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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. HIP Investigator, Dr. Maureen Smith and team (including HIP Investigator, 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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Yao Liu with camera

Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA

Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA

Teleophthalmology is an evidence-based form of diabetic eye screening. This technology has been proven to substantially increase diabetic eye screening rates and decrease blindness. However, teleophthalmology implementation remains limited among U.S. health systems. In this paper, HIP Investigator Dr. Yao Liu et al. discuss opportunities to address key barriers to widespread implementation of teleophthalmology programs for diabetic eye screening in the United States (U.S.).

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Elderly person falling

Using the Hendrich II inpatient fall risk screen to predict outpatient falls after ED visits

Using the Hendrich II inpatient fall risk screen to predict outpatient falls after ED visits

Dr. Brian Patterson et al. used electronic health record data to evaluate whether routinely collected Hendrich II fall scores can predict returns to the emergency department (ED) for falls within 6 months. The investigators found that using the score alone, the odds of returning to the ED for a fall in 6 months were 1.23 times as high for every 1-point increase in the Hendrich II score. When routinely collected data on other fall risk factors was combined with the fall risk score, the screening performed much better. 

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File folder marked "Claims" in front of computer keyboard

Can claims data algorithms identify the physician of record?

Can claims data algorithms identify the physician of record?

Eva DuGoff and co-authors investigated the agreement of primary care providers (PCPs) identified by claims algorithms and in EHR data. This study looked at Medicare fee-for-service beneficiaries with diabetes age 65+ and found agreement was higher for algorithms based on primary care visits. The algorithms perform less well among vulnerable populations and those experiencing fragmented care.

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Brainstorming with sticky notes

Bridging clinical researcher perceptions and health IT realities: A case study of stakeholder creep

Bridging clinical researcher perceptions and health IT realities: A case study of stakeholder creep

In an article co-authored by Drs. Edmond Ramly and Christie Bartels, the investigators describe "stakeholder creep," which resulted in a 3-month delay in go-live and increased work hours in a health information technology implementation project. The authors define stakeholder creep as not thoroughly identifying which stakeholders need to be involved and why before starting the project, and consequently not understanding the truee effort, skill sets, social capital, and time required to complete the project. In a root cause analysis, the team identified four main misconceptions that contributed to stakeholder creep. They developed a stakeholder planning tool, described in the article, that was perceived to be feasible and helpful in mitigating the effect of stakeholder creep.

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Mobile phone

Implementing a mobile health system to integrate the treatment of addiction into primary care

Implementing a mobile health system to integrate the treatment of addiction into primary care

Dr. Andrew Quanbeck et al. implemented a mobile health (mHealth) system to help treat patients with substance use disorders. The investigators evaluated the effect of the system on patients and clinicians using the RE-AIM framework and found that the system improved care among primary care patients with substance use disorders and that patients using the system supported one another in their recovery. However, among clinicians, use of the technology was less robust than the use by patients, and ongoing funding and lack of availibility of the data in the electronic health record were challenges.

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Young adult browsing the web

MyHEART: Development & dissemination of a patient-centered website for young adults with hypertension

MyHEART: Development & dissemination of a patient-centered website for young adults with hypertension

In this article, Dr. Heather Johnson and team discuss the development of the MyHEART website and toolkit for young adults with hypertension. The website and toolkit were implemented successfully with input from community and healthcare stakeholders to provide evidence-based education to a hard-to-reach population.

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Elderly woman fall

Using chief complaint in addition to diagnosis codes to identify falls in the ED

Using chief complaint in addition to diagnosis codes to identify falls in the ED

Dr. Brian Patterson et al. compared the incidence of falls in an emergency department cohort using ICD-9 codes and an expanded definition that included chief complaint. Of the falls evaluated in the retrospective electronic health record review, 80% met the ICD-9 definition of a fall-related visit and 61% met the chief-complaint definition. Nearly 20% were missed when applying the ICD-9 definition alone. 

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Person working on laptop

Approaches and challenges to optimising primary care teams' electronic health record usage

Approaches and challenges to optimising primary care teams' electronic health record usage

The UW PATH collaborative examined the approaches used and challenges perceived by analysts supporting the optimization of primary care teams' EHR use at a large U.S. academic health system. Analysts and their supervisor were interviewed and data were analyzed for themes. Dedicated optimization analysts can add value to health systems through playing a mediating role between health information technology leadership and care teams. EHR optimization should be performed with an understanding of workflow, cognitive and interactional activities in primary care.

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