Episodic oral antibiotic use in CF: Discordance between the electronic medical record and self-report.
Ontology highlight
ABSTRACT:
SUBMITTER: Caverly LJ
PROVIDER: S-EPMC5014681 | biostudies-literature | 2016 Sep
REPOSITORIES: biostudies-literature
Publications
Episodic oral antibiotic use in CF: Discordance between the electronic medical record and self-report.
Caverly Lindsay J LJ Caverly Tanner J TJ Kalikin Linda M LM Foster Bridget K BK Simon Richard H RH LiPuma John J JJ
Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society 20160505 5
<h4>Background</h4>Accurate accounting of antibiotic use is necessary for studies comparing the CF airway microbiota across clinically relevant disease states. While poor adherence to chronic therapies is well described for individuals with CF, use patterns of episodic oral antibiotics are less clear.<h4>Methods</h4>Eleven individuals with CF completed daily questionnaires regarding antibiotic use for a mean of 458days. Self-report of episodic oral antibiotic use was compared to antibiotic presc ...[more]
Similar Datasets
Project description:IntroductionSelf-reported measures of healthcare utilisation are often used in longitudinal cohort studies involving older community-dwelling people. The aim of this study is to compare healthcare utilisation rates using patient self-report and manual extraction from the general practice (GP) electronic medical record (EMR).MethodsStudy population: Two prospective cohort studies (n = 806 and n = 1,377, aged ?70 years) conducted in the Republic of Ireland were compared. Study outcomes: GP, outpatient department (OPD) and emergency department (ED) visits over a one-year period. Statistical analysis: Descriptive statistics of the two cohorts are presented. A negative binomial regression was performed and results are presented as incidence rate ratios (IRR) with 95% confidence intervals (CI). For the outcome of any ED visit, linear regression was performed, yielding risk ratios (RR) with 95% CI.ResultsThe annual rates of GP, OPD and ED visits were 6.30 (SD 4.63), 2.11 (SD 2.46) and 0.26 (SD 0.62) respectively in GP EMR cohort, compared to 5.65 (SD 8.06), 2.09 (SD 5.83) and 0.32 (SD 0.84) in the self-report cohort. In univariate regression analysis comparing healthcare utilisation, the self-report cohort reported a lower frequency of GP visits (unadjusted IRR 0.90 (95% CI 0.84, 0.96), p = 0.02)), a greater frequency of ED visits (1.20 (0.98, 1.49), p = 0.083)), and no difference in OPD visits (unadjusted IRR 0.99 (95% CI 0.86, 1.13), p = 0.845)). In multivariate analysis, adjusted for relevant confounders, there was no difference in GP visits (adjusted IRR 0.99 (95% CI 0.92, 1.06), p = 0.684)) or OPD visits (adjusted IRR 1.09 (0.95, 1.25), p = 0.23)) between the two cohorts. However, the self-report cohort reported 37% more ED visits (adjusted IRR 1.37 (1.10, 1.71), p = 0.005)) and were more likely to report any ED visit (adjusted RR 1.23 (95% CI 1.02, 1.48), p = 0.028)).ConclusionsThis study demonstrates that reported rates of GP and OPD visits were similar but there were differences in reported ED visits, with significantly higher self-reported visits. This may be due to ED visits not being notified to the GP and contextual issues such as transfer of healthcare utilisation data between sectors may vary in different healthcare systems.
| S-EPMC6203362 | biostudies-literature
Project description:IntroductionKnowing patients' smoking history helps guide who may benefit from preventive services such as lung cancer screening. The accuracy of smoking history electronic health records remains unclear.MethodsThis was a secondary analysis of data collected from a portal-based lung cancer screening decision aid. Participants of an academically affiliated health system, aged 55-76 years, completed an online survey that collected a detailed smoking history including years of smoking, years since quitting, and smoking intensity. Eligibility for lung cancer screening was defined using the Centers for Medicare and Medicaid Services criteria. Data analysis was performed May-December 2018, and data collection occurred between November 2016 and February 2017.ResultsA total of 336 participants completed the survey and were included in the analysis. Of 175 participants with self-reported smoking intensity, 72% had packs per day and 62% had pack-years recorded in the electronic health record. When present, smoking history in the electronic health records correlated well with self-reported years of smoking (r =0.78, p≤0.0001) and years since quitting (r =0.94, p≤0.0001). Self-reported smoking intensity, including pack-years (r =0.62, p<0.0001) and packs per day (r =0.65, p≤0.0001), was less correlated. Of those participants eligible for lung cancer screening by self-report, only 35% met criteria for screening by electronic health records data alone. Others were either incorrectly classified as ineligible (23%) or had incomplete data (41%).ConclusionsThe electronic health records frequently misses critical elements of a smoking history, and when present, it often underestimates smoking intensity, which may impact who receives lung cancer screening.
| S-EPMC7533103 | biostudies-literature
Project description:BackgroundElectronic Medical Records (EMRs) are one of a range of digital health solutions that are key enablers of the data revolution transforming the health sector. They offer a wide range of benefits to health professionals, patients, researchers and other key stakeholders. However, effective implementation has proved challenging.MethodsA qualitative methodology was used in the study. Interviews were conducted with 12 clinical and administrative staff of a cancer centre at one-month pre-launch and eight clinical and administrative staff at 12-months post-launch of an EMR. Data from the interviews was collected via audio recording. Audio recordings were transcribed, de-identified and analysed to identify staff experiences with the EMR.ResultsData from the pre-implementation interviews were grouped into four categories: 1) Awareness and understanding of EMR; 2) Engagement in launch process; 3) Standardisation and completeness of data; 4) Effect on workload. Data from the post-launch interviews were grouped into six categories: 1) Standardisation and completeness of data; 2) Effect on workload; 3) Feature completeness and functionality; 4) Interaction with technical support; 5) Learning curve; 6) Buy-in from staff. Two categories: Standardisation and completeness of data and effect on workload were common across pre and post-implementation interviews.ConclusionFindings from this study contribute new knowledge on barriers and enablers to the implementation of EMRs in complex clinical settings. Barriers to successful implementation include lack of technical support once the EMR has launched, health professional perception the EMR increases workload, and the learning curve for staff adequately familiarize themselves with using the EMR.
| S-EPMC7789279 | biostudies-literature
Project description:Comorbidity is an important adjustment measure in research focusing on outcomes such as health status and mortality. One recurrent methodological issue concerns the concordance of comorbidity data obtained from different reporting sources. The purpose of these prospectively planned analyses was to examine the concordance of comorbidity data obtained from patient self-report survey interviews and hospital medical record documentation.Comorbidity data were obtained using survey interviews and medical record entries from 525 hospitalized Acute Coronary Syndrome patients. Frequencies and descriptive statistics of individual and composite comorbidity data from both sources were completed. Individual item agreement was evaluated with simple and weighted kappas, Spearman Rho coefficients for composite scores.On average, patients reported more comorbidities during their patient survey interviews (mean = 1.78, SD = 1.99) than providers had documented in medical records (mean = 1.27, SD = 1.43). Higher proportions of positive responses were obtained from self-reports compared to medical records for all conditions except congestive heart failure and renal disease. Older age and higher depressive symptom levels were significantly associated with poorer levels of data concordance.These results demonstrate that survey comorbidity data from ACS patients may not be entirely concordat with medical record documentation. In the absence of a gold standard, it is possible that hospital records did not include all pre-admission comorbidities and these patient survey interview methods may need to be refined. Self-report methods to facilitate some patients' complete recall of comorbid conditions may need to be refined by health services researchers.ClinicalTrials.gov NCT00416026.
| S-EPMC2346463 | biostudies-other
Project description:To characterize patterns of electronic medical record (EMR) use at pediatric primary care acute visits.Direct observational study of 529 acute visits with 27 experienced pediatric clinician users.For each 20 s interval and at each stage of the visit according to the Davis Observation Code, we recorded whether the physician was communicating with the family only, using the computer while communicating, or using the computer without communication. Regression models assessed the impact of clinician, patient and visit characteristics on overall visit length, time spent interacting with families, and time spent using the computer while interacting.The mean overall visit length was 11:30 (min:sec) with 9:06 spent in the exam room. Clinicians used the EMR during 27% of exam room time and at all stages of the visit (interacting, chatting, and building rapport; history taking; formulation of the diagnosis and treatment plan; and discussing prevention) except the physical exam. Communication with the family accompanied 70% of EMR use. In regression models, computer documentation outside the exam room was associated with visits that were 11% longer (p=0.001), and female clinicians spent more time using the computer while communicating (p=0.003).The 12 study practices shared one EMR.Among pediatric clinicians with EMR experience, conversation accompanies most EMR use. Our results suggest that efforts to improve EMR usability and clinician EMR training should focus on use in the context of doctor-patient communication. Further study of the impact of documentation inside versus outside the exam room on productivity is warranted.
| S-EPMC3005866 | biostudies-other
Project description:Introduction:The adoption of electronic health records (EHRs) presents new challenges for information gathering, documentation, and patient care. Medical students spend a significant amount of time using the EHR during their clerkship experiences and will continue to do so as they progress to residency. However, formal training varies between institutions and leaves gaps in data-gathering skills, documentation skills, and order entry-these three skills formed the basis for our learning objectives. We designed a workshop using a simulated EHR to teach these skills. Methods:We offered the workshop during a class-wide transition-to-internship course for senior medical students. After a brief didactic, students worked in small groups using a simulated EHR to complete cases addressing each of the three learning objectives. Faculty facilitators assisted groups and then guided a large-group discussion of the challenges encountered during the cases. Results:Twenty-five senior medical students attended the first optional workshop. Of these students, 66.7% recommended that the workshop continue to be included in the curriculum. Comments from those who recommended otherwise suggested that many of them would recommend the workshop if it used our local EHR (Epic). Correct answers to the factual questions increased for most questions between the pretest and the posttest. Confidence to perform all skills targeted in the learning objectives increased between the pretest and the posttest. Discussion:This EHR workshop was well received by senior medical students and increased confidence in EHR skills, including data gathering, documentation, and handling unsolicited information with a plan including order entry.
| S-EPMC6946580 | biostudies-literature
Project description:Ambulatory providers were administered an EHR skills self-assessment survey to assess their confidence in learning about and using the electronic health record (EHR). Seventy-one providers participated. Only 35% of respondents felt that they had strong EHR skills, 92% felt confident that they could learn new skills, and 90% felt they could improve with practice. Forty-five percent of faculty physicians felt confident that they could use the EHR in a time-efficient manner and 52% felt could keep up with advances but 16% felt apprehensive about using the EHR. Ninety-four percent of faculty would welcome opportunities to learn more. These results suggest that most providers view using the EHR as a clinical skill they can master with training and practice and that physicians may be engaged by EHR training programs that focus on the use of the EHR as a clinical skill. This work has informed new training programs at our institution.
| S-EPMC8423415 | biostudies-literature
Project description:Composite models that combine medical imaging with electronic medical records (EMR) improve predictive power when compared to traditional models that use imaging alone. The digitization of EMR provides potential access to a wealth of medical information, but presents new challenges in algorithm design and inference. Previous studies, such as Phenome Wide Association Study (PheWAS), have shown that EMR data can be used to investigate the relationship between genotypes and clinical conditions. Here, we introduce Phenome-Disease Association Study to extend the statistical capabilities of the PheWAS software through a custom Python package, which creates diagnostic EMR signatures to capture system-wide co-morbidities for a disease population within a given time interval. We investigate the effect of integrating these EMR signatures with radiological data to improve diagnostic classification in disease domains known to have confounding factors because of variable and complex clinical presentation. Specifically, we focus on two studies: First, a study of four major optic nerve related conditions; and second, a study of diabetes. Addition of EMR signature vectors to radiologically derived structural metrics improves the area under the curve (AUC) for diagnostic classification using elastic net regression, for diseases of the optic nerve. For glaucoma, the AUC improves from 0.71 to 0.83, for intrinsic optic nerve disease it increases from 0.72 to 0.91, for optic nerve edema it increases from 0.95 to 0.96, and for thyroid eye disease from 0.79 to 0.89. The EMR signatures recapitulate known comorbidities with diabetes, such as abnormal glucose, but do not significantly modulate image-derived features. In summary, EMR signatures present a scalable and readily applicable.
| S-EPMC6844192 | biostudies-literature
Project description:BackgroundUnnecessary antibiotic use in the community in Canada is not well defined. Our objective was to quantify unnecessary antibiotic prescribing in a Canadian primary care setting.MethodsWe performed a descriptive analysis in Ontario from April 2011 to March 2016 using the Electronic Medical Records Primary Care database linked to other health administrative data sets at ICES. We determined antibiotic prescribing rates (per 100 patient-physician encounters) for 23 common conditions and estimated rates of unnecessary prescribing using predefined expected prescribing rates, both stratified by condition and patient age group.ResultsThe study included 341 physicians, 204 313 patients and 499 570 encounters. The rate of unnecessary antibiotic prescribing for included conditions was 15.4% overall and was 17.6% for those less than 2 years of age, 18.6% for those aged 2-18, 14.5% for those aged 19-64 and 13.0% for those aged 65 or more. The highest unnecessary prescribing rates were observed for acute bronchitis (52.6%), acute sinusitis (48.4%) and acute otitis media (39.3%). The common cold, acute bronchitis, acute sinusitis and miscellaneous nonbacterial infections were responsible for 80% of the unnecessary antibiotic prescriptions. Of all antibiotics prescribed, 12.0% were for conditions for which they are never indicated, and 12.3% for conditions for which they are rarely indicated. In children, 25% of antibiotics were for conditions for which they are never indicated (e.g., common cold).InterpretationAntibiotics were prescribed unnecessarily for 15.4% of included encounters in a Canadian primary care setting. Almost one-quarter of antibiotics were prescribed for conditions for which they are rarely or never indicated. These findings should guide safe reductions in the use of antibiotics for the common cold, bronchitis and sinusitis.
| S-EPMC7207032 | biostudies-literature
Project description:OBJECTIVE:This study sought to quantitatively characterize medical students' expectations and experiences of an electronic health record (EHR) system in a hospital setting, and to examine perceived and actual impacts on learning. METHODS:Medical students from July to December 2016 at a tertiary pediatric institution completed pre- and postrotation surveys evaluating their expectations and experience of using an EHR during a pediatric medicine rotation. Survey data included past technology experience, EHR accessibility, use of learning resources, and effect on learning outcomes and patient-clinician communication. RESULTS:Students generally reported high computer self-efficacy (4.16 ± 0.752, mean ± standard deviation), were comfortable with learning new software (4.08 ± 0.771), and expected the EHR to enhance their overall learning (4.074 ± 0.722). Students anticipated the EHR to be easy to learn, use, and operate, which was consistent with their experience (pre 3.86 vs. post 3.90, p = 0.56). Students did not expect nor experience that the EHR reduced their interaction, visual contact, or ability to build rapport with patients. The EHR did not meet expectations to facilitate learning around medication prescribing, placing orders, and utilizing online resources. Students found that the EHR marginally improved feedback surrounding clinical contributions to patient care from clinicians, although not to the expected levels (pre 3.50 vs. post 3.17, p < 0.01). CONCLUSION:Medical students readily engaged with the EHR, recognized several advantages in clinical practice, and did not consider their ability to interact with patients was impaired. There was widespread consensus that the EHR enhanced their learning and clinician's feedback, but not to the degree they had expected.
| S-EPMC6221827 | biostudies-other