EGEMS (Washington, DC)最新文献_第3页

Denominators Matter: Understanding Medical Encounter Frequency and Its Impact on Surveillance Estimates Using EHR Data 分母很重要:了解医疗接触频率及其对使用电子病历数据的监测估计的影响

EGEMS (Washington, DC)

Pub Date : 2019-07-23 DOI: 10.5334/egems.292

N. Cocoros, Aileen Ochoa, Karen Eberhardt, Bob Zambarano, M. Klompas

Background: There is scant guidance for defining what denominator to use when estimating disease prevalence via electronic health record (EHR) data. Objectives: Describe the intervals between medical encounters to inform the selection of denominators for population-level disease rates, and evaluate the impact of different denominators on the prevalence of chronic conditions. Methods: We analyzed the EHRs of three practices in Massachusetts using the Electronic medical record Support for Public Health (ESP) system. We identified adult patients’ first medical encounter per year (2011–2016) and counted days to next encounter. We estimated the prevalence of asthma, hypertension, obesity, and smoking using different denominators in 2016: ≥1 encounter in the past one year or two years and ≥2 encounters in the past one year or two years. Results: In 2011–2016, 1,824,011 patients had 28,181,334 medical encounters. The median interval between encounters was 46, 56, and 66 days, depending on practice. Among patients with one visit in 2014, 82–84 percent had their next encounter within 1 year; 87–91 percent had their next encounter within two years. Increasing the encounter interval from one to two years increased the denominator by 23 percent. The prevalence of asthma, hypertension, and obesity increased with successively stricter denominators – e.g., the prevalence of obesity was 24.1 percent among those with ≥1 encounter in the past two years, 26.3 percent among those with ≥1 encounter in the last one year, and 28.5 percent among those with ≥2 encounters in the past one year. Conclusions: Prevalence estimates for chronic conditions can vary by >20 percent depending upon denominator. Understanding such differences will inform which denominator definition is best to be used for the need at hand.

背景：在通过电子健康记录（EHR）数据估计疾病流行率时，很少有关于定义使用什么分母的指导。目的：描述两次就诊之间的间隔，以告知人群疾病率的分母选择，并评估不同分母对慢性病患病率的影响。方法：我们使用公共卫生电子病历支持（ESP）系统分析了马萨诸塞州三家诊所的EHR。我们确定了成年患者每年（2011-2016年）的第一次就诊，并计算了下一次就诊的天数。我们在2016年使用不同的分母估计了哮喘、高血压、肥胖和吸烟的患病率：在过去一年或两年内≥1次，在过去一两年内≥2次。结果：2011-2016年，1824011名患者共有28181334次就诊。两次相遇的中位间隔时间分别为46、56和66天，具体取决于练习情况。在2014年一次就诊的患者中，82%-84%的患者在一年内再次就诊；87–91%的人在两年内有了下一次邂逅。将相遇间隔从一年增加到两年，分母增加了23%。哮喘、高血压和肥胖的患病率随着分母的不断严格而增加——例如，在过去两年中，≥1次发作的患者中，肥胖的发病率为24.1%，在过去一年中≥1次的患者中为26.3%，在过去1年中≥2次发作的人中为28.5%。结论：根据分母的不同，慢性病的患病率估计值可能相差20%以上。了解这些差异将告知哪种分母定义最适合用于手头的需求。

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引用次数: 7

Cardiovascular Health Trends in Electronic Health Record Data (2012-2015): A Cross-Sectional Analysis of The Guideline Advantage™. 电子健康记录数据中的心血管健康趋势（2012-2015）：指南优势的横断面分析™.

EGEMS (Washington, DC)

Pub Date : 2019-07-18 DOI: 10.5334/egems.268

Joyce E Rudy, Yosef Khan, Julie K Bower, Sejal Patel, Randi E Foraker

Background: Electronic health record (EHR) data can measure cardiovascular health (CVH) of patient populations, but have limited generalizability when derived from one health care system.

Objective: We used The Guideline Advantage™ (TGA) data repository, comprising EHR data of patients from 8 diverse health care systems, to describe CVH of adult patients and progress towards the American Heart Association's (AHA's) 2020 Impact Goals.

Methods: Our analysis included 203,488 patients with 677,733 encounters recorded in TGA from 2012 to 2015. Five measures from EHRs [cigarette smoking status, body mass index (BMI), blood pressure (BP), cholesterol, and diabetes mellitus (DM)] were categorized as poor/intermediate/ideal according to AHA's Life's Simple 7 algorithm. We presented distributions and trends of CVH for each metric over time, first using all available data, and then in a subsample (n = 1,890) of patients with complete data on all metrics.

Results: Among all patients, the greatest stride towards ideal CVH attainment from 2012 to 2015 was for cigarette smoking (50.6 percent to 65 percent), followed by DM (17.3 percent to 20.7 percent) and BP (21.1 percent to 23.2 percent). Overall, prevalence of ideal CVH did not increase for any metric in the subsample. Males slightly improved in ideal CVH for BMI and cholesterol; meanwhile, females saw no improvement in ideal CVH for any metric. As ideal CVH for BP and cholesterol increased slightly among white patients, ideal CVH for BP, cholesterol, BMI, and DM worsened for non-whites.

Conclusion: Despite improvements in some CVH metrics in the outpatient setting, more tangible progress is needed to meet AHA's 2020 Impact Goals.

背景：电子健康记录（EHR）数据可以测量患者群体的心血管健康（CVH），但当从一个医疗保健系统中获得时，其可推广性有限。目标：我们使用了The Guideline Advantage™ （TGA）数据库，包括来自8个不同医疗保健系统的患者的EHR数据，以描述成年患者的CVH以及实现美国心脏协会（AHA）2020年影响目标的进展。方法：我们的分析包括2012年至2015年TGA记录的203488名患者，677733次接触。根据AHA的Life’s Simple 7算法，EHRs的五项指标[吸烟状况、体重指数（BMI）、血压（BP）、胆固醇和糖尿病（DM）]被归类为差/中等/理想。我们首先使用所有可用数据，然后在具有所有指标完整数据的患者子样本（n=1890）中，展示了每个指标的CVH随时间的分布和趋势。结果：在所有患者中，从2012年到2015年，实现理想CVH的最大步伐是吸烟（50.6%到65%），其次是糖尿病（17.3%到20.7%）和血压（21.1%到23.2%）。总体而言，理想CVH的患病率在子样本中的任何指标都没有增加。男性在BMI和胆固醇的理想CVH方面略有改善；同时，女性在任何指标的理想CVH方面都没有改善。由于白人患者的理想血压和胆固醇CVH略有增加，非白人患者的血压、胆固醇、BMI和DM CVH恶化。结论：尽管门诊环境中的一些CVH指标有所改善，但要实现AHA的2020年影响目标，还需要取得更实实在在的进展。

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引用次数: 3

The NQRN Registry Maturational Framework: Evaluating the Capability and Use of Clinical Registries NQRN注册成熟框架：评估临床注册的能力和使用

EGEMS (Washington, DC)

Pub Date : 2019-07-17 DOI: 10.5334/egems.278

Seth E. Blumenthal

Clinical registries are increasingly used as national performance measurement platforms. In 2018, nearly 70 percent of the more than 50 specialty society registries in the United States were used by the Centers for Medicare & Medicaid Services (CMS) to measure the quality of clinical care. Private payers and evaluating organizations also use or desire to use registry information to inform quality improvement programs and value-based payment models. The requirements for an entity to become a CMS Qualified Clinical Data Registry (QCDR) constitute a minimum set of standards for the purpose of reporting to the CMS Quality Payment Program. Models and frameworks exist that can help classify registries by purpose and use, and maturity models are available for evaluating health IT systems generally. However, there is currently no framework that describes the capability that should be expected from a registry at different phases of its development and maturity. In response, the National Quality Registry Network (NQRN) has developed a registry maturational framework. The framework models early, intermediate and mature development phases, the capabilities anticipated during these phases and 17 domains across which registry programs support those capabilities. The framework was developed and refined by NQRN registry stewards, users and other stakeholders between 2013–2018. It is intended to be used as a developmental guide or for registry evaluation. The successful use of registry information to execute value-based payment models is a critical need in U.S. health care. The NQRN framework can help ensure that our national system of registries is rising to the occasion.

临床登记越来越多地被用作国家绩效衡量平台。2018年，美国医疗保险和医疗补助服务中心(CMS)使用了美国50多个专业协会登记处中近70%的登记册来衡量临床护理质量。私人付款人和评估机构也使用或希望使用注册信息来通知质量改进计划和基于价值的支付模式。实体成为CMS合格临床数据注册(QCDR)的要求构成了一套最低标准，用于向CMS质量支付计划报告。现有的模型和框架可以帮助按目的和用途对注册中心进行分类，成熟度模型可用于一般地评估医疗IT系统。然而，目前还没有框架描述注册中心在其开发和成熟的不同阶段应该期望的功能。作为回应，国家质量注册网络(NQRN)开发了一个注册成熟框架。框架对早期、中期和成熟的开发阶段、这些阶段预期的能力和17个域进行建模，注册程序跨这些域支持这些能力。该框架由NQRN注册管理人员、用户和其他利益相关方在2013-2018年期间开发和完善。它的目的是用作发展指南或注册表评估。成功地使用注册信息来执行基于价值的支付模式是美国医疗保健的一个关键需求。NQRN框架可以帮助确保我们的国家注册管理系统能够应对这种情况。

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引用次数: 5

A Method for Segmenting Medicare Expenditures to Inform Cost Effective Care Delivery for Older Adults 一种划分医疗保险支出以告知老年人成本效益护理的方法

EGEMS (Washington, DC)

Pub Date : 2019-07-16 DOI: 10.5334/egems.272

C. Crowley, T. Kent, Liane Wardlow, M. Twaddle

Introduction: Faced with growing populations of older, medically complex patients, health systems are now incentivized to deliver cost-effective, high-value care. We evaluated a new method that builds upon existing Medicare spending concentration studies to further segment these expenditures, revealing use patterns to inform care redesign. Methods: We obtained monthly Medicare expenditure data and derived baseline comparison data using typical methods for identifying a yearly high-cost subpopulation. We then applied the new methodology, ordering monthly patient expenditures from highest to lowest to more extensively segment the baseline data. Our evaluation examined the following within the new more extensive segmentation: monthly expenditure distribution, corresponding patient counts, and occupancy of specific patient subgroups within the extended segmentation of baseline data. Results: Compared to the baseline data, we found further spending concentration, with 16.7 percent of high-cost patients being responsible for about two-thirds of baseline expenditures. The remaining 83.3 percent of the high-cost subpopulation exhibited lower spending, collectively accounting for about one third of baseline expenditures. Additionally, we found that unique patient subgroups occupied different segments over time, with specific subgroups comprising 8.3 percent of the study subpopulation patients migrating into and out of each highest spending segment, accounting for almost half of monthly baseline expenditures. Conclusions: With monthly health care expenditures concentrated among small numbers of migrating patients, our evaluation suggested potential cost-effectiveness in tiered care delivery models, where small subgroups receive direct, active care interactions, while the remainder experience surveillance-level care, designed to both address ongoing medical needs and to detect emergent migration.

引言：面对越来越多的老年、医疗复杂的患者，卫生系统现在被激励提供具有成本效益、高价值的护理。我们评估了一种新方法，该方法建立在现有的医疗保险支出集中度研究的基础上，以进一步细分这些支出，揭示使用模式，为护理重新设计提供信息。方法：我们获得了每月的医疗保险支出数据，并使用典型的方法得出了基线比较数据，以确定年度高成本亚群。然后，我们应用了新的方法，将每月患者支出从最高到最低排序，以更广泛地划分基线数据。我们的评估在新的更广泛的细分中检查了以下内容：每月支出分布、相应的患者计数以及基线数据扩展细分中特定患者亚组的占用情况。结果：与基线数据相比，我们发现支出更加集中，16.7%的高成本患者承担了约三分之二的基线支出。其余83.3%的高成本人群支出较低，合计约占基线支出的三分之一。此外，我们发现，随着时间的推移，独特的患者亚组占据了不同的细分市场，特定的亚组占研究亚组患者的8.3%，患者进出每个最高支出细分市场，几乎占每月基线支出的一半。结论：由于每月的医疗保健支出集中在少数迁移患者中，我们的评估表明，分层护理提供模式具有潜在的成本效益，其中小部分患者接受直接、积极的护理互动，而其余患者则接受监督级别的护理，旨在满足持续的医疗需求并检测紧急迁移。

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引用次数: 1

Controlling Confounding in a Study of Oral Anticoagulants: Comparing Disease Risk Scores Developed Using Different Follow-Up Approaches 控制口服抗凝剂研究中的混淆：比较使用不同随访方法得出的疾病风险评分

EGEMS (Washington, DC)

Pub Date : 2019-07-15 DOI: 10.5334/egems.254

J. Bohn, S. Schneeweiss, R. Glynn, S. Toh, R. Wyss, R. Desai, J. Gagne

Purpose: Little is known about how disease risk score (DRS) development should proceed under different pharmacoepidemiologic follow-up strategies. In an analysis of dabigatran vs. warfarin and risk of major bleeding, we compared the results of DRS adjustment when models were developed under “intention-to-treat” (ITT) and “as-treated” (AT) approaches. Methods: We assessed DRS model discrimination, calibration, and ability to induce prognostic balance via the “dry run analysis”. AT treatment effects stratified on each DRS were compared with each other and with a propensity score (PS) stratified reference estimate. Bootstrap resampling of the historical cohort at 10 percent–90 percent sample size was performed to assess the impact of sample size on DRS estimation. Results: Historically-derived DRS models fit under AT showed greater decrements in discrimination and calibration than those fit under ITT when applied to the concurrent study population. Prognostic balance was approximately equal across DRS models (–6 percent to –7 percent “pseudo-bias” on the hazard ratio scale). Hazard ratios were between 0.76 and 0.78 with all methods of DRS adjustment, while the PS stratified hazard ratio was 0.83. In resampling, AT DRS models showed more overfitting and worse prognostic balance, and led to hazard ratios further from the reference estimate than did ITT DRSs, across sample sizes. Conclusions: In a study of anticoagulant safety, DRSs developed under an AT principle showed signs of overfitting and reduced confounding control. More research is needed to determine if development of DRSs under ITT is a viable solution to overfitting in other settings.

目的：在不同的药物流行病学随访策略下，人们对疾病风险评分（DRS）的制定应该如何进行知之甚少。在对达比加群与华法林和大出血风险的分析中，我们比较了在“意向治疗”（ITT）和“治疗后”（AT）方法下开发模型时DRS调整的结果。方法：我们通过“干运行分析”评估了DRS模型的识别、校准和诱导预后平衡的能力。将每个DRS上分层的AT治疗效果相互比较，并与倾向评分（PS）分层参考估计值进行比较。以10%-90%的样本量对历史队列进行Bootstrap重采样，以评估样本量对DRS估计的影响。结果：当应用于同时进行的研究人群时，在AT下拟合的历史推导的DRS模型显示出比在ITT下拟合的DRS模型在辨别和校准方面更大的下降。DRS模型的预后平衡大致相等（在风险比量表上为-6%--7%的“伪偏倚”）。所有DRS调整方法的风险比均在0.76至0.78之间，而PS分层风险比为0.83。在重新采样中，AT DRS模型显示出更多的过拟合和更差的预后平衡，并导致在不同样本量下，风险比比比ITT DRS更远离参考估计。结论：在一项抗凝安全性研究中，根据AT原则开发的DRS显示出过度拟合的迹象，并减少了混杂控制。需要更多的研究来确定ITT下DRS的开发是否是解决其他环境中过度拟合的可行方案。

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引用次数: 2

Applying an Electronic Health Records Data Quality Framework Across Service Sectors: A Case Study of Juvenile Justice System Data 跨服务部门应用电子健康记录数据质量框架:青少年司法系统数据的案例研究

EGEMS (Washington, DC)

Pub Date : 2019-07-11 DOI: 10.5334/egems.258

M. Aalsma, K. Schwartz, K. Haight, G. Jarjoura, A. Dir

Context: Integrating electronic health records (EHR) with other sources of administrative data is key to identifying factors affecting the long-term health of traditionally underserved populations, such as individuals involved in the justice system. Linking existing administrative data from multiple sources overcomes many of the limitations of traditional prospective studies of population health, but the linking process assumes high levels of data quality and consistency within administrative data. Studies of EHR, unlike other types of administrative data, have provided guidance to evaluate the utility of big data for population health research. Case Description: Here, an established EHR data quality framework was applied to identify and describe the potential shortcomings of administrative juvenile justice system data collected by one of four case management systems (CMSs) across 12 counties in a Midwest state. The CMS data were reviewed for logical inconsistencies and compared along the data quality dimensions of plausibility and completeness. Major Themes: After applying the data quality framework, several patterns of logical inconsistencies within the data were identified. To resolve these inconsistencies, recommendations regarding data entry, review, and extraction are offered. Conclusion: The recommendations related to achieving quality justice system data can be applied to future efforts to link administrative databases from multiple sources. Increasing trust in administrative data quality related to vulnerable populations ultimately improves knowledge of pressing public health concerns.

背景:将电子健康记录(EHR)与其他行政数据来源相结合，对于确定影响传统上得不到充分服务的人群(例如涉及司法系统的个人)长期健康的因素至关重要。将来自多个来源的现有行政数据联系起来克服了传统的人口健康前瞻性研究的许多局限性，但这种联系过程假定行政数据具有高水平的数据质量和一致性。与其他类型的行政数据不同，电子病历的研究为评估大数据在人口健康研究中的效用提供了指导。案例描述:本研究采用已建立的电子病历数据质量框架来识别和描述美国中西部一个州12个县的四个案例管理系统(cms)收集的行政少年司法系统数据的潜在缺陷。审查CMS数据的逻辑不一致性，并沿着数据质量的合理性和完整性维度进行比较。主要主题:在应用数据质量框架之后，确定了数据中逻辑不一致的几个模式。为了解决这些不一致，提供了有关数据输入、审查和提取的建议。结论:与实现高质量司法系统数据有关的建议可应用于今后将多个来源的行政数据库连接起来的工作。提高对与弱势群体有关的行政数据质量的信任，最终会提高对紧迫的公共卫生问题的认识。

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引用次数: 3

Symptom Burden in Long-Term Survivors of Head and Neck Cancer: Patient-Reported Versus Clinical Data 头颈癌长期幸存者的症状负担:患者报告与临床数据对比

EGEMS (Washington, DC)

Pub Date : 2019-07-10 DOI: 10.5334/egems.271

G. Pocobelli, Rebecca A. Ziebell, M. Fujii, K. Hutcheson, Steven S. Chang, J. McClure, Jessica Chubak

Introduction: The symptom burden faced by long-term head and neck cancer survivors is not well understood. In addition, the accuracy of clinical data sources for symptom ascertainment is not clear. Objective: To 1) describe the prevalence of symptoms in 5-year survivors of head and neck cancer, and 2) to evaluate agreement between symptoms obtained via self-report and symptoms obtained from clinical data sources. Methods: We recruited 5-year survivors of head and neck cancer enrolled at Kaiser Permanente Washington (n = 54). Symptoms were assessed using the MD Anderson Symptom Inventory head and neck cancer module. For each symptom, we assessed the agreement of the patient’s survey response (“gold standard”) with the 1) medical chart and 2) administrative health care claims data. We computed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value, along with their 95 percent confidence intervals, for each clinical data source. Results: Eighty percent of patients responded. Nearly all participants (95 percent) reported experiencing at least one symptom from the MDASI-HN, and 93 percent reported two or more symptoms. Among patients reporting a given symptom, there was generally no evidence of the symptom from either clinical data source (i.e., sensitivity was generally no greater than 40 percent). The specificity and PPV of the clinical data sources were generally higher than the sensitivity. Conclusion: Relying only on medical chart review and/or administrative health data would substantially underestimate symptom burden in long-term head and neck cancer survivors.

简介：长期头颈癌症幸存者所面临的症状负担尚不清楚。此外，用于确定症状的临床数据来源的准确性尚不清楚。目的：1）描述癌症5年幸存者的症状患病率，2）评估通过自我报告获得的症状与从临床数据来源获得的症状之间的一致性。方法：我们招募了在华盛顿凯萨永久医院登记的癌症5年幸存者（n=54）。使用MD Anderson症状量表癌症头颈部模块评估症状。对于每种症状，我们评估了患者的调查反应（“金标准”）与1）医疗图表和2）行政医疗索赔数据的一致性。我们计算了每个临床数据源的敏感性、特异性、阳性预测值（PPV）和阴性预测值，以及它们的95%置信区间。结果：80%的患者有反应。几乎所有参与者（95%）都报告至少经历过一种MDASI-HN症状，93%的参与者报告有两种或两种以上症状。在报告特定症状的患者中，通常没有来自任何临床数据来源的症状证据（即，敏感性通常不超过40%）。临床数据来源的特异性和PPV通常高于敏感性。结论：仅依赖医学图表审查和/或管理健康数据会大大低估长期头颈部癌症幸存者的症状负担。

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引用次数: 3

Health Information Technology and Accountable Care Organizations: A Systematic Review and Future Directions 卫生信息技术和负责任的保健组织:系统回顾和未来方向

EGEMS (Washington, DC)

Pub Date : 2019-07-08 DOI: 10.5334/egems.261

Casey P. Balio, Nate C. Apathy, Robin Danek

Background: Since the inception of Accountable Care Organizations (ACOs), many have acknowledged the potential synergy between ACOs and health information technology (IT) in meeting quality and cost goals. Objective: We conducted a systematic review of the literature in order to describe what research has been conducted at the intersection of health IT and ACOs and identify directions for future research. Methods: We identified empirical studies discussing the use of health IT via PubMed search with subsequent snowball reference review. The type of health IT, how health IT was included in the study, use of theory, population, and findings were extracted from each study. Results: Our search resulted in 32 studies describing the intersection of health IT and ACOs, mainly in the form of electronic health records and health information exchange. Studies were divided into three streams by purpose; those that considered health IT as a factor for ACO participation, health IT use by current ACOs, and ACO performance as a function of health IT capabilities. Although most studies found a positive association between health IT and ACO participation, studies that address the performance of ACOs in terms of their health IT capabilities show more mixed results. Conclusions: In order to better understand this emerging relationship between health IT and ACO performance, we propose future research should consider more quasi-experimental studies, the use of theory, and merging health, quality, cost, and health IT use data across ACO member organizations.

背景:自问责制医疗组织(ACOs)成立以来，许多人已经认识到ACOs与卫生信息技术(IT)在满足质量和成本目标方面的潜在协同作用。目的:我们对文献进行了系统的回顾，以描述在健康信息技术和ACOs交叉领域进行的研究，并确定未来的研究方向。方法:我们通过PubMed搜索和随后的滚雪球参考综述确定了讨论卫生IT使用的实证研究。从每项研究中提取健康信息技术的类型、健康信息技术如何纳入研究、理论的使用、人群和研究结果。结果:我们检索了32项描述健康信息技术和ACOs交叉的研究，主要以电子健康记录和健康信息交换的形式出现。研究按目的分为三类;认为健康信息技术是影响ACO参与、当前ACO使用健康信息技术以及ACO绩效是健康信息技术能力的一个因素的研究。尽管大多数研究发现医疗信息技术与辅助医疗服务参与之间存在正相关关系，但针对辅助医疗服务组织在医疗信息技术能力方面的表现进行的研究显示出更为复杂的结果。结论:为了更好地理解医疗信息技术与助理医生绩效之间的这种新兴关系，我们建议未来的研究应该考虑更多的准实验研究，运用理论，并整合跨助理医生成员组织的健康、质量、成本和医疗信息技术使用数据。

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引用次数: 7

Validation of Algorithms Used to Identify Red Blood Cell Transfusion Related Admissions in Veteran Patients with End Stage Renal Disease. 用于识别终末期肾病退伍军人患者红细胞输血相关入院的算法验证

EGEMS (Washington, DC)

Pub Date : 2019-07-03 DOI: 10.5334/egems.257

Celena B Peters, Jared L Hansen, Ahmad Halwani, Monique E Cho, Jianwei Leng, Tina Huynh, Zachary Burningham, John Caloyeras, Tara Matsuda, Brian C Sauer

Background: The goal of this study was to compare the performance of several database algorithms designed to identify red blood cell (RBC) Transfusion Related hospital Admissions (TRAs) in Veterans with end stage renal disease (ESRD).

Methods: Hospitalizations in Veterans with ESRD and evidence of dialysis between 01/01/2008 and 12/31/2013 were screened for TRAs using a clinical algorithm (CA) and four variations of claims-based algorithms (CBA 1-4). Criteria were implemented to exclude patients with non-ESRD-related anemia (e.g., injury, surgery, bleeding, medications known to produce anemia). Diagnostic performance of each algorithm was delineated based on two clinical representations of a TRA: RBC transfusion required to treat ESRD-related anemia on admission regardless of the reason for admission (labeled as TRA) and hospitalization for the primary purpose of treating ESRD-related anemia (labeled TRA-Primary). The performance of all algorithms was determined by comparing each to a reference standard established by medical records review. Population-level estimates of classification agreement statistics were calculated for each algorithm using inverse probability weights and bootstrapping procedures. Due to the low prevalence of TRAs, the geometric mean was considered the primary measure of algorithm performance.

Results: After application of exclusion criteria, the study consisted of 12,388 Veterans with 26,672 admissions. The CA had a geometric mean of 90.8% (95% Confidence Interval: 81.8, 95.6) and 94.7% (95% CI: 80.5, 98.7) for TRA and TRA-Primary, respectively. The geometric mean for the CBAs ranged from 60.3% (95% CI: 53.2, 66.9) to 91.8% (95% CI: 86.9, 95) for TRA, and from 80.7% (95% CI: 72.9, 86.7) to 96.7% (95% CI: 94.1, 98.2) for TRA-Primary. The adjusted proportions of admissions classified as TRAs was 3.2% (95% CI: 2.8, 3.8) and TRA-Primary was 1.3% (95% CI: 1.1, 1.7).

Conclusions: The CA and select CBAs were able to identify TRAs and TRA-primary with high levels of accuracy and can be used to examine anemia management practices in ESRD patients.

背景:本研究的目的是比较几种数据库算法的性能，这些算法设计用于识别终末期肾病(ESRD)退伍军人的红细胞(RBC)输血相关住院(TRAs)。方法:使用临床算法(CA)和四种基于索赔的算法(CBA 1-4)筛选2008年1月1日至2013年12月31日期间住院的ESRD退伍军人和透析证据。实施标准以排除非esrd相关性贫血(例如，损伤、手术、出血、已知导致贫血的药物)的患者。每种算法的诊断性能是基于TRA的两种临床表现来描述的:入院时治疗esrd相关贫血所需的红细胞输血，而不管入院原因(标记为TRA)和住院治疗esrd相关贫血的主要目的(标记为TRA- primary)。所有算法的性能都是通过与医疗记录审查建立的参考标准进行比较来确定的。使用逆概率权重和自举程序计算每种算法的分类协议统计的总体水平估计。由于TRAs的发生率较低，几何平均值被认为是算法性能的主要衡量标准。结果:应用排除标准后，该研究包括12,388名退伍军人，26,672名入院。TRA和TRA- primary的几何平均CA分别为90.8%(95%可信区间:81.8,95.6)和94.7% (95% CI: 80.5, 98.7)。TRA的cba几何平均值为60.3% (95% CI: 53.2, 66.9)至91.8% (95% CI: 86.9, 95)， TRA- primary的cba几何平均值为80.7% (95% CI: 72.9, 86.7)至96.7% (95% CI: 94.1, 98.2)。经调整后归类为tra的入院比例为3.2% (95% CI: 2.8, 3.8)， TRA-Primary为1.3% (95% CI: 1.1, 1.7)。结论:CA和精选cba能够以高水平的准确性识别TRAs和TRA-primary，可用于检查ESRD患者的贫血管理实践。

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引用次数: 2

Moving Ahead: What's Next for the eGEMs Community. 前进:eGEMs社区的下一步是什么?

EGEMS (Washington, DC)

Pub Date : 2019-05-16 DOI: 10.5334/egems.313

Paul Wallace

eGEMs, in close partnership with our key sponsor and publisher, AcademyHealth, has provided a window to the transformational impact of electronic health data (EHD) on how we pursue health and deliver healthcare. This commentary traces key milestones in that journey and announces the next chapter for this community and the critical work it produces.

eGEMs与我们的主要赞助商和出版商AcademyHealth密切合作，为电子健康数据(EHD)对我们如何追求健康和提供医疗保健的变革性影响提供了一个窗口。这篇评论追溯了这段旅程中的关键里程碑，并宣布了这个社区的下一个篇章以及它所产生的关键工作。

引用次数: 1