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The use of administrative data to assess quality of care for bipolar disorder in a large staff model HMO

GENERAL HOSPITAL PSYCHIATRY 2000年第1期22卷 1-10页

作者： Unützer, J Simon, G Pabiniak, C Bond, K Katon, W Univ Calif Los Angeles Inst Neuropsychiat Ctr Hlth Serv Res Los Angeles CA 90024 USA Grp Hlth Cooperat Puget Sound Ctr Hlth Studies Seattle WA 98121 USA Univ Washington Dept Psychiat & Behav Sci Seattle WA 98195 USA

We examined patterns of care for 1246 adults treated for bipolar disorder in a large health maintenance organization. Computerized pharmacy and visit data were used to identify patients treated for bipolar disorder. Automated medical records for the following year were used to assess continuity and nosing of treatment with mood stabilizers, laboratory monitoring for adverse effects and therapeutic serum levels, and frequency of follow-up visits. Of our 1246 subjects 83% filled a mood stabilizer prescription during the 1-year study period, and doses were within recommended ranges 80% of the rime. Over 75% of the patients on mood stabilizers had at least one apparent interruption in medication use. Approximately half of the long-term users of mood stabilizers had at least one 7-month period without a recorded blood level and approximately half had a similar period without monitoring for adverse medication effects. Of the 116 subjects discharged from a psychiatric hospitalization 58% had a visit with a psychiatrist or a psychiatric nurse practitioner within 30 days. Of those discontinuing mood stabilizer treatment 68% made a mental health visit within 90 days. Our findings demonstrate the feasibility of using administrative data systems for population-based qualify of care assessment and suggest opportunities for improving the care of bipolar patients. (C) 2000 Elsevier Science Inc.

关键词：抗躁狂药/副作用抗躁狂药/药代动力学抗躁狂药/治疗应用双相情感障碍/血液双相情感障碍/药物疗法数据收集/统计学和数值数据药物监测/统计学和数值数据可行性研究健康维护组织/组织和管理病案系统计算机化/统计学和数值数据病人医疗小组/统计学和数值数据质量保证卫生保健/统计学和数值数据华盛顿青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Comparing methods to identify general internal medicine clinic patients with chronic heart failure

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AMERICAN HEART JOURNAL 2001年第6期142卷 1003-1009页

作者： Udris, EM Au, DH McDonell, MB Chen, LW Martin, DC Tierney, WM Fihn, SD Vet Affairs Puget Sound Hlth Care Syst NW Hlth Serv Res & Dev Ctr Excellence Seattle WA 98108 USA Univ Washington Dept Med Seattle WA USA Univ Rochester Dept Med Div Cardiol Rochester NY USA Richard L Roudebush Vet Affairs Med Ctr Hlth Serv Res & Dev Program Indianapolis IN USA Indiana Univ Sch Med Dept Med Div Gen Internal Med & Geriatr Indianapolis IN USA

Objectives Identification of patients with left ventricular systolic dysfunction is the first step in identifying which patients may benefit from clinical practice guidelines. The purpose of this study was to develop and validate a computerized tool using clinical information that is commonly available to identify patients with left ventricular systolic dysfunction (LVSD). Methods We performed a cross-sectional study of patients seen in a Department of Veterans Affairs General Internal Medicine Clinic who had echocardiography or radionuclide ventriculography performed as part of their clinical care. Results We identified 2246 subjects who had at least one cardiac imaging study. A total of 778 (34.6%) subjects met study criteria for LVSD. Subjects with LVSD were slightly older than subjects without LVSD (70 years vs 68 years, P = .00002) but were similar with regard to sex and race. Subjects with LVSD were more likely to have prescriptions for angiotensin-converting enzyme (ACE) inhibitors, carvedilol, digoxin, loop diuretics, hydralazine, nitrates, and angiotensin II receptor antagonists. Of the variables included in the final predictive model, ACE inhibitors, loop diuretics, and digoxin exerted the greatest predictive power. Discriminant analysis demonstrated that models containing pharmacy information were consistently more accurate (75% accurate [65% sensitivity, 81% specificity]) than those models that contained only International Classification of Diseases, 9th revision (ICD-9), codes, including ICD-9 codes for congestive heart failure (72% accurate [80% sensitivity, 68% specificity]). Conclusions We demonstrated that an automated, computer-driven algorithm identifying LVSD permits simple, rapid, and timely identification of patients with congestive heart failure by use of only routinely collected data. Future research is needed to develop accurate electronic identification of heart failure and other common chronic conditions.

关键词：心血管疾病/药物疗法心血管疾病/流行病学卡方分布共病现象计算机模拟横断面研究数据说明统计判别分析超声心动描记术内科学/统计学和数值数据病案系统计算机化/统计学和数值数据模型统计学试验预期值 ROC曲线放射性核素心室显像术敏感性与特异性美国/流行病学心室功能障碍左/诊断心室功能障碍左/流行病学老年人女(雌)性人类男(雄)性

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Syndromic analysis of computerized emergency department patients' chief complaints: An opportunity for bioterrorism and influenza surveillance

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 447-452页

作者： Irvin, CB Nouhan, PP Rice, K Wayne State Univ Sch Med Dept Emergency Med St John Hosp & Med Ctr Detroit MI USA

Study objective: Emergency department computerized triage logs might be useful for automated ED surveillance and potentially for early identification of bioterrorism events. We describe a Web-based surveillance program and its feasibility for surveillance. Methods: A Web-based surveillance program that receives computerized chief complaint data daily from a large academic urban teaching hospital and performs syndromic analysis on these data was developed. On the basis of preset limits, the Web-based surveillance program sends an alert e-mail message when the syndromic analysis reveals an increase in the number of patients in predefined symptom groups. The feasibility of this system was tested by using historical data during an influenza outbreak (December 1999 to January 2000) and applying the anthrax symptom group. Results: The Web-based surveillance program identified the influenza outbreak in the first week. Conclusion: Computerized triage logs might be a feasible method for bioterrorism and influenza surveillance. The Web-based nature of the surveillance program creates the opportunity for other hospitals to contribute data, potentially resulting in an automated network of ED computerized triage log surveillance.

关键词：医学科学研究中心炭疽/流行病学生物恐怖/统计学和数值数据肉毒中毒/流行病学疾病暴发流行/统计学和数值数据急诊室医院/统计学和数值数据可行性研究医院信息系统/统计学和数值数据医院教学医院市区流感人/流行病学病案系统计算机化/统计学和数值数据密执安/流行病学试点项目鼠疫/流行病学人群监测/方法方案评价敏感性与特异性天花/流行病学伤病员分拣土拉菌病/流行病学人类

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The Society of Thoracic Surgeons National Congenital Heart Surgery Database report: Analysis of the first harvest (1994-1997)

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ANNALS OF THORACIC SURGERY 1999年第2期68卷 601-624页

作者： Mavroudis, C Gevitz, M Ring, WS McIntosh, CL Schwartz, M Childrens Mem Hosp Chicago IL 60614 USA

This analysis summarizes the first report of the Society of Thoracic Surgeons National Congenital Heart Surgery Database Committee in association with Summit Medical Systems. Twenty-four centers joined the program at various dates of entry resulting in 18,894 enrolled patient records. This report compiled the relevant clinical features of 18 congenital heart categories over a 4-year period (1994-1997), which included 8,149 patient records. The data analyses are largely descriptive in character. Missing data points were described and not omitted in the analysis. Statistical analysis was not performed due to missing data points in some categories. Certain trends, however, could be identified and are discussed. The first Society of Thoracic Surgeons National Congenital Heart Surgery Database Report has succeeded in establishing a finite record that can be improved to establish universal national and international utility, risk stratification, and scholarly outcome analyses. (C) 1999 by The Society of Thoracic Surgeons.

关键词：心肺转流术/统计学和数值数据数据说明统计数据库事实型/统计学和数值数据心脏缺损先天性/诊断心脏缺损先天性/流行病学心脏缺损先天性/外科学医院死亡率病案系统计算机化/统计学和数值数据结果与过程评价(卫生保健) 手术后并发症/死亡率危险因素学会医学胸外科学美国青少年儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性

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Computer-based patient records: findings from the HIMSS Leadership Survey.

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Health information management : journal of the Health Information Management Association of Australia 1999年第1期29卷 49-50页

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