Dataset Information

Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer.

ABSTRACT:

Background

Strategies to ensure timely diagnostic evaluation of hematuria are needed to reduce delays in bladder cancer diagnosis.

Objective

To evaluate the performance of electronic trigger algorithms to detect delays in hematuria follow-up.

Methods

We developed a computerized trigger to detect delayed follow-up action on a urinalysis result with high-grade hematuria (>50 red blood cells/high powered field). The trigger scanned clinical data within a Department of Veterans Affairs (VA) national data repository to identify all patient records with hematuria, then excluded those where follow-up was unnecessary (e.g., terminal illness) or where typical follow-up action was detected (e.g., cystoscopy). We manually reviewed a randomly-selected sample of flagged records to confirm delays. We performed a similar analysis of records with hematuria that were marked as not delayed (non-triggered). We used review findings to calculate trigger performance.

Results

Of 310,331 patients seen between 1/1/2012-12/31/2014, the trigger identified 5,857 patients who experienced high-grade hematuria, of which 495 experienced a delay. On manual review of 400 randomly-selected triggered records and 100 non-triggered records, the trigger achieved positive and negative predictive values of 58% and 97%, respectively.

Conclusions

Triggers offer a promising method to detect delays in care of patients with high-grade hematuria and warrant further evaluation in clinical practice as a means to reduce delays in bladder cancer diagnosis.

SUBMITTER: Murphy DR

PROVIDER: S-EPMC5373770 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Publications

Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer.

Murphy Daniel R DR Meyer Ashley N D AN Vaghani Viralkumar V Russo Elise E Sittig Dean F DF Richards Kyle A KA Wei Li L Wu Louis L Singh Hardeep H

Applied clinical informatics 20170322 1

<h4>Background</h4>Strategies to ensure timely diagnostic evaluation of hematuria are needed to reduce delays in bladder cancer diagnosis.<h4>Objective</h4>To evaluate the performance of electronic trigger algorithms to detect delays in hematuria follow-up.<h4>Methods</h4>We developed a computerized trigger to detect delayed follow-up action on a urinalysis result with high-grade hematuria (>50 red blood cells/high powered field). The trigger scanned clinical data within a Department of Veterans ...[more]

PMID: 28326433

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Project description:ObjectivesThis study sought to describe characteristics and risk of adverse outcomes associated with the H2FPEF and HFA-PEFF scores among participants in the community with unexplained dyspnea.BackgroundDiagnosing heart failure with preserved ejection fraction (HFpEF) can be challenging. The H2FPEF and HFA-PEFF scores have recently been developed to estimate the likelihood that HFpEF is present among patients with unexplained dyspnea.MethodsThe study included 4,892 ARIC (Atherosclerosis Risk In Communities) study participants 67 to 90 years of age at visit 5 (2011 to 2013) without other common cardiopulmonary causes of dyspnea. Participants were categorized as asymptomatic (76.6%), having known HFpEF (10.3%), and having tertiles of each score among those with ≥moderate, self-reported dyspnea (13.1%). The primary outcome was heart failure (HF) hospitalization or death.ResultsMean age was 75 ± 5 years, 58% were women, and 22% were black. After a mean follow-up of 5.3 ± 1.2 years, rates of HF hospitalization or death per 1,000 person-years for asymptomatic and known HFpEF were 20.7 (95% confidence interval [CI]: 18.9 to 22.7) and 71.6 (95% CI: 61.6 to 83.3), respectively. Among 641 participants with unexplained dyspnea, rates were 27.7 (95% CI: 18.2 to 42.1), 44.9 (95% CI: 34.9 to 57.7), and 47.3 (95% CI: 36.5 to 61.3) (tertiles of H2FPEF score) and 31.8 (95% CI: 20.3 to 49.9), 32.4 (95% CI: 23.4 to 44.9), and 54.3 (95% CI: 43.8 to 67.3) (tertiles of HFA-PEFF score). Participants with unexplained dyspnea and scores above the diagnostic threshold suggested for each algorithm, H2FPEF score ≥6 and HFA-PEFF score ≥5, had equivalent risk of HF hospitalization or death compared with known HFpEF. Among those with unexplained dyspnea, 28% had "discordant" findings (only high risk by 1 algorithm), while 4% were high risk by both.ConclusionsParticipants with unexplained dyspnea and higher H2FPEF or HFA-PEFF scores face substantial risks of HF hospitalization or death. A significant fraction of patients are classified discordantly by using both algorithms.

Dataset Information

Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer.

Background

Objective

Methods

Results

Conclusions

Publications

Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer.

Similar Datasets

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