Big Data Word Scramble

The Importance of Health Insurance Claims Data in Creating Learning Health Systems: Evaluating Care for High-Need High-Cost Patients Using the National Patient-Centered Clinical Research Network (PCORNet)

The Importance of Health Insurance Claims Data in Creating Learning Health Systems: Evaluating Care for High-Need High-Cost Patients Using the National Patient-Centered Clinical Research Network (PCORNet)

Case management programs for high-need high-cost patients are spreading rapidly among health systems. PCORNet has substantial potential to support learning health systems in rapidly evaluating these programs, but access to complete patient data on health care utilization is limited as PCORNet is based on electronic health records not health insurance claims data. Because matching cases to comparison patients on baseline utilization is often a critical component of high-quality observational comparative effectiveness research for high-need high-cost patients, limited access to claims may negatively affect the quality of the matching process. A team of authors including HIP Investigators Dr. Maureen Smith and Dr. Menggang Yu sought to determine whether the evaluation of programs for high-need high-cost patients required claims data to match cases to comparison patients.

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NNT vs number referred

Training and Interpreting Machine Learning Algorithms to Evaluate Fall Risk After Emergency Department Visits

Training and Interpreting Machine Learning Algorithms to Evaluate Fall Risk After Emergency Department Visits

Machine learning is increasingly used for risk stratification in health care. Achieving accurate predictive models do not improve outcomes if they cannot be translated into efficacious intervention. HIP Investigator, Dr. Brian Patterson et al. examined the potential utility of automated risk stratification and referral intervention to screen older adults for fall risk after emergency department visits. This study evaluated several machine learning methodologies for the creation of a risk stratification algorithm using electronic health record data and estimated the effects of a resultant intervention based on algorithm performance in test data.

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Holding hands

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

With the growing cost of health care in the United States, the need to improve efficiency and efficacy has become increasingly urgent. There has been a keen interest in developing interventions to effectively coordinate the typically fragmented care of patients with many comorbidities. Evaluation of such interventions is often challenging given their long-term nature and their differential effectiveness among different patients. Furthermore, care coordination interventions are often highly resource-intensive. Hence there is pressing need to identify which patients would benefit the most from a care coordination program. In this work, Dr. Jared Huling and HIP Investigators Dr. Menggang Yu and Dr. Maureen Smith introduced a subgroup identification procedure for long-term interventions whose effects are expected to change smoothly over time.

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Hospital corridor

The Effects of Discrete Work Shifts on a Nonterminating Service System

The Effects of Discrete Work Shifts on a Nonterminating Service System

Hospital emergency departments (EDs) provide around‐the‐clock medical care, and as such are generally modeled as nonterminating queues. However, from the care provider's point of view, ED care is not a never‐ending process, but rather occurs in discrete work shifts and may require passing unfinished work to the next care provider at the end of the shift. HIP Investigator, Dr. Brian Patterson et al. used data from a large, academic medical center Emergency Department to show that the patients’ rate of service completion varies over the course of the physician shift. Furthermore, patients that have experienced a physician handoff have a higher rate of service completion than nonhanded off patients.

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Patient using tablet

Inpatients Sign On: An Opportunity to Engage Hospitalized Patients and Caregivers Using Inpatient Portals

Inpatients Sign On: An Opportunity to Engage Hospitalized Patients and Caregivers Using Inpatient Portals

Inpatient portals are online patient portals linked to electronic health records that provide hospitalized patients and caregivers secure access to real-time clinical information and tools to enhance their communication with providers and hospital experience. HIP Investigator, Dr. Ryan Coller et al. provided a perspective that inpatient portals are innovative tools poised to engage patients and caregivers during hospitalization and, thus, enhance patient-centered care. This article highlights the potential of using inpatient portals to engage hospitalized patients and caregivers and proposes next steps to evaluate this emerging technology.

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Female doctor with child

Encounters From Device Complications Among Children With Medical Complexity

Encounters From Device Complications Among Children With Medical Complexity

Children with medical complexity (CMC) are commonly assisted by medical devices to support essential body functions, although complications may lead to preventable emergency department (ED) and hospital use. HIP Investigator, Dr. Ryan Coller et al. identified predictors of device-complicated ED visits and hospitalizations. The team of authors found that device-complicated ED visits and hospitalizations comprised a substantial proportion of total hospital and ED use. Developing interventions to prevent device complications may be a promising strategy to reduce overall CMC use.

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Doctor at computer

Secure Provider-to-Provider Communication With Electronic Health Record Messaging: An Educational Outreach Study.

Secure Provider-to-Provider Communication With Electronic Health Record Messaging: An Educational Outreach Study.

With increasing electronic health record (EHR) use, providers are talking with one another less. Now, many rely on EHRs, informal emails, or texts, introducing fragmentation and new data security challenges with new communication strategies. HIP Investigator, Dr. Christie Bartels et al. aimed to examine the impact of a physician champion educational outreach intervention to promote electronic provider-to-provider communication in a large academic multispecialty group. Physician champion educational outreach increased the use of the secure provider-to-provider EHR messaging tool.

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Doctors working around table

Optimal treatment assignment to maximize expected outcome with multiple treatments.

Optimal treatment assignment to maximize expected outcome with multiple treatments.

When there is substantial heterogeneity of treatment effectiveness, it is crucial to identify individualized treatment assignment rules for comparative treatment selection. HIP Investigator, Dr. Menggang Yu et al. propose an outcome weighted learning method that extends estimating individualized treatment rules to multi‐treatment case by using a vector hinge loss as a target function. Consistency of the resulting estimator is shown in the article.

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Doctor with patient

Inpatient Portals for Hospitalized Patients and Caregivers: A Systematic Review.

Inpatient Portals for Hospitalized Patients and Caregivers: A Systematic Review.

Patient portals, web-based personal health records linked to electronic health records (EHRs), provide patients access to their healthcare information and facilitate communication with providers. A team of authors, including HIP Investigator Dr. Ryan Coller, conducted a systematic review of the literature evaluating the design, use, and impact of inpatient portals, which are patient portals designed to give hospitalized patients and caregivers inpatient EHR clinical information for the purpose of engaging them in hospital care.

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Asian doctor with computer

Scope and Influence of Electronic Health Record-Integrated Clinical Decision Support in the Emergency Department.

Scope and Influence of Electronic Health Record-Integrated Clinical Decision Support in the Emergency Department.

Widespread adoption of electronic health records offers an unprecedented opportunity to apply informatics techniques to clinical and operational data. As electronic health records evolve, integration of computerized clinical decision support offers the promise of sorting, collecting, and presenting this information to improve patient care. HIP Investigator, Dr. Brian Patterson et al. conducted a systematic review to examine the scope and influence of electronic health record-integrated clinical decision support technologies implemented in the emergency department.

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