes independently at increments of 10%; for induced data inaccuracy, our model randomly replaced a diagnosis or medication code with another code of the same data type and induced 2% incremental change from -100% to +10% in laboratory result values; and lastly, for timeliness, data were modeled for induced incremental shift of date records by 30 days to 365 days. Less than a quarter (n=47,326, 23%) of the population overlapped across all phenotypes using EHRs. The population identified by each phenotype varied across all combinations of data types. Induced incompleteness identified fewer patients with each increment; for example, at 100% diagnostic incompleteness, the Chronic Conditions Data Warehouse phenotype identified zero patients, as its phenotypic characteristics included only diagnosis codes. Induced inaccuracy and timeliness similarly demonstrated variations in performance of each phenotype, therefore resulting in fewer patients being identified with each incremental change. We used EHR data with diagnosis, medication, and laboratory data types from a large tertiary hospital system to understand T2D phenotypic differences and performance. We used induced data quality methods to learn how data quality issues may impact identification of the denominator populations upon which clinical (eg, clinical research and trials, population health evaluations) and financial or operational decisions are made. The novel results from our study may inform future approaches to shaping a common T2D computable phenotype definition that can be applied to clinical informatics, managing chronic conditions, and additional industry-wide efforts in health care.