Development Of Quality Metrics Research Articles

Accurately identifying incident cases of venous thromboembolism in the electronic health record: Performance of a novel phenotyping algorithm

Accurate identification of incident venous thromboembolism (VTE) for quality improvement and health services research is challenging. The purpose of this study was to evaluate the performance of a novel incident VTE phenotyping algorithm defined using standard terminologies, requiring three key indicators documented in the electronic health record (EHR): VTE diagnostic code, VTE-related imaging procedure code, and anticoagulant medication code. Retrospective chart reviews were conducted to assess the performance of the algorithm using a random sample of phenotype(+) and phenotype(-) diagnostic encounters from primary care practices and acute care sites affiliated with five hospitals across a large integrated care delivery system in Massachusetts. The performance of the algorithm was evaluated by calculating the positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity, using the phenotype(+) and phenotype(-) diagnostic encounters sample and target population data. Based on gold-standard manual chart review, the algorithm had a PPV of 95.2% (95% CI: 93.1-96.8%), NPV of 97.1% (95% CI: 95.3-98.4%), sensitivity of 91.7% (95% CI: 90.8-92.6%), and specificity of 98.4% (95% CI: 98.1-98.6%). The algorithm systematically misclassified a low number of specific types of encounters, highlighting potential areas for improvement. This novel phenotyping algorithm offers an accurate approach for identifying incident VTE in general populations using EHR data and standard terminologies, and accurately identifies the specific encounter and date of diagnosis of the incident VTE. This approach can be used for measurement of incident VTE to drive quality improvement, research to expand the evidence, and development of quality metrics and clinical decision support to improve the diagnostic process.

Consecutive Inpatient Hematology Consultation Service Utilization across 11 Years in the Medical Intensive Care Unit

INTRODUCTION The current understanding of hematology consultation service utilization is limited to four studies in the outpatient setting and zero in the inpatient setting. While training programs in non-hematology specialties (i.e., cardiology, infectious diseases, nephrology) invest in dual-trained specialty-intensivists, investments into dual-trained hematologist-intensivists are systematically underdeveloped. Despite the high clinical volume of hematology patients admitted to the Medical Intensive Care Unit (MICU), there is currently no characterization of hematology MICU service needs. We sought to begin to fill this gap by examining the volume of consecutive consultations, time to consultation, consult patient characteristics, type, and number of consult question per patient and consult categories originating in the MICU at the largest hospital in the United States (2023 Becker's Hospital Review). METHODS We conducted a retrospective observational study of consecutive patients 18 years of age or older who had an incident (i.e., de novo) hematology consultation while admitted to the MICU from February 2013 through March 2023 at a single academic center. Inclusion criteria included (1) age of ≥ 18, and (2) initial consultation generated during MICU admission. To ensure only incident hematology consultations originating in the MICU were examined, patients with consultation placed on the medical floor with subsequent transfer to the MICU, and re-consultations in the MICU for the same patient, were excluded. Each consult note was manually reviewed to determine the exact consultation query. Descriptive statistics collected for each patient included (1) baseline demographics, (2) labs from day of consultation, (3) time to consultation, (4) binary hospital discharge status (alive or dead), and (5) number and type of consult queries within each consult. For the latter, number of queries per each consult were also recorded (i.e., anemia and thrombocytopenia would be two independent queries), and each query was further adjudicated as pertaining to either classical or malignant hematology. Descriptive statistics were tabulated using Microsoft Excel and GraphPad 9.4.1. RESULTS Across 11 years of consecutive, incident consultations requested from the MICU, there were a total of 594 hematology consults with 776 total consultation queries. At time of consultation request, the median age of patients was 60 years, 47% were of female sex, and mean time to hematology consultation was 30 hours after initial MICU admission (Table 1). Of the queries, 75% pertained to classical and 25% to malignant hematology. Of the 776 consult queries, the top three overall hematology consultation queries were for thrombocytopenia (n=105), coagulopathy (n = 86), and lymphoproliferative disorders (n=77). The top three classical hematology queries were for thrombocytopenia (n=105), coagulopathy (n=86), and thrombosis (n = 76). The top three malignant hematology queries were for lymphoproliferative disorders (n=77), acute leukemia (n=48), and plasma cell dyscrasias (n=25) (Table 1). CONCLUSIONS To our knowledge, our study is the first to describe the volume of incident inpatient hematology consultations originating from the MICU. We found that classical hematology queries constitute three quarters of consultation volume, yet the existing literature on hematologic critical care focus only on quality improvement metrics for hematologic malignancies in the ICU. The development of quality metrics for classical hematology critical care management and identification of research are needed, particularly in the context of the identified national workforce shortage in classical hematology. Future work to examine intensivists' consultation queries originating from other intensive care units (i.e., surgical, cardiac, and neurological), would allow a data-driven evaluation of the service need for dual-trained hematologist-intensivists in the United States. The volume and complexity of classical hematology consults that arise in the ICU, as demonstrated in this study, in addition to frequent ICU consultations and admission for hematologic malignancies, highlights an area of both research and clinical practice that could support developing dual trained hematologist-intensivist to help protocolize and deliver safe and expedient care for all consult queries.

Identifying the Factors of E-service Quality among Indian Millennial Streaming Service Users

This research sought to explore the preferences of Indian Millennial in the realm of streaming services, specifically focusing on music. The goal was to uncover the intricate connections between various quality dimensions within six services: web design, performance, personalization, trust, satisfaction, and repurchase intention. Employing an e-service quality measurement and a quantitative research methodology, the study distributed questionnaires to 400 Indian millennial known for their heavy usage of music streaming services, gathered from local private colleges and universities. Data analysis involved descriptive analysis and partial least squares for structural modeling. The study's findings indicated significant associations between web design, customization, and repurchase intention. Performance factors, such as reliability and responsiveness, played a crucial role in satisfaction, and a link between satisfaction and repurchase intention was established. Notably, trust did not show a significant influence on purchase intention. These findings contribute valuable insights that can be applied not only to streaming music services but also to other e-services, aiding in the development of quality metrics to assess customer-centric effectiveness. The suggestion for future research includes exploring different types of e-services with varied quality dimensions for a comprehensive and comparative analysis.Top of Form

Can We Improve the Quality of Care Delivered to Cervical Cancer Patients? Development of Quality Metrics and Quality Improvement Program at a Single Institution

Cervical cancer patients often face significant barriers to receiving high quality, multi-disciplinary standard of care therapy due to socio-economic factors and failures in the health care system. Other cancers, such as rectal cancer, requiring complex multi-disciplinary care, have shown improved outcomes with the use of standardized quality metrics. We hypothesized that developing evidence-based quality metrics for cervical cancer and tracking adherence in a large tertiary care medical system would allow identification of systemic issues that can then be addressed to improve quality of care and patient outcomes. We also implemented a weekly cervical cancer huddle in September 2021 attended by a physician, nurse practitioner, social workers, and other caregivers to discuss all newly diagnosed patients prior to treatment with a focus on improving quality in real time. Here we report our initial results. AnIRB-approved retrospective review of cervical cancer patients treated at our institution from January 2019 to December 2022 was performed using a data collection web application. We assessed quality metrics in newly diagnosed patients including: tumor board presentation, outside pathology review, receipt of PET-CT/MRI prior to treatment start, use of radiology and pathology synoptic reports, receipt of external beam radiation and brachytherapy, completion of chemotherapy and radiation within 56 days, receipt of post-treatment PET-CT, referral to social work, and laparotomy for radical hysterectomy. In addition, we tracked the impact of the "huddle" on pre-treatment quality metrics before and after implementation. One hundred seventy-three patients were identified with newly diagnosed cervical cancer; most were squamous cell carcinoma (61%). 44% were stage I, 39% stage II or III, and 16% stage IV. Over the entire study period, 65% of patients completed imaging prior to treatment start, 73% had a radiology synoptic report on MRI, 71% of hysterectomy patients had pathology synoptic reports, 90% of eligible patients had receipt of both external beam radiation and brachytherapy, 91% of eligible patients had completion of chemotherapy and radiation within 56 days, and 96% had a post-treatment PET-CT within 3-6 months. The impact of the huddle on pre-treatment quality metrics was evident: tumor board presentation increased from 38% to 73%, social work referral increased from 42% to 59%, outside pathology review increased from 64% to 83%, and use of laparotomy increased from 67% to 81%. Definingquality metrics in cervical cancer and tracking adherence can help identify areas of improvement in the continuum of care in a large healthcare system. A dedicated weekly huddle can help reduce barriers to diagnosis and initiation of treatment with earlier and increased referral to social work and increased multi-disciplinary review and discussion that can affect patient treatment and subsequent outcomes. Future work will focus on implementation of systemic processes to improve adherence to metrics.

Exploring stakeholders' perspectives on the quality of services provided through community pharmacies

It is important to understand the factors impacting the quality of services provided through community pharmacies. Exploring how key stakeholders perceive good quality in these services is a logical first step. This could also inform the development of quality measures, such as quality indicators (QIs). To identify key stakeholders' perspectives on the quality of services provided through community pharmacies in Norway, specifically by exploring their experiences and perceptions about what constitutes good service quality. A convenient sampling approach was used to recruit participants for five semi-structured focus groups from Facebook, pharmacy chains, and patient organizations. The interviews with twenty-six participants were conducted via Microsoft Teams. Interviews were transcribed verbatim, and an inductive thematic analysis with a reflexive approach was used. Four main themes emerged from the analysis; 1) sufficient and substantively suitable information to cover individual needs, 2) communication skills and relationships with the pharmacy professionals, 3) customer satisfaction with knowledgeable employees and conveniently located pharmacies, and 4) factors that affect the pharmacy working environment. This study has identified areas that pharmacy professionals and customers regard as essential to define good quality of community pharmacy services. Effective communication skills, appropriate provision of information, customer satisfaction, and working environment are all essential factors when developing quality metrics for community pharmacies.

Health Services in Huntington Disease: A Systematic Literature Review.

Clinical trials for Huntington disease (HD) have primarily focused on managing chorea and, more recently, the development of disease-modifying therapies (DMTs). Nonetheless, understanding health services among patients with HD is essential for assessing new therapeutics, development of quality metrics, and overall quality of life of patients and families with HD. Health services assess health care utilization patterns, outcomes, and health care-associated costs, which can help shape the development of therapeutics and aid in policies that affect patients with a specific condition. In this systematic literature review, we analyze data of published studies looking at causes of hospitalization, outcomes, and health care costs in HD. The search yielded 8 articles published in the English language and comprising data from the United States, Australia, New Zealand, and Israel. The most common cause of hospitalization among patients with HD was dysphagia or dysphagia-related complications (e.g., aspiration pneumonia or malnutrition), followed by psychiatric or behavioral symptoms. Patients with HD had more prolonged hospitalizations than non-HD patients, and it was most prominent among those with advanced disease. Patients with HD were more likely to be discharged to a facility. A small percentage received inpatient palliative care consultation, and behavioral symptoms were a primary cause of discharge to another facility. Interventions such as gastrostomy tube placement had associated morbidity, and it was common among patients with HD with a diagnosis of dementia. Palliative care consultation and specialized nursing care were associated with more routine discharges and fewer hospitalizations. In terms of cost, patients with HD with private and public insurances had the highest expenditure with more advanced disease, and expenses were associated with hospitalization and medication costs. In addition to DMTs, HD clinical trial development should also consider the leading causes of hospitalization, morbidity, and mortality in patients with HD, including dysphagia and psychiatric disease. No research study, to our knowledge, has systematically reviewed health services research studies in HD. Evidence from health services research is needed to evaluate the efficacy of pharmacologic and supportive therapies. This type of research is also critical in understanding health care costs associated with the disease and to better advocate and shape policies that can benefit this patient population.

Physician Practice in Ontario Nursing Homes: Defining Physician Commitment.

To characterize the practice profile of nursing home (NH) physicians in Ontario, Canada. Population-based cross-sectional study. A total of 1527 most responsible physicians (MRPs) across 626 NHs in Ontario, Canada, for the calendar year,2017. We examined physician services within all publicly regulated and funded NH facilities. Descriptive summaries were generated to characterize MRPs and their practice patterns by the physician's primary practice location, the NH facility size, and the proportion of physician billings that occurred within NHs. Community sizes were classified into quintiles based on population size and assigned as urban or rural. The number of ministry-designated NH beds were assessed by quintiles to examine physician services by facility size. We also assessed the proportion of physician billings within NHs by quintiles. MRPs tended to be older, male, and practice family medicine. The majority of MRPs practiced in communities with populations exceeding 100,000 residents, although physicians with greater NH billings tended to practice in rural locations. The mean number of NH residents that a physician was MRP for was positively associated with the community size. Physicians provided care for more NH residents than they were assigned most responsible. Fifty-one percent of physicians were MRP for 90% of all NH residents. Our work provides an exemplar for characterizing physician commitment in NHs, using 2 approaches, according to the NH specialist model. We demonstrated the medical practice characteristics, locations, and billing patterns of physicians within Ontario NHs. Future work can investigate the association between physician commitment and the quality of care provided to NH residents. A greater understanding of physician commitment may lead to the development of quality metrics based on physician practice patterns.

Measuring quality and value in genetic counseling: The current landscape and future directions.

Genetic counselors strive to provide high-quality genetic services. To do so, it is essential to define quality in genetic counseling and identify opportunities for improvement. This Professional Issues article provides an overview of the evaluation of healthcare quality in genetic counseling. The National Society of Genetic Counselors' Research, Quality, and Outcomes Committee partnered with Discern Health, a value-based healthcare policy consulting firm, to develop a care continuum model of genetic counseling. Using the proposed model, currently available quality measures relevant to genetic counseling in the US healthcare system were assessed, allowing for the identification of gaps and priority areas for further development. A total of 560 quality measures were identified that can be applied to various aspects of the care continuum model across a range of clinical specialty areas in genetic counseling, although few measures were specific to genetic counseling or genetic conditions. Areas where quality measures were lacking included: attitudes toward genetic testing, family communication, stigma, and issues of justice, equity, diversity, and inclusion. We discuss these findings and other strategies for an evidence-based approach to quality in genetic counseling. Strategic directions for the genetic counseling profession should include a consolidated approach to research on quality and value of genetic counseling, development of quality metrics and patient-experience measures, and engagement with other improvement activities. These strategies will allow for benchmarking, performance improvement, and future implementation in accountability programs which will strengthen genetic counseling as a profession that provides evidence-based high-quality care to all patients.

АЛГОРИТМЫ И ПРОГРАММНОЕ ОБЕСПЕЧЕНИЕ АВТОМАТИЗАЦИИ ПРОЦЕССОВ ИЗМЕРЕНИЙ И ОБРАБОТКИ ДАННЫХ ОПЕРАТИВНОЙ ДИАГНОСТИКИ ИОНОСФЕРЫ И ИОНОСФЕРНЫХ РАДИОЛИНИЙ

The article contains the main architectural principles and technical solutions in the development of the software part of the hardware and software complex for the operational diagnostics of the ionosphere and ionospheric radio channels, mainly through remote ground-based radiosonding. A brief description of measurement techniques and measuring equipment is given. The tasks of automating the measurement process itself and data recording have been solved, which allow organizing the work of the complex according to a given schedule without direct human participation. The tasks of extracting information from the obtained experimental data of radiosonding and ionosphere diagnostics have also been solved, including the possibilities for working with the hierarchy of experimental data, including the possibility of degeneration of derived data, the possibility of viewing available data and the possibility of batch processing of large data arrays to obtain and study their statistical characteristics. The organization of processing when collecting statistics of variations of intermode delays, amplitude-frequency characteristics of partial modes of propagation of short waves, as well as classification of these data according to the so-called empirical multipath models are considered; examples of results are given. The prospects and preliminary results of applying the achievements of the machine learning to solve the problems of automating the extraction of information from radiosonding data are shown; the software of marking data for the formation of training samples is described. The plans for further research are the development of quality metrics and the choice of optimal architectures of deep neural networks, as well as the development of markup tools, including instruments of cross-monitoring the results.

Improving the Endoscopic Detection and Management of Gastric Intestinal Metaplasia Through Training: A Practical Guide

Improving the Endoscopic Detection and Management of Gastric Intestinal Metaplasia Through Training: A Practical Guide

Learning Contextualized User Preferences for Co‐Adaptive Guidance in Mixed‐Initiative Topic Model Refinement

AbstractMixed‐initiative visual analytics systems support collaborative human‐machine decision‐making processes. However, many multi‐objective optimization tasks, such as topic model refinement, are highly subjective and context‐dependent. Hence, systems need to adapt their optimization suggestions throughout the interactive refinement process to provide efficient guidance. To tackle this challenge, we present a technique for learning context‐dependent user preferences and demonstrate its applicability to topic model refinement. We deploy agents with distinct associated optimization strategies that compete for the user's acceptance of their suggestions. To decide when to provide guidance, each agent maintains an intelligible, rule‐based classifier over context vectorizations that captures the development of quality metrics between distinct analysis states. By observing implicit and explicit user feedback, agents learn in which contexts to provide their specific guidance operation. An agent in topic model refinement might, for example, learn to react to declining model coherence by suggesting to split a topic. Our results confirm that the rules learned by agents capture contextual user preferences. Further, we show that the learned rules are transferable between similar datasets, avoiding common cold‐start problems and enabling a continuous refinement of agents across corpora.

Quality Assessment of Heterogeneous Training Data Sets for Classification of Urban Area with Landsat Imagery

Quality assessment of training samples collected from heterogeneous sources has received little attention in the existing literature. Inspired by Euclidean spectral distance metrics, this article derives three quality measures for modeling uncertainty in spectral information of open-source heterogeneous training samples for classification with Landsat imagery. We prepared eight test case data sets from volunteered geographic information and open government data sources to assess the proposed measures. The data sets have significant variations in quality, quantity, and data type. A correlation analysis verifies that the proposed measures can successfully rank the quality of heterogeneous training data sets prior to the image classification task. In this era of big data, pre-classification quality assessment measures empower research scientists to select suitable data sets for classification tasks from available open data sources. Research findings prove the versatility of the Euclidean spectral distance function to develop quality metrics for assessing open-source training data sets with varying characteristics for urban area classification.

The future of continuous renal replacement therapy.

Over the last 40years, acute renal replacement therapy (RRT) in the intensive care units (ICUs) of high-income countries has transitioned from the predominant use of intermittent hemodialysis (and the much less common use of peritoneal dialysis) to the almost exclusive use of continuous renal replacement therapy (CRRT). Accordingly, CRRT has become the most common form of vital organ support delivered to critically ill patients. A series of clinical and technical advances has enabled the transformation of basic CRRT machines into highly sophisticated and customized devices. Recent work has focused on using evidence from clinical trials to enhance the application of CRRT with regard to timing of initiation, choice of modality, dose, and anticoagulation. However, many questions remain unanswered. Uncertainty surrounding volume control and the utility of strategies to minimize circulatory stress are key areas for future development. Advances in membrane technology, combination with other extracorporeal therapies, and personalization of CRRT delivery may provide additional benefit to certain subgroups. Development of quality metrics and use of data analytics to audit and benchmark could provide important insight into practice, while biofeedback and automated CRRT prescription could increase safety. In this review, we summarize the evolution of CRRT and highlight several future areas for development.

Mortality differences among patients with in-hospital ST-elevation myocardial infarction.

BackgroundIn‐hospital ST‐elevation myocardial infarction (STEMI) is associated with a higher mortality rate than out‐of‐hospital STEMI. Quality measures and universal protocols for treatment of in‐hospital STEMI do not exist, likely contributing to delays in recognition and treatment.HypothesisTo analyze differences in mortality among three subsets of patients who develop in‐hospital STEMI.MethodsThis was a multicenter, retrospective observational study of patients who developed in‐hospital STEMI at six United States medical centers between 2008 and 2017. Patients were stratified into three groups: (1) cardiac, (2) periprocedure, or (3) noncardiac/nonpostprocedure. Outcomes examined include time from electrocardiogram (ECG) acquisition to cardiac catheterization lab arrival (ECG‐to‐CCL) and survival to discharge.ResultsWe identified 184 patients with in‐hospital STEMI (mean age 68.7 years, 58.7% male). Group 1 (cardiac) patients had a shorter average ECG‐to‐CCL time (69 minutes) than group 2 (periprocedure, 215 minutes) and group 3 (noncardiac/nonpostprocedure, 199 minutes). Compared to group 1, survival to discharge was lower for group 2 (OR 0.33, P = .102) and group 3 (OR 0.20, P = .016). After adjusting for prespecified covariates, the relationship between group and survival showed a similar trend but did not reach statistical significance.ConclusionsPatients who develop in‐hospital STEMI in the context of a preceding procedure or noncardiac illness appear to have longer reperfusion times and higher in‐hospital mortality than patients admitted with cardiac diagnoses. Larger studies are warranted to further investigate these observations. Health systems should place an increased emphasis on developing quality metrics and implementing quality improvement initiatives to improve outcomes for in‐hospital STEMI.

Risk Factors of Extended Hospital Stay After One-Level Anterior Cervical Discectomy Fusion or Disc Replacement: Results from 1004 Patients in Food and Drug Administration Trials

Extended length of stay (LOS) after surgery is costly to the health care system and can be distressing to the patient and family. Previous studies have shown conflicting data on factors associated with increased LOS and are limited by using multiple different surgeries. Our study seeks to analyze factors that are associated with extended LOS. The objective of this study was to analyze data from 2 Food and Drug Administration trials of one-level cervical surgery to identify risk factors that are associated with extended LOS in the hospital. Extended LOS was defined to be >1 day. Patients with LOS ≤1 day were compared with those with LOS >1 day. Data from the BRYAN and Prestige ST Trial (n= 1004) were analyzed. Subjects with LOS ≤1 day were compared with those with LOS >1 day. Variables analyzed for their effect on LOS included demographic characteristics, patient-reported outcome measures, preoperative medical conditions, preoperative neurologic status, and intraoperative factors. A total of 912 patients (90.84%) had an LOS ≤1 day and 92 patients (9.16%) had an extended LOS >1 day. Weak narcotic medication use (P= 0.021; odds ratio [OR], 1.72), Nurick gait (P= 0.019; OR, 1.796), and operative time (P < 0.0001; OR, 2.062) were found to significantly affect LOS. Nurick gait, operative time, and history of weak narcotic use are associated with extended hospital stay. These data may be useful in preoperatively counseling patients, developing quality metrics for hospitals, and helping create financial models for cost/diagnosis-related group reimbursement for single-level anterior cervical surgery.

Creating equitable healthcare quality and safety for children with intellectual disability in hospital

Children with intellectual disability are susceptible to poor experiences of care and treatment outcomes, and this may compound existing health inequities. Evidence to date indicates three priority areas that must be addressed in order to reduce these inequities in the safety and quality of care for children with intellectual disability. Firstly, we need reliable methods to identify children with intellectual disability so that healthcare organizations understand their needs. Secondly, we need to develop quality metrics that can assess care quality and unwarranted care variation for children with intellectual disability in hospital. Finally, for a comprehensive understanding of the safety and quality of care for these children, and how to improve, it is critical that healthcare organizations partner with parents/carers and enable children with intellectual disability to voice their experiences of care. Children with intellectual disability have higher healthcare utilization than their peers; yet, their voice is rarely sought to optimize the safety and quality of their healthcare experience. Patient experience narratives enhance our understanding of the genesis of adverse events. By addressing these priorities, children with intellectual disability will be identified, and health services will measure and understand the problematic and beneficial variations in care delivery and can then effectively partner with children and their parents/carers to address the inequities in care quality and create safer healthcare.

Automated Identification of Chemical Series: Classifying like a Medicinal Chemist.

We investigate different automated approaches for the classification of chemical series in early drug discovery, with the aim of closely mimicking human chemical series conception. Chemical series, which are commonly defined by hand-drawn scaffolds, organize datasets in drug discovery projects. Often, they form the basis for further project decisions. To trace and evaluate these decisions in historic and ongoing projects, it is important to know or reconstruct chemical series. There is not a unique correct definition of chemical series, and the human definition certainly involves a subjective bias. Hence, we first develop quality metrics for the chemical series definitions, evaluating the size and specificity of chemical series. These metrics are applied to categorize human series definitions and implemented in automated classification approaches. For the automated classification of chemical series, we test different fragmentation and similarity-based clustering algorithms and apply different approaches to infer series definitions from these clusters or sets of fragments. We benchmark the classification results against human-defined series from 30 internal projects. The best results in reproducing the composition of human-defined series are achieved when applying UPGMA (unweighted pair group method with arithmetic mean) clustering to the project dataset and calculating maximum common substructures of the clusters as series definitions. We evaluate this approach in more detail on a public dataset and assess its robustness by 10-fold cross-validation, each time sampling 40% of the dataset. Through these benchmarking and validation experiments, we show that the proposed automated approach is able to accurately and robustly identify human-defined series, which comply with a certain, predefined level of specificity and size. Suggesting a thoroughly tested algorithm for series classification, as well as quality metrics for series and several benchmarking approaches, this work lays the foundation for further analysis of project decisions, and it offers an enhanced understanding of the properties of human-defined chemical series.

Decision aids in anesthesia: do they help?

Patient decision aids are educational tools used to assist patients and clinicians in healthcare decisions. As healthcare moves toward patient-centered care, these tools can provide support to anesthesiologists by facilitating shared decision-making. Recent research has shown that patient decision aids are beneficial in the clinical setting for patients and physicians. Studies have shown that patients feel better informed, have better knowledge, and have less anxiety, depression, and decisional conflict after using patient decision aids. In addition, a structured approach for the development of patient decision aids in the field of anesthesia has been established. Patient decision aids can support patient-centered care delivery and shared decision-making, especially in the field of anesthesia. Current research involves implementing the use of patient decision aids in the discussion for monitored anesthesia care. Further development of quality metrics is needed to improve the decision aids and maximize decision quality.

Improving cirrhosis care: The potential for telemedicine and mobile health technologies.

Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failure-from successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.

The Effects of Survey Enhancements on the Quality of Reporting in the Medical Expenditure Panel Survey, 2008–2015

Abstract It is well established that survey respondents imperfectly recall health care use in surveys. However, careful attention to both survey design and fielding procedures can enhance recall. We examine the effects of a comprehensive, multi-pronged approach to changing field procedures in the Medical Expenditure Panel Survey (MEPS) to improve quality of health care use reporting. Conducted annually since 1996, the MEPS is the leading large-scale nationally representative health survey with detailed individual and household information on health care use and expenditures. These survey enhancements were undertaken in 2013–2014 because of concerns over a drop in the quality of reporting in 2010 that persisted into 2011–2012. The approach combined focused retraining of field supervisors and interviewers, developing quality metrics and reports for ongoing monitoring of interviewers, and revising advanced letters and materials sent to respondents. We seek to determine the extent to which changes in field procedures and trainings improved interviewer and respondent behaviors associated with better reporting, and more importantly, improved reporting accuracy. We use longitudinal MEPS data from 2008 through 2015, combining household reported use with sociodemographic and health status characteristics, and paradata on the characteristics of the interviews and interviewers. We exploit the longitudinal data and timings of major trainings and changes in field procedures in regression models, separating out the effects of the trainings and other fielding changes to the extent possible. We find that the 2013–2014 data quality improvement activities substantially improved reporting quality. Positive interviewer behaviors increased substantially to above pre-2010 levels, and utilization reporting has recovered to above pre-2010 levels, returning MEPS to trend. Importantly, these substantial gains occurred in 2013, prior to extensive in-person training for most of the field force. We examine the lessons learned from this data quality initiative both for the MEPS program and for other large household surveys.