Proceedings / AMIA ... Annual Symposium. AMIA Symposium
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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.
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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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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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Automated physiologic event detection and alerting is a challenging task in the ICU. Ideally care providers should be alerted only when events are clinically significant and there is opportunity for corrective action. However, the concepts of clinical significance and opportunity are difficult to define in automated systems, and effectiveness of alerting algorithms is difficult to measure. ⋯ During a 6-month test period in the trauma ICU at Vanderbilt University Medical Center, 530 alerts were detected in 2280 hours of data spanning 14 patients. Clinical users electronically documented 81% of these alerts as they occurred. Retrospectively classifying documentation based on therapeutic actions taken, or reasons why actions were not taken, provided useful information about ways to potentially improve event definitions and enhance system utility.
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Comparative Study
A comparison of communication needs of charge nurses in two operating room suites.
To achieve the potential inherent in the use of computer applications in distributed environments, we need to understand the information needs of users. Communication is the method by which information is transferred and is essential for all organizational interaction. The primary goal of operating room coordination is to insure the prompt, safe, and effective care of surgical patients. ⋯ A data collection tool was developed to record: 1) the purpose of the communication, 2) mode of communication, 3) the target individual, and 4) the length of time taken for each occurrence. The chosen data collection categories provided a functional structure for data collection and analysis involving communication. Study findings are discussed within the context of opportunities for application design