Patient Encounter Data Research Articles

Burden of COPD, Asthma, and Concomitant COPD and Asthma Among Adults: Racial Disparities in a Medicaid Population

Asthma and COPD are characterized by substantial racial disparities in morbidity and mortality. We hypothesized that because African-American patients with these conditions experience greater mortality and morbidity than their white counterparts, they would use more health-care resources when no difference in health insurance exists. A retrospective, population-based cohort study was conducted using Maryland Medicaid Managed Care patient encounter data. We compared health services utilization and cost outcomes in both African-American and white patients with COPD, asthma, or coexisting COPD and asthma. The study population consisted of 9,131 patients with COPD, asthma, or both conditions. Of the total population, 52% were African American (n = 4,723), and 44% were white (n = 4,021); all other races were combined into the "unknown race" category to account for the remaining 4% (n = 387). After controlling for age, gender, cohort allocation, and comorbidities, we found that African-American adults with COPD, asthma, or coexisting COPD and asthma actually used fewer medical services and accounted for lower medical costs than white adults. Lower health services utilization and medical costs among African-American patients with COPD and asthma may provide a possible explanation for the racial disparities in outcomes of patients with these conditions.

The Accuracy of Student-Reported Patient Encounter Data

The Accuracy of Student-Reported Patient Encounter Data

Use of a diagnosis-based risk adjustment model to estimate costs of indigent care in a community at Medicaid reimbursement rates

Objectives: This study used a diagnosis-based risk adjustment model to estimate the annual costs of uninsured patients in Austin, Texas, and describe the prevalence and costs of their chronic conditions. The data were supplied by the Indigent Care Collaboration, a partnership of local safety-net hospitals and clinics.Methods: This study used the Diagnostic Cost Groups prospective Medicaid All-Encounters model, which uses diagnoses, age and gender to assign relative risk scores to patients. The relative risk scores were multiplied by the per capita Texas Medicaid expenditure to obtain estimated annual costs. Chronic diseases were described in terms of prevalence and total estimated annual cost.Results: A total of 471,194 encounters were recorded for 163,729 patients meeting the study inclusion criteria between the 1st March 2004 and the 28th February 2005. The mean estimated patient yearly cost was US $1,307, and the total estimated yearly population cost was $228,909,529. The most common chronic conditions included hypertension, diabetes, depression, substance abuse, pregnancy, asthma, chronic obstructive pulmonary disease and congestive heart failure.Conclusions: This study demonstrates how the unknown costs associated with caring for indigent uninsured patients in a community can be estimated at Medicaid reimbursement rates using the Diagnostic Cost Group model on aggregated patient encounter data.

Advanced Statistics: Developing a Formal Model of Emergency Department Census and Defining Operational Efficiency

Emergency department (ED) crowding has been a frequent topic of investigation, but it is a concept without an objective definition. This has limited the scope of research and progress toward the development of consistent and meaningful operational responses.To develop a straightforward model of ED census that incorporates concepts of ED crowding, daily patient surge, throughput time, and operational efficiency.Using 2005-2006 patient encounter data at a Level 1 urban trauma center, a set of three stylized facts describing daily patterns of ED census was observed. These facts guided the development of a formal, mathematical model of ED census. Using this model, a metric of ED operational efficiency and a forecast of ED census were developed.The three stylized facts of daily ED census were 1) ED census is cyclical, 2) ED census exhibits an input-output relationship, and 3) unexpected shocks have long-lasting effects. These were represented by a three-equation system. This system was solved for the following expression, Census(t) = A(.) + B(.) cos(vT + epsilon) + a(e(t)), that captured the time path of ED census. Using nonlinear estimation, the parameters of this expression were estimated and a forecasting tool was developed.The basic pattern of ED census can be represented by a straightforward expression. This expression can be quickly adapted to a variety of inquiries regarding ED crowding, daily surge, and operational efficiency.

Are Self-reported Patient Encounter Data Accurate?

Introduction: Medical education programs are using Personal Digital Assistants (PDA’s) to facilitate the recording of encounters between students and patients during clinical rotations. Wichita State University Physician Assistant Program (WSU-PA) uses PDA’s to track clinical patient encounters during its clinical year. The WSU-PA clinical rotation at Pratt Regional Medical Center Emergency Department (PRMC-ED) provided an opportunity for a comparison of medical records and PDA entries made by students who spent 4 to 6 weeks at that site. Purpose: The purpose of this study was to verify the selfreported data submitted by students with the actual documentation on the medical record and identify any significant inconsistencies. Methods: Student submitted data of all patient encounters by WSU-PA students at PRMC-ED were compared to data obtained through review of medical records for patients seen by the student. The age and sex of the patient as well as the diagnosis of each visit were compared for consistency using HandEchart® Software and Microsoft Excel® Spreadsheets. Results: 32.16% of reported diagnosis matched the medical records, 24.69% of patient age matched the medical records, and 31.18% of patient sex matched the medical records. Conclusion: Data revealed an inconsistency between medical charts and PDA entries of patient encounters during clinical rotations at PRMC. The data that represented the age, sex, and diagnosis of patients encountered in clinical rotations by 2 year PA students was consistent 1/3 of the time. Introduction The second year of Physician Assistant (PA) education at Wichita State University (WSU) allots the student an opportunity to practice principles of medicine presented and studied during the 1 didactic year of training. In a clinical setting under the supervision of a mentor, the student experiences patient encounters that demonstrate the application of previously presented medical concepts and reinforces the principles of sound practice. As a way to track patient encounters, WSU-PA has used paper based tracking systems and web-based tracking systems in the past. Each has been valuable at tracking patient encounters. Since the fall of 2003, the program has implemented the use of Personal Digital Assistants (PDA) to track patient encounters by students. PDA’s have grown in popularity among medical care providers themselves over the past 10 years. It is estimated that by the year 2008, 60% of medical care providers will incorporate a PDA into their clinical practice [1] The use of PDA’s in the past has been found mostly in event planning, calculations, and address directories. [2] It is evident that PDA’s are becoming a very important part in the practice and education of medicine in The United States of America. Medical Programs are using PDA’s as resources to track patient encounters experienced by their students. WSU-PA has implemented PDA’s into its program as a way to track the encounters of its students and stay current in its teaching methods. Experiments, Results, Discussion, and significance The population of this study consisted of the medical charts of patients that were seen and treated under supervision by 2 year WSU-PA students at Pratt Regional Medical Center (PRMC) in Pratt, Kansas. This was a convenience sample of students assigned to PRMC. The demographics of each patient encounter were collected by the 2 year students by using drop down boxes included in HandEChart software. The author used drop down boxes included in HandEChart software to collect the data that represented the demographics of each patient visit included in the medical chart. The collected information from the student and the author were separately uploaded into Microsoft XL spreadsheets. Microsoft XL spreadsheets were made and data was categorized by dates in order to facilitate the comparison of student data and data collected by the author. Auto Filters were used to separate the data according to the date of the patient encounter. Once the dates of patient encounters were matched between the student data and the medical chart data, a comparison of patient demographics was performed. The names of the students were omitted and replaced by representing letters A, B, C, and D. The data was analyzed by comparing the diagnosis, age, and gender of patients who were seen by students A, B, C, and D. A total number of 737 patient encounters that occurred during 4 clinical rotations (July 11,2006-August 17,2006: August 22, 2005-September 28, 2005: January 30, 2006-Feburary 22, 2006: April 3, 2006May 2, 2006) were Proceedings of the 3 Annual GRASP Symposium, Wichita State University, 2007 Return to Table of

Advanced Statistics: Developing a Formal Model of Emergency Department Census and Defining Operational Efficiency

Emergency department (ED) crowding has been a frequent topic of investigation, but it is a concept without an objective definition. This has limited the scope of research and progress toward the development of consistent and meaningful operational responses. To develop a straightforward model of ED census that incorporates concepts of ED crowding, daily patient surge, throughput time, and operational efficiency. Using 2005-2006 patient encounter data at a Level 1 urban trauma center, a set of three stylized facts describing daily patterns of ED census was observed. These facts guided the development of a formal, mathematical model of ED census. Using this model, a metric of ED operational efficiency and a forecast of ED census were developed. The three stylized facts of daily ED census were 1) ED census is cyclical, 2) ED census exhibits an input-output relationship, and 3) unexpected shocks have long-lasting effects. These were represented by a three-equation system. This system was solved for the following expression, Census(t) = A(.) + B(.) cos(vT + epsilon) + a(e(t)), that captured the time path of ED census. Using nonlinear estimation, the parameters of this expression were estimated and a forecasting tool was developed. The basic pattern of ED census can be represented by a straightforward expression. This expression can be quickly adapted to a variety of inquiries regarding ED crowding, daily surge, and operational efficiency.

Gender Disparities in Colorectal Cancer Screening: True or False?

To date, nearly all studies examining gender disparities in colorectal cancer screening report a lower endoscopic screening rate in women. Using a statewide claims database, gender differences in screening rates were analyzed in an attempt to validate gender disparities reported in prior survey-based studies. Procedural-level dataset containing all patient encounters for 2003 in which a colonoscopy or flexible sigmoidoscopy were performed was created. Procedures were selected using CPT codes and univariate analysis was performed using SAS v 8.0. Statewide for average-risk individuals 50 years or older, 65,232 endoscopic procedures were performed in 2003. The majority (83%) of endoscopic screening procedures were colonoscopies. Overall, the rate of screening in average-risk women 50 years or older (38 procedures/1000 people) was slightly lower than in men (42/1000) but not statistically significant. The rates of screening were higher in women before the age of 60 years and lower after the age of 60 years. No clinically significant difference was found in the type of screening procedure performed. Gender disparities in rates and types of colorectal cancer screening reported in prior survey studies are not validated in this patient encounter data study.

Wireless Handheld Computers in the Undergraduate Medical Curriculum

Wayne State University Medical School has implemented wireless handheld computers or PocketPCs (PPCs) into all four years of the undergraduate curriculum. A transition from a passive to an interactive learning environment in the classroom, as well as administrative solutions for monitoring patient encounter data by students in their clinical rotations was fostered by this educational technology. Implementation of the wireless devices into the curriculum will be described in this report. This will include the technical specifications and justification for the required device, as well as a detailed discussion of the different applications used for educational and administrative purposes by the preclinical and clinical students. Outcomes from the educational and administrative aspects of the project will also be presented in this report.

Comparing Diagnostic Coding and Laboratory Results

Comparing Diagnostic Coding and Laboratory Results

Emergency medicine resident work productivity and procedural accomplishment.

The purpose of this study was to assess procedural accomplishment, work productivity, and efficiency for emergency medicine residents in a community-based, osteopathic emergency medicine residency. These data are compared with limited existing data from other training sites. The authors conducted a retrospective analysis of patient-encounter data logged into a computerized main-frame database over 8 years by 19 resident physicians. Only data from residents who had complete logs for all 3 years of residency were included. Procedures and diagnoses were from the core content areas defined in the basic standards for approval of residency training programs in emergency medicine. Approximately 98,000 patient encounters were logged during the study period. First-year emergency medicine residents saw an average of 1.06 patients per hour, second-year emergency medicine residents an average of 1.33 patients per hour, and third-year emergency medicine residents an average of 1.41 patients per hour. Residents performed an average of 65 intubations, 533 adult resuscitations, 144 pediatric resuscitations, 49 central line insertions, 47 lumbar punctures, and 280 laceration repairs. Residents tend to see more patients per hour as their training progresses. Residents in this program get significant experience in some procedures but little or no clinical exposure to other procedures. These results are consistent with the few other published reports attempting to quantify the emergency medicine resident experience. The data may assist in setting clinical objectives and establishing uniform tracking systems and coding terminology.

The Frontlines of Medicine Project: A proposal for the standardized communication of emergency department data for public health uses including syndromic surveillance for biological and chemical terrorism

The Frontlines of Medicine Project is a collaborative effort of emergency medicine (including emergency medical services and clinical toxicology), public health, emergency government, law enforcement, and informatics. This collaboration proposes to develop a nonproprietary, “open systems” approach for reporting emergency department patient data. The common element is a standard approach to sending messages from individual EDs to regional oversight entities that could then analyze the data received. ED encounter data could be used for various public health initiatives, including syndromic surveillance for chemical and biological terrorism. The interlinking of these regional systems could also permit public health surveillance at a national level based on ED patient encounter data. Advancements in the Internet and Web-based technologies could allow the deployment of these standardized tools in a rapid time frame. [Barthell EN, Cordell WH, Moorhead JC, Handler J, Feied C, Smith MS, Cochrane DG, Felton CW, Collins MA. The Frontlines of Medicine Project: a proposal for the standardized communication of emergency department data for public health uses including syndromic surveillance for biological and chemical terrorism. Ann Emerg Med. April 2002;39:422-429.]

A Descriptive Analysis of Patient Encounter Data from the Fleet Hospital FIVE Humanitarian Relief Mission in Haiti

Fleet Hospital FIVE personnel treated more than 24,000 patients during a 1997 military operation other than war in Haiti. Sample data were analyzed for 10,215 Haitians who received humanitarian assistance care at field treatment sites and for 353 military, United Nations personnel, and Haitian nationals who were treated at the fleet hospital. Demographic data, type of encounter, diagnoses, and prescriptions were tabulated. Children aged 1 to 10 years accounted for 31% of humanitarian assistance visits. Females outnumbered males; in adults aged 21 to 30 years, the proportion was almost three to one. Most (97%) were initial encounters. Infectious and parasitic diseases, such as worms or scabies, accounted for 25% of diagnoses. At the fleet hospital, more than 80% of patients were males; these were most often older than 21 years. Injuries and aftercare procedures constituted 51.5% of diagnoses. Of 18,100 prescriptions, 57% were for anti-inflammatories, vitamins, or anti-parasitics. Implications for medical planning are described.

Exposure to a rural population in a rural residency training program

Previous reports of rural training programs conducted by medical schools have not examined the relationship between the population residing in an area and the population receiving medical services through the clinical training program. In the present study rural household survey data were compared with patient encounter data from a rural ambulatory cliinic engaged in training Family Practice residents from the Texas Tech University School of Medicine. Clinic patients were found to resemble the rural population subgroup that visits a physician at least once a year. Wide variations in individual clinical experiences were observed when health problems and conditions encountered by residents were compared with problems encountered in the clinic as a whole. In light of current national efforts to increase medical care access in unserved and underserved populations, the demographic findings raise questions concerning appropriate patient exposure goals in clinical training programs.

Prehospital coronary care. Proposal for a uniform reporting system.

Prehospital coronary care is becoming a common feature of community emergency medical systems. To date, results have been reported in a variety of formats, making meaningful comparison and aggregate analysis impossible. A flexible patient encounter form and data analysis scheme are proposed for universal adoption in future published accounts.

Prehospital Coronary Care

Prehospital coronary care is becoming a common feature of community emergency medical systems. To date, results have been reported in a variety of formats, making meaningful comparison and aggregate analysis impossible. A flexible patient encounter form and data analysis scheme are proposed for universal adoption in future published accounts.