المؤلفون: Rodriguez, Hector P, Ciemins, Elizabeth L, Rubio, Karl, Rattelman, Cori, Cuddeback, John K, Mohl, Jeff T, Bibi, Salma, Shortell, Stephen M

المصدر: The American journal of managed care. 29(1)

مصطلحات موضوعية: Humans, Hypertension, Diabetes Mellitus, Telemedicine, Adult, Pandemics, COVID-19, Clinical Research, Rural Health, Health Services, Diabetes, Networking and Information Technology R&D (NITRD), Metabolic and endocrine, Good Health and Well Being, Public Health and Health Services, Health Policy & Services

الوصف: ObjectivesThe COVID-19 pandemic accelerated telemedicine use nationally, but differences across health systems are understudied. We examine telemedicine use for adults with diabetes and/or hypertension across 10 health systems and analyze practice and patient characteristics associated with greater use.Study designEncounter-level data from the AMGA Optum Data Warehouse for March 13, 2020, to December 31, 2020, were analyzed, which included 3,016,761 clinical encounters from 764,521 adults with diabetes and/or hypertension attributed to 1 of 1207 practice sites with at least 50 system-attributed patients.MethodsLinear spline regression estimated whether practice size and ownership were associated with telemedicine during the adoption (weeks 0-4), de-adoption (weeks 5-12), and maintenance (weeks 13-42) periods, controlling for patient socioeconomic and clinical characteristics.ResultsTelemedicine use peaked at 11% to 42% of weekly encounters after 4 weeks. In adjusted analyses, small practices had lower telemedicine use for adults with diabetes during the maintenance period compared with larger practices. Practice ownership was not associated with telemedicine use. Practices with higher proportions of Black patients continued to expand telemedicine use during the de-adoption and maintenance periods.ConclusionsPractice ownership was not associated with telemedicine use during first months of the pandemic. Small practices de-adopted telemedicine to a greater degree than medium and large practices. Technical support for small practices, irrespective of their ownership, could enable telemedicine use for adults with diabetes and/or hypertension.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/8d4333nz

المؤلفون: Rodriguez, Hector P, Ciemins, Elizabeth L, Rubio, Karl, Shortell, Stephen M

المصدر: Health Affairs. 41(3)

مصطلحات موضوعية: Clinical Research, Aging, Health Services, Health and social care services research, 8.1 Organisation and delivery of services, Disputed aetiology and other, Good Health and Well Being, Aged, Fee-for-Service Plans, Group Practice, Humans, Medicare, Patient Care, Physicians, United States, Public Health and Health Services, Applied Economics, Health Policy & Services

الوصف: No research has considered a range of physician practice capabilities for managing patient care when examining practice-level influences on quality of care, utilization, and spending. Using data from the 2017 National Survey of Healthcare Organizations and Systems linked to 2017 Medicare fee-for-service claims data from attributed beneficiaries, we examined the association of practice-level capabilities with process measures of quality, utilization, and spending. In propensity score-weighted mixed-effects regression analyses, physician practice locations with "robust" capabilities had lower total spending compared to locations with "mixed" or "limited" capabilities. Quality and utilization, however, did not differ by practice-level capabilities. Physician practice locations with robust capabilities spend less on Medicare fee-for-service beneficiaries but deliver quality of care that is comparable to the quality delivered in locations with low or mixed capabilities. Reforms beyond those targeting practice capabilities, including multipayer alignment and payment reform, may be needed to support larger performance advantages for practices with robust capabilities.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/52m7f170

المؤلفون: Kelley, Amy S, Hanson, Laura C, Ast, Katherine, Ciemins, Elizabeth L, Dunning, Stephan C, Meskow, Chris, Ritchie, Christine S

المصدر: Journal of Pain and Symptom Management. 62(3)

مصطلحات موضوعية: Health Services, Clinical Research, Patient Safety, Generic health relevance, Good Health and Well Being, Adolescent, Adult, Electronic Health Records, Emergency Service, Hospital, Humans, Information Storage and Retrieval, Medicare, Middle Aged, Palliative Care, United States, Young Adult, Health services research, medicare advantage, palliative care, Medical and Health Sciences, Anesthesiology

الوصف: ContextPalliative care can improve the lives of people with serious illness, yet clear operational definitions of this population do not exist. Prior efforts to identify this population have not focused on Medicare Advantage (MA) and commercial health plan enrollees.ObjectivesWe aimed to operationalize our conceptual definition of serious illness to identify those with serious medical conditions (SMC) among commercial insurance and MA enrollees, and to compare the populations identified through electronic health record (EHR) or claims data sources.MethodsWe used de-identified claims and EHR data from the OptumLabs Data Warehouse (2016-2017), to identify adults age ≥18 with SMC and examine their utilization and mortality. Within the subset found in both data sources, we compared the performance of claims and EHR data.ResultsWithin claims, SMC was identified among 10% of those aged ≥18 (5.4% ages 18-64, 27% age ≥65). Within EHR, SMC was identified among 9% of those aged ≥18 (5.6% ages 18-64, 21% ages ≥65). Hospital, emergency department and mortality rates were similar between the EHR and claims-based groups. Only 50% of people identified as having SMC were recognized by both data sources.ConclusionThese results demonstrate the feasibility of identifying adults with SMC in a commercially insured population, including MA enrollees; yet separate use of EHR or claims result in populations that differ. Future research should examine methods to combine these data sources to optimize identification and support population management, quality measurement, and research to improve the care of those living with serious illness.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/6jj5w0jz

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المؤلفون: Wu, Danny TY, Smart, Nikolas, Ciemins, Elizabeth L, Lanham, Holly J, Lindberg, Curt, Zheng, Kai

مصطلحات موضوعية: Information and Computing Sciences, Information Systems, Health Sciences, Cancer, Networking and Information Technology R&D (NITRD), Clinical Research, Patient Safety, Ambulatory Care Facilities, Clinical Audit, Electronic Health Records, Humans, Workflow

الوصف: To develop a workflow-supported clinical documentation system, it is a critical first step to understand clinical workflow. While Time and Motion studies has been regarded as the gold standard of workflow analysis, this method can be resource consuming and its data may be biased due to the cognitive limitation of human observers. In this study, we aimed to evaluate the feasibility and validity of using EHR audit trail logs to analyze clinical workflow. Specifically, we compared three known workflow changes from our previous study with the corresponding EHR audit trail logs of the study participants. The results showed that EHR audit trail logs can be a valid source for clinical workflow analysis, and can provide an objective view of clinicians' behaviors, multi-dimensional comparisons, and a highly extensible analysis framework.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/9406z1c9

المؤلفون: Rattelman, Cori R.^Aff1, Ciemins, Elizabeth L., Stempniewicz, Nikita, Mocarski, Michelle, Ganguly, Rahul, Cuddeback, John K.

المصدر: Diabetes Therapy: Research, treatment and education of diabetes and related disorders. 12(2):581-594

المؤلفون: Appel, Lawrence J, Greene, Tom, Chen, Teresa K, Chalmers, John, Arima, Hisatomi, Perkovic, Vlado, Levin, Adeera, Djurdjev, Ognjenka, Tang, Mila, Nally, Joseph, Navaneethan, Sankar D, Schold, Jesse D, Weldegiorgis, Misghina, Herrington, William G, Smith, Margaret, Hsu, C Yenchih, Hwang, Shih-Jen, Chang, Alex R, Kirchner, H. Lester, Green, Jamie A, Ho, Kevin, Marks, Angharad, Prescott, Gordon, Clark, Laura E, Fluck, Nick, Shalev, Varda, Chodick, Gabriel, Blankestijn, Peter J, Van Zuilen, Arjan, Van den Brand, Jan A, Sarnak, Mark J, Bottinger, Erwin, Nadkarni, Girish N, Ellis, Stephen G, Nadukuru, Rajiv, Metzger, Marie, Flamant, Martin, Houillier, Pascal, Haymann, Jean-Philippe, Froissart, Marc, Kenealy, Timothy, Elley, Raina C, Collins, John F, Drury, Paul L, Cuddeback, John K, Ciemins, Elizabeth L, Stempniewicz, Rich, Nelson, Robert G, Knowler, William C, Bakker, Stephen J, Major, Rupert W, Medcalf, James F, Shepherd, David, Barrett-Connor, Elizabeth, Bergstrom, Jaclyn, Ix, Joachim H, Molnar, Miklos Z, Sumida, Keiichi, de Zeeuw, Dick, Brenner, Barry, Qureshi, Abdul R, Elinder, Carl-Gustaf, Runesson, Bjorn, Evans, Marie, Segelmark, Marten, Stendahl, Maria, Schön, Staffan, Naimark, David M, Tangri, Navdeep, Sud, Maneesh, Hirayama, Atsushi, Ichikawa, Kazunobu, Bilo, Henk JG, Landman, Gijs WD, Van Hateren, Kornelis JJ, Kleefstra, Nanne, Hallan, Stein I, Ballew, Shoshana H, Chen, Jingsha, Kwak, Lucia, Surapaneni, Aditya, Parving, Hans-Henrik, Rodby, Roger A., Rohde, Richard D, Lewis, Julia B, Lewis, Edmund, Perrone, Ronald D, Abebe, Kaleab Z, Hou, Fan F, Xie, Di, Hunsicker, Lawrence G, Imai, Enyu, Kobayashi, Fumiaki, Makino, Hirofumi, Ito, Sadayoshi, Remuzzi, Giuseppe, Ruggenenti, Piero, Eckardt, Kai-Uwe, Gudmundsdottir, Hrefna, Maciulaitis, Romaldas, Manley, Tom, Smith, Kimberly, Stockbridge, Norman, Thompson, Aliza, Vetter, Thorsten, Willis, Kerry, Zhang, Luxia, Coresh, Josef, Heerspink, Hiddo J L, Sang, Yingying, Matsushita, Kunihiro, Arnlov, Johan, Astor, Brad C, Black, Corri, Brunskill, Nigel J, Carrero, Juan-Jesus, Feldman, Harold I, Fox, Caroline S, Inker, Lesley A, Ishani, Areef, Jassal, Simerjot, Konta, Tsuneo, Polkinghorne, Kevan, Romundstad, Solfrid, Solbu, Marit D, Stempniewicz, Nikita, Stengel, Benedicte, Tonelli, Marcello, Umesawa, Mitsumasa, Waikar, Sushrut S, Wen, Chi-Pang, Wetzels, Jack F M, Woodward, Mark, Grams, Morgan E, Kovesdy, Csaba P, Levey, Andrew S, Gansevoort, Ron T

المصدر: In The Lancet Diabetes & Endocrinology February 2019 7(2):115-127

المؤلفون: Ciemins, Elizabeth L., Ritchey, Matthew D., Joshi, Vaishali V., Loustalot, Fleetwood, Hannan, Judy, Cuddeback, John K.

المصدر: Morbidity and Mortality Weekly Report, 2018 Jul . 67(29), 798-802.

URL الوصول: https://www.jstor.org/stable/26491812

المؤلفون: Keippel, April Ennis, Henderson, Melissa A., Golbeck, Amanda L., Gallup, TommiLee, Duin, Diane K., Hayes, Stephen, Alexander, Stephanie, Ciemins, Elizabeth L.

المصدر: In Women's Health Issues 17 October 2017 27 Supplement 1:S22-S28