Management Tool For Populations Research Articles

Population Health Management effectiveness in the primary healthcare setting: a systematic review

Abstract Background Population Health Management (PHM) has shown promise as a tool in the improvement of health at scale. It works by; harnessing health-related datasets, allowing for population segmentation and risk stratification, and targeting interventions to yield positive health impact. Prior reviews on PHM, have sought to define PHM and assess feasibility. To date, there have been no systematic reviews that assess the effectiveness of PHM in achieving some or all of the quintuple aims of PHM (WHO 2023). The aim of this study is to determine the value and impact of a PHM approach in managing ambulatory care sensitive conditions (ACSCs) in the primary healthcare setting. Methods This systematic review is underpinned by a Population-Intervention-Comparator-Outcome (PICO) framework. The PROSPERO-registered study commenced in February 2024 for papers published since January 2000. Pubmed, Cinahl and Web of Science databases were used. Titles and abstracts of studies were reviewed using agreed eligibility criteria to select studies for inclusion and risk of bias assessment. Data abstraction and synthesis determined the effectiveness of PHM against agreed outcome measures. Results The search yielded 427 articles of which 19 were included. Studies addressed diabetes, hypertension, atrial fibrillation, asthma and comorbid conditions. Nearly all studies were based in the U.S.A. Almost 50% of studies showed a significant improvement in health outcomes following PHM. Study features that corresponded with positive health outcomes included; the use of population management tools, the employment of disease/population health managers and the mobilisation of medication reviews/education. Conclusions The challenges facing communities and health services require an alternative innovative approach to health such as a PHM approach. The results of this study will inform a larger body of work which seeks to establish a PHM approach to the delivery of services in the Mid-West region of Ireland. Key messages • Population health management (PHM) could be a viable mechanism for health services to serve increasing need and multi-morbid populations. • This is the first systematic review of PHM against the quintuple aims of PHM, specifically in the management of ambulatory care sensitive conditions in primary healthcare.

Combining Local Ecological Knowledge (LEK) and Conventional Scientific Knowledge (CSK) for Exploring Nursery Grounds and Spawning Biology of Yellowtail Catfish Pangasius pangasius in the Meghna River Estuary, Bangladesh

ABSTRACTThe yellowtail catfish (Pangasius pangasius) population in Bangladesh is facing imminent threats that led to endangered status. We used conventional scientific knowledge (CSK) and local ecological knowledge (LEK) of fishers (n = 155) to identify nursery grounds and spawning seasons of yellowtail catfish in the Meghna river estuary. Nineteen nursery grounds were pinpointed using fishers' LEK (confluence/influent zone, current, depth, catch data, and turbidity) and later validated by CPUE data. The peak spawning season was identified in July–September based on GSI (gonadosomatic index) and LEK (58.06% of fishers identified the spawning season). Fecundity (810,980 ± 455,679) and condition factor (0.94–1.52) were quantified with CSK. Using CSK and LEK to delineate nursery grounds and spawning season underscores the value of LEK as a tool for fish population management that deserves policy recommendation and wider application.

Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort.

Direct oral anticoagulants (DOACs) have complex dosing regimens and are often incorrectly prescribed. We evaluated a nationwide DOAC population management dashboard rollout whose purpose includes pharmacist review and correction of off-label dosing prescriptions. Using data from Veterans Health Affairs, we identified all patients prescribed DOACs for atrial fibrillation or venous thromboembolism between August 2015 and December 2019. Sites were grouped on the basis of the timing of moderate-high usage of the DOAC population management tool dashboard. Effectiveness was defined as the monthly rate of off-label DOAC prescribing and the rate of clinical adverse events (bleeding, composite of stroke or venous thromboembolism). Implementation was evaluated as the percentage of off-label DOAC prescriptions changed within 7 days. Among the 128 652 patients receiving DOAC therapy at 123 centers, between 6.9% and 8.6% had off-label DOAC prescriptions. Adoption of the DOAC population management tool dashboard before July 2018 was associated with a decline in off-label dosing prescriptions (8.7%-7.6%). Only 1 group demonstrated a significant reduction in monthly rates of bleeding following implementation. All sites experienced a reduction in the composite of venous thromboembolism or stroke following dashboard adoption. There was no difference in the implementation outcome of DOAC prescription change within 7 days in any of the adoption groups. Early adoption of the DOAC population management tool dashboard was associated with decreased rates of off-label DOAC dosing prescription and reduced bleeding. Following adoption of the DOAC population management tool dashboard, all sites experienced reductions in venous thromboembolism and stroke events.

Targeted recreational hunting can reduce animal-vehicle collisions and generate substantial revenue for wildlife management agencies

Reduction of conflicts arising from human-wildlife interactions is necessary for coexistence. Collisions between animals and automobiles cost the world's economy billions of dollars, and wildlife management agencies often are responsible for reducing wildlife-vehicle collisions. But wildlife agencies have few proven options for reducing wildlife-vehicle collisions that are effective and financially feasible at large spatiotemporal scales germane to management. Recreational hunting by humans is a primary population management tool available for use with abundant wild ungulates that often collide with automobiles. Therefore, we tested how well policies designed to increase human hunting of deer (longer hunting seasons and increased harvest limits) reduced collisions between white-tailed deer and automobiles along 618 km of high-risk roadways in Indiana, USA. We used a 20-y dataset that compiled >300,000 deer-vehicle collisions. Targeted recreational hunting decreased deer-vehicle collisions by 21.12 % and saved society up to $653,756 (95 % CIs = $286,063–$1,154,118) in economic damages from 2018 to 2022. Potential savings was up to $1,265,694 (95 % CIs = $579,108–$2,402,813) during the same 5-y span if relaxed hunting regulations occurred along all high-risk roadways. Moreover, license sales from targeted hunting generated $206,268 in revenue for wildlife management. Targeted hunting is likely effective in other systems where ungulate-vehicle collisions are prevalent, as behavioral changes in response to human hunting has been documented in many ungulate species across several continents. Our methods are attractive for management agencies with limited funds, as relaxed hunting regulations are relatively inexpensive to implement and may generate substantial additional revenue.

Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration.

The Veterans Health Administration provides care to more than 100,000 Veterans with cirrhosis. This implementation evaluation aimed to understand organizational resources and barriers associated with cirrhosis care. Clinicians across 145 Department of Veterans Affairs (VA) medical centers (VAMCs) were surveyed in 2022 about implementing guideline-concordant cirrhosis care. VA Corporate Data Warehouse data were used to assess VAMC performance on two national cirrhosis quality measures: HCC surveillance and esophageal variceal surveillance or treatment (EVST). Organizational factors associated with higher performance were identified using linear regression models. Responding VAMCs (n = 124, 86%) ranged in resource availability, perceived barriers, and care processes. In multivariable models, factors independently associated with HCC surveillance included on-site interventional radiology and identifying patients overdue for surveillance using a national cirrhosis population management tool ("dashboard"). EVST was significantly associated with dashboard use and on-site gastroenterology services. For larger VAMCs, the average HCC surveillance rate was similar between VAMCs using vs. not using the dashboard (47% vs. 41%), while for smaller and less resourced VAMCs, dashboard use resulted in a 13% rate difference (46% vs. 33%). Likewise, higher EVST rates were more strongly associated with dashboard use in smaller (55% vs. 50%) compared to larger (57% vs. 55%) VAMCs. Resources, barriers, and care processes varied across diverse VAMCs. Smaller VAMCs without specialty care achieved HCC and EVST surveillance rates nearly as high as more complex and resourced VAMCs if they used a population management tool to identify the patients due for cirrhosis care.

Design and implementation of electronic health record-based tools to support a weight management program in primary care.

This paper reports on a mixed methods formative evaluation to support the design and implementation of information technology (IT) tools for a primary care weight management intervention delivered through the patient portal using primary care staff as coaches. We performed a qualitative needs assessment, designed the IT tools to support the weight management program, and developed implementation tracking metrics. Implementation tracking metrics were designed to use real world electronic health record (EHR) data. The needs assessment revealed IT requirements as well as barriers and facilitators to implementation of EHR-based weight management interventions in primary care. We developed implementation metrics for the IT tools. These metrics were used in weekly project team calls to make sure that project resources were allocated to areas of need. This study identifies the important role of IT in supporting weight management through patient identification, weight and activity tracking in the patient portal, and the use of the EHR as a population management tool. An intensive multi-level implementation approach is required for successful primary care-based weight management interventions including well-designed IT tools, comprehensive involvement of clinic leadership, and implementation tracking metrics to guide the process of workflow integration. This study helps to bridge the gap between informatics and implementation by using socio-technical formative evaluation methods early in order to support the implementation of IT tools. clinicaltrials.gov, NCT04420936. Registered June 9, 2020.

Effects of select herbicides for management of American lotus, white waterlily, and watershield

Literature describing effective control measures for the floating-leaved plants American lotus (Nelumbo lutea Willd.), white waterlily (Nymphaea odorata Aiton), and watershield (Brasenia schreberi J.F. Gmel.) is minimal as these are usually considered as desirable species. However, floating-leaved plants can cause ecological, economic, and social problems when undergoing demographic expansions, usually following alterations of natural hydrologic cycles. Therefore, a mesocosm trial was conducted to determine the potential of foliar applications of seven aquatic herbicides to reduce abundance of the three target species at maximum and half-maximum label rates. Three of the herbicides (glyphosate, imazamox, and florpyrauxifen-benzyl) provided short- and long-term suppression (.75% reduction) of white waterlily and watershield leaf density or biomass. As a followup trial, field work was conducted using glyphosate, imazamox, and florpyrauxifen-benzyl to determine plant response to these herbicides in a natural setting. All herbicides resulted in long-term (52 wk after treatment) leaf density reduction of white waterlily (64 to 100% reduction) and watershield (46 to 75% reduction; except 2.83 kg ae ha 1 glyphosate) in field sites while the abundance of American lotus increased. Reduction of white waterlily and watershield may have reduced competition thereby favoring higher abundance of lotus. Regardless, long-term (52-wk) reduction of white waterlily and watershield suggest the potential for these herbicides as operational management tools for nuisance populations of these species. Future work should evaluate chemical techniques for control of American lotus, where both timing of leaf emergence and potential interactions with other plant species must be considered in the design of those studies.

Phallus eversion sexing in Phrynops geoffroanus (Testudines: Chelidae): a new non-invasive approach.

The sexing of species is an important tool for population management. In tortoises and turtles, sexing is usually done according to secondary characteristics, such as plastron morphology or phallus eversion techniques. In this paper, we present the phallus eversion method and compare its efficiency to other existing techniques. This new method aims at shortening the management time and reducing the physical aftereffects on the animals, fostering the clinical and reproductive management of Geoffroy's side-necked turtle (Phrynops geoffroanus) and related species. A sample of fifty individuals was taken in the central region of Piauí state, Northeastern Brazil. The proposed method consisted of moving the head from its resting position. The methods achieving a success rate higher than 80% were compared to each other as for the stimulation time required for phallus eversion. The method as here proposed achieved 100% efficiency in the sex determination of specimens with a linear carapace length between 10 and 34 cm. Also, when compared to the second most efficient method, it substantially reduced the time needed for managing the specimens (91%), avoiding possible sequelae in the individuals handled.

The ADEM project: implementation of ‘Good medicines use conversation’ for COPD-patients, embedded in multidisciplinary context.

COPD is a chronic, progressive disease, for which a multidisciplinary approach is crucial. Appropriate follow-up is crucial to improve the quality of life of COPD-patients and reduce associated healthcare costs. 
 A ‘Good medicines use conversation’ COPD is a pharmaceutical care intervention, conducted by the community pharmacist, consisting of a tailored-made education of the COPD-patient on the disease and its treatment. Scientific research (PHARMACOP-trial) has shown that this intervention significantly improves therapy adherence and inhalation technique and reduces exacerbation rates and associated hospitalizations. 
 The aim of the ADEM implementation project was to investigate the needs for a sustainable implementation of this intervention.
 The ADEM project was conducted in Flemish-Brabant (Belgium), with the integrated care region ‘Leuven Cares’ as a separate entity. 
 All participating pharmacies (9 in region Flemish-Brabant and 8 in region ‘Leuven Cares’) received a support package consisting of: 1) a three-part online training about COPD and a visual COPD-atlas; 2) a population management-tool (a query to identify COPD-patients in the pharmacy, resulting in a list of COPD-patients with a ‘score’ per patient as an initial proxy for patient prioritization); and 3) local interdisciplinary meetings (LIM) to discuss and promote the intervention. Pharmacist of the region Caring Leuven additionally received individual care plans, providing an overview of the healthcare status of each COPD-patient, and an individual coaching session.
 Semi-structured interviews were conducted with 8 participating pharmacists (4 region Flemish-Brabant, 4 region ‘Leuven Cares’). Thematic analysis was performed.
 
 All elements of the support package were positively evaluated by the participating pharmacists. The population management tool seemed to support pharmacists in planning, interpreting and prioritizing care for COPD-patients. A follow-up study is needed to further investigate the tool and to what extent population management contributes to a more qualitative and effective pharmaceutical care. 
 COVID-19, lack of personnel, lack of reimbursement and lack of time were identified as limiting factors for the implementation of the protocol-based COPD-intervention. Cooperation with the GP was indicated by the majority as minimal and insufficient. Therefore, LIM’s were evaluated as very important to inform GP’s about the pharmaceutical intervention and make local agreements about the multidisciplinary approach of COPD.
 The findings of this study are in line with the available evidence on the implementation of new services in pharmacies. Many pharmacists have the intrinsic motivation to offer extended pharmaceutical care, but current practices often do not allow this. Population management appeared to be a major factor that can be used to facilitate the implementation. By considering the needs of the local population, pharmacists can work in a more targeted way and prioritize the pharmaceutical services they offer. Given the group of chronically ill people in Belgium is expected to grow in the coming years due to the increasing ageing of the population, there will be an increasing demand for specialized interventions and advice from the pharmacist. It is therefore necessary to provide a sufficient framework for these services, bearing in mind the needs of the local population and the requirement for a pragmatic approach in the pharmacy. 

Implementation of a digital tool for population management in Primary Health Care.

Describe the implementation of a digital diagnostic and territorial monitoring tool in primary healthcare. Quantitative and qualitative study, developed in 14 basic healthcare units in São Paulo, with community health workers, coordinators, nurses, and physicians. Data collection occurred in four phases: analysis of the instruments used by the team for territory management; development of the digital tool; training and implementation; and evaluation after 90 days using focus groups. Descriptive analyses were conducted by calculating absolute and relative frequencies to treat quantitative data. Qualitative data were subjected to content analysis. Three hundred thirty-four professionals participated in the study. In the first step, territory management's main challenges were filling out various instruments, system failures, data inconsistency, internet infrastructure/network, and lack of time. Therefore, a digital tool was developed consisting of 1) a spreadsheet recording the number of family members and markers of health conditions, date of visit, and number of return visits; 2) a spreadsheet with a summary of families visited, not visited, and refusals; and 3) a panel with a summary of the data generated instantly. In the evaluation, after the initial use of the tool, the themes that emerged were integration of the tool into daily work, evaluation of the digital tool implementation process, and improvement and opportunities for improvement. Faced with the challenges faced by family healthcare teams when filling out systems and managing the territory, the tool developed provided greater reliability and agility in data visualization, reduced the volume of instruments, and optimized the work process.

BAITING AND BANDING: EXPERT OPINION ON HOW BAIT TRAPPING MAY INFLUENCE THE OCCURRENCE OF HIGHLY PATHOGENIC AVIAN INFLUENZA (HPAI) AMONG DABBLING DUCKS.

A Eurasian lineage highly pathogenic avian influenza virus (HPAIV) of the clade 2.3.4.4b (Goose/Guangdong lineage) was detected in migratory bird populations in North America in December 2021, and it, along with its reassortants, have since caused wild and domestic bird outbreaks across the continent. Relative to previous outbreaks, HPAIV cases among wild birds in 2022 exhibited wider geographic extent within North America and higher levels of mortality, suggesting the potential for population-level impacts. Given the possible conservation implications of HPAIV in wild birds, natural resource managers have sought guidance on actions that may mitigate negative effects of disease among North American bird populations, including modification of existing management practices. Banding of waterfowl is a critical tool for population management for several harvested species in North America, but some banding techniques, such as bait trapping, can lead to increased congregation of waterfowl, potentially altering HPAIV transmission. We used an expert opinion exercise to assess how bait trapping of dabbling ducks in Canada may influence HPAIV transmission and wild bird health. The expert group found that it is moderately likely that bait trapping of dabbling ducks in wetlands will significantly increase the transmission of HPAIV among individual ducks, but there is a low probability that this will result in significant population-level effects on North American dabbling ducks. Considering the lack of empirical work studying how capture and handling methods may change transmission of HPAIV among waterfowl, as well as the importance of bait trapping for waterfowl management in North America, future work should focus on filling knowledge gaps pertaining to the influence of baiting on HPAIV occurrence to better inform banding procedures and management decision making.

Remote fruit fly detection using computer vision and machine learning-based electronic trap.

Intelligent monitoring systems must be put in place to practice precision agriculture. In this context, computer vision and artificial intelligence techniques can be applied to monitor and prevent pests, such as that of the olive fly. These techniques are a tool to discover patterns and abnormalities in the data, which helps the early detection of pests and the prompt administration of corrective measures. However, there are significant challenges due to the lack of data to apply state of the art Deep Learning techniques. This article examines the detection and classification of the olive fly using the Random Forest and Support Vector Machine algorithms, as well as their application in an electronic trap version based on a Raspberry Pi B+ board. The combination of the two methods is suggested to increase the accuracy of the classification results while working with a small training data set. Combining both techniques for olive fly detection yields an accuracy of 89.1%, which increases to 94.5% for SVM and 91.9% for RF when comparing all fly species to other insects. This research results reports a successful implementation of ML in an electronic trap system for olive fly detection, providing valuable insights and benefits. The opportunities of using small IoT devices for image classification opens new possibilities, emphasizing the significance of ML in optimizing resource usage and enhancing privacy protection. As the system grows by increasing the number of electronic traps, more data will be available. Therefore, it holds the potential to further enhance accuracy by learning from multiple trap systems, making it a promising tool for effective and sustainable fly population management.

Association of Direct Oral Anticoagulation Management Strategies With Clinical Outcomes for Adults With Atrial Fibrillation

Anticoagulation management services (AMSs; ie, warfarin clinics) have evolved to include patients treated with direct oral anticoagulants (DOACs), but it is unknown whether DOAC therapy management services improve outcomes for patients with atrial fibrillation (AF). To compare outcomes associated with 3 DOAC care models for preventing adverse anticoagulation-related outcomes among patients with AF. This retrospective cohort study included 44 746 adult patients with a diagnosis of AF who initiated oral anticoagulation (DOAC or warfarin) between August 1, 2016, and December 31, 2019, in 3 Kaiser Permanente (KP) regions. Statistical analysis was conducted from August 2021 through May 2023. Each KP region used an AMS to manage warfarin but used distinct approaches to DOAC care: (1) usual care (UC) by the prescribing clinician, (2) UC plus an automated population management tool (PMT), or (3) pharmacist-managed AMS care. Propensity scores and inverse probability of treatment weights (IPTWs) were estimated. Direct oral anticoagulant care models were first indirectly compared using warfarin as a common comparator within each region and then directly compared across regions. Patients were followed up until the first occurrence of an outcome (composite of thromboembolic stroke, intracranial hemorrhage, other major bleeding, or death), discontinuation of KP membership, or December 31, 2020. Overall, 44 746 patients were included: 6182 in the UC care model (3297 DOAC; 2885 warfarin), 33 625 in the UC plus PMT care model (21 891 DOAC; 11 734 warfarin), and 4939 in the AMS care model (2089 DOAC; 2850 warfarin). Baseline characteristics (mean [SD] age, 73.1 [10.6] years, 56.1% male, 67.2% non-Hispanic White, median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female sex] score of 3 [IQR, 2-5]) were well balanced after IPTW. Over a median follow-up of 2 years, patients who received the UC plus PMT or AMS care model did not have significantly better outcomes than those who received UC. The incidence rate of the composite outcome was 5.4% per year for DOAC and 9.1% per year for warfarin for those in the UC group, 6.1% per year for DOAC and 10.5% per year for those in the UC plus PMT group, and 5.1% per year for DOAC and 8.0% per year for those in the AMS group. The IPTW-adjusted hazard ratios (HRs) for the composite outcome comparing DOAC vs warfarin were 0.91 (95% CI, 0.79-1.05) in the UC group, 0.85 (95% CI, 0.79-0.90) in the UC plus PMT group, and 0.84 (95% CI, 0.72-0.99) in the AMS group (P = .62 for heterogeneity across care models). When directly comparing patients receiving DOAC, the IPTW-adjusted HR was 1.06 (95% CI, 0.85-1.34) for the UC plus PMT group vs the UC group and 0.85 (95% CI, 0.71-1.02) for the AMS group vs the UC group. This cohort study did not find appreciably better outcomes for patients receiving DOAC who were managed by either a UC plus PMT or AMS care model compared with UC.

Managing the Conflict of Human–Wildlife Coexistence: A Community-Based Approach

One of the most recent and pressing issues for policymakers to address is the presence of wild boars in urban and rural areas. Their aggressive spread and invasion of human-populated areas have created an alarming problem as the coexistence of wild boars and people poses serious threats to human life and property. Human-caused factors, such as residential zone expansion and land use change, have exacerbated this problem. Furthermore, natural factors, such as predator reduction and climate change effects, create favorable conditions for population growth. This study sought to gain insights into citizens’ perspectives on a current issue, specifically wild boar colonization and coexistence in urban and rural settings. Between September 2021 and November 2022, a survey was conducted in two communities of northern and central Greece, addressing 800 citizens in total. Obtained through hierarchical log-linear analysis, factor analysis and two-step cluster analysis, the findings indicate that rural citizens appear to be more concerned about agricultural production losses and the high risk of road accidents, while the invasion-level perception was high in both areas. Intensive hunting has gained widespread acceptance as a management tool for wild boar populations in both urban and rural areas, while anthropocentric (EGO) and ecocentric (ECO) social groups have emerged.

Mitigating the effects of climate change on the nests of sea turtles with artificial irrigation.

For sea turtles, like many oviparous species, increasing temperatures during development threaten to increase embryonic mortality, alter offspring quality, and potentially create suboptimal primary sex ratios. Various methods are being implemented to mitigate the effects of climate change on reproductive success, but these methods, such as breeding programs, translocations, and shading, are often invasive and expensive. Irrigation is an alternative strategy for cooling nests that, depending on location, can be implemented relatively quickly and cheaply. However, multiple factors, including ambient conditions, nest substrate, and species characteristics, can influence irrigation success. Additionally, irrigation can vary in duration, frequency, and the volume of water applied to nests, which influences the cooling achieved and embryonic survival. Thus, it is critical to understand how to maximize cooling and manage risks before implementing irrigation as a nest-cooling strategy. We reviewed the literature on nest irrigation to examine whether artificial irrigation is feasible as a population management tool. Key factors that affected cooling were the volume of water applied and the frequency of applications. Embryonic responses varied with species, ambient conditions, and the timing of irrigation during development. Nest inundation was the key risk to a successful irrigation regime. Future irrigation regimes must identify clear targets, either primary or adult sex ratios, that maximize population viability. Monitoring population responses and adjusting the irrigation regime in response to population characteristics will be critical. Most studies reported on the manipulation of only one or two variables, further research is required to understand how altering multiple factors in an irrigation regime influences the cooling achieved and embryonic responses.

Abstract PR001: The use of risk prediction for patients with abnormal fecal testing (FIT) to prioritize patient navigation

Abstract Context: “Precision delivery involves using an individual’s electronic health data to predict risk and personalize care to substantially improve value” (Parikh). Rates of completion of the follow-up colonoscopy following an abnormal FIT are low in community clinics. Tools like predictive analytics can be used for population management and more precise delivery of care to those who need it the most. Objective: We describe 3 studies use of predictive analytics after abnormal FIT testing to prioritize patient navigation to complete subsequent colonoscopies. Study design and analysis: The Strategies and Opportunities to Prevent Colorectal Cancer (STOP CRC) trial developed an initial risk prediction model identifying patients unlikely to complete a follow-up colonoscopy on their own. Kaiser Permanente Northwest (KPNW) then redeveloped the model for use with Navigation. The Predicting and Addressing Colonoscopy Non-adherence in Community Settings (PRECISE) study then redeveloped the model for use with Navigation in a large Federally Qualified Health Center (FQHC). Results: The STOP CRC model included 8 variables, 1596 patients had an abnormal FIT result, 34.8% had a recorded colonoscopy within 6 months. The model shows an adequate separation of patients across risk levels for non-adherence to follow-up colonoscopy (bootstrap-corrected C-statistic > 0.63). The KPNW model included 14 variables, and the performance of the model was adequate with a bootstrap corrected C-statistic of 0.65. The PRECISE model included 12 variables and a bootstrap corrected C-statistic of 0.58. Here we will describe each of the models and the differences in the application of the models. Conclusions: Risk prediction can be used to identify patients unlikely to complete colonoscopies, and as a population management tool to tailor interventions to specific populations. Tailoring interventions can save money, and increase patient satisfaction. Citation Format: Amanda F. Petrik. The use of risk prediction for patients with abnormal fecal testing (FIT) to prioritize patient navigation [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer; 2022 Oct 1-4; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;82(23 Suppl_1):Abstract nr PR001.

Electronic health record data use in the assessment of quality indicators for glucocorticoid osteoporosis screening in systemic lupus erythematosus.

To determine whether electronic health record (EHR) data components could be identified and used to assess bone health quality indicators in patients with systemic lupus erythematosus as a foundation for population health management. We identified patients in our EHR system who had diagnosis codes for lupus from 2012 to 2017 and characterized them based on the frequency and dosage of prescribed glucocorticoid medications. The medical records of patients who received repeated high-dose glucocorticoid orders were further reviewed for osteoporosis, osteoporotic fractures, receipt of appropriate preventive screening, and orders for protective medications based on established quality indicators. Descriptive statistics were calculated to summarize results. We identified 617 patients with a lupus diagnosis; 414 received glucocorticoid prescriptions, 189 received chronic, high-dose; and 83 received chronic, low-dose prescription orders. Of those with chronic high-dose glucocorticoid prescriptions, 14% had an osteoporosis diagnosis, 3% had an osteoporotic fracture, 51% received a prescription for calcium/vitamin D, 43% had bone mineral density screening orders, 20% received a spine radiograph order, 29% had a documented T-score, 12% received a prescription for osteoporosis medication, and 6% had a documented osteoporosis screening. We were able to identify data elements in the EHR for all nine components of the osteoporosis management quality indicator. It is possible to identify data in the EHR for all attributes of the quality indicator for osteoporosis in lupus patients who receive chronic high-dose glucocorticoids. However, missing data and need to extract data from text-based notes may make development of population management tools challenging.

Exploring Public Support for Large-Scale Commercial Axis Deer Harvests in Maui, Hawaii

Commercial harvests have been effectively employed to manage wildlife populations across the world. Although commercial harvesting of the nonnative, invasive axis deer (Axis axis) in Maui, Hawaii, occurs at small scales and only on private lands, there is potential for large-scale implementation to be used as a population management tool. To investigate local stakeholder interest in a hypothetical, large-scale commercial harvest of axis deer, we used an online survey of individuals and businesses in Maui to analyze their attitudes towards axis deer populations and management, their experiences with axis deer, and potential to utilize axis deer venison and products, as relevant. We found evidence of public support for commercial harvesting to be employed as one of the many tools available to manage axis deer populations. Additionally, we documented support on both the supply-side and demand-side for axis deer-derived products that may be available if large-scale commercialized harvesting were implemented. We leverage these results to contribute to conversations about commercial wildlife harvesting in the United States by challenging assumptions that the practice is inconsistent with the public’s perceptions of the North American Model of Wildlife Conservation and suggesting policies and programs that would ease axis deer commercial harvest growing pains.

Clinical pharmacy initiative to increase naloxone prescribing in patients with opioid use disorder

AbstractIntroductionThe national opioid epidemic has garnered the attention of various health agencies. A leading strategy in mitigating risk from the opioid public health crisis, including opioid use disorder (OUD), is via increased promotion and access to the lifesaving opioid antagonist, naloxone. Pharmacists have been recognized as integral in addressing this emergency; however, literature evaluating outcomes from multifaceted clinical pharmacy specialist (CPS) interventions and involvement is lacking. The purpose of this quality improvement initiative was to evaluate the impact of a CPS initiative to increase naloxone prescribing proportions (number of patients with OUD with an active prescription for naloxone within the past year divided by the number of patients with OUD), patient access to care, and clinical interventions.MethodsPain management CPSs, mental health CPSs, and clinical pharmacy leadership within a Veterans Health System spearheaded a variety of interventions to increase naloxone prescribing in patients with OUD including focused education with prescribers, naloxone informational letters, review of population management tools identifying patients with OUD indicated to receive naloxone, CPS naloxone prescribing, and automated naloxone drug orders integrated into electronic health record progress note templates. The preintervention and postintervention evaluation periods were three‐month time frames. Naloxone prescribing proportions were compared before and after implementation of these interventions. Additional outcomes evaluated were number of encounters, number of patients seen/reviewed, and number of clinical interventions completed by the CPSs.ResultsThere was a significant increase observed in naloxone prescribing proportions from 34.1% to 57.5% postintervention (P < .01). The total number of encounters, patients, and clinical interventions had an absolute increase of 58.0%, 88.4%, and 49.9%, respectively, postintervention.ConclusionThe observed improvement in naloxone prescribing proportions suggests the value of CPS involvement in initiatives for increasing naloxone prescribing to optimize patient safety and justify clinical pharmacy services.

Artificial Intelligence Assesses Clinicians’ Adherence to Asthma Guidelines Using Electronic Health Records

Clinicians' asthma guideline adherence in asthma care is suboptimal. The effort to improve adherence can be enhanced by assessing and monitoring clinicians' adherence to guidelines reflected in electronic health records (EHRs), which require costly manual chart review because many care elements cannot be identified by structured data. This study was designed to demonstrate the feasibility of an artificial intelligence tool using natural language processing (NLP) leveraging the free text EHRs of pediatric patients to extract key components of the 2007 National Asthma Education and Prevention Program guidelines. This is a retrospective cross-sectional study using a birth cohort with a diagnosis of asthma at Mayo Clinic between 2003 and 2016. We used 1,039 clinical notes with an asthma diagnosis from a random sample of 300 patients. Rule-based NLP algorithms were developed to identify asthma guideline-congruent elements by examining care description in EHR free text. Natural language processing algorithms demonstrated a sensitivity (0.82-1.0), specificity (0.95-1.0), positive predictive value (0.86-1.0), and negative predictive value (0.92-1.0) against manual chart review for asthma guideline-congruent elements. Assessing medication compliance and inhaler technique assessment were the most challenging elements to assess because of the complexity and wide variety of descriptions. Natural language processing technologies may enable the automated assessment of clinicians' documentation in EHRs regarding adherence to asthma guidelines and can be a useful population management and research tool to assess and monitor asthma care quality. Multisite studies with a larger sample size are needed to assess the generalizability of these NLP algorithms.