Proceedings / AMIA ... Annual Symposium. AMIA Symposium
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Collaboration is an important part of healthcare delivery. However, in home care, collaboration is difficult due to the mobility and schedule variability of the workers. ⋯ We present recommendations for incorporating support for each of these areas into point-of-care clinical information systems that provide access to shared patient records. Finally, we discuss general design approaches for incorporating this type of support, including the need for workers to maintain awareness of the activities of others, and the need to integrate communication with the presentation of the health record.
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As part of developing a record linkage algorithm using de-identified patient data, we analyzed the performance of several demographic variables for making linkages between patient registry records from two hospital registries and the Social Security Death Master File. We analyzed samples from each registry totaling 6,000 record-pairs to establish a linkage gold-standard. Using Social Security Number as the exclusive linkage variable resulted in substantial linkage error rates of 4.7% and 9.2%. ⋯ This found 87% and 88% of the links without any false links. We achieved sensitivities of 90% to 92% while maintaining 100% specificity using combinations of social security number, gender, name, and birth date fields. This represents an accurate method for linking patient records to death data and is the basis for a more generalized de-identified linkage algorithm.
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Randomized Controlled Trial Clinical Trial
Health care provider quality improvement organization Medicare data-sharing: a diabetes quality improvement initiative.
This paper describes a collaborative Medicare claims data linkage and sharing effort between the Baylor Health Care System (BHCS) and Texas Medical Foundation (TMF, the Texas Quality Improvement Organization) designed to assess the effect of three quality improvement interventions on care delivered to elderly patients with diabetes. The randomized controlled trial is being conducted among a network of primary care physician practices owned by BHCS and focuses on measures of care process and outcome. ⋯ The use of Medicare claims data, through collaboration with a QIO, can help health care providers overcome a significant barrier associated with quality improvement initiatives. Limitations associated with the use of Medicare claims can impact implementation of intervention strategies, but do not prevent them from being a practical tool for improving care.
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Patient safety assessment in anaesthesia increasingly relies on the monitoring of frequent but merely undesirable events, like hypotension. We report on the design and implementation of such a monitoring system, where 8032 patients were included over a three years period. Thirty two 'Significant Anaesthetic Events' were defined and their occurrence was routinely collected for each patient. ⋯ The system sensitivity to change in the frequency of significant anaesthetic events was investigated by a controlled intervention, designed to increase the incidence of bradycardia by changing anxyolitic medication. During the intervention, the incidence of bradycardia doubled, while the incidence of other undesirable events was not affected. The system described for the collection of significant anaesthetic events was easy to set up, sensitive to changes and provided valuable tools in performance monitoring.
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We present a prototype of a decision support system for anesthesia that applies set covering theory. The system is designed to generate dynamically configured check-lists for intra-operative problems. These lists have the potential to help anesthesiologists detect and manage problems in a timely manner. ⋯ A set covering algorithm that accommodates multiple problem sets was used to implement the prototype. A simulated case and the system behavior are presented. The ultimate goals of a system such as the one presented are to function as an intelligent alarm module for electronic monitors and to facilitate the task of correcting intra-operative problems.