المؤلفون: Zheng, Yaguang, Zhang, Yanfu, Huang, Heng, Tison, Geoffrey H, Burke, Lora E, Blecker, Saul, Dickson, Victoria Vaughan, Olgin, Jeffrey E, Marcus, Gregory M, Pletcher, Mark J

المصدر: Nursing Research. 72(4)

مصطلحات موضوعية: Health Services and Systems, Health Sciences, Clinical Research, Cardiovascular, Humans, Male, Middle Aged, Female, Blood Pressure, Prospective Studies, Blood Pressure Monitoring, Ambulatory, Longitudinal Studies, Hypertension, blood pressure, blood pressure monitoring, mobile health, self, Nursing, Midwifery

الوصف: BackgroundEngagement with self-monitoring of blood pressure (BP) declines, on average, over time but may vary substantially by individual.ObjectivesWe aimed to describe different 1-year patterns (groups) of self-monitoring of BP behaviors, identify predictors of those groups, and examine the association of self-monitoring of BP groups with BP levels over time.MethodsWe analyzed device-recorded BP measurements collected by the Health eHeart Study-an ongoing prospective eCohort study-from participants with a wireless consumer-purchased device that transmitted date- and time-stamped BP data to the study through a full 12 months of observation starting from the first day they used the device. Participants received no instruction on device use. We applied clustering analysis to identify 1-year self-monitoring, of BP patterns.ResultsParticipants had a mean age of 52 years and were male and White. Using clustering algorithms, we found that a model with three groups fit the data well: persistent daily use (9.1% of participants), persistent weekly use (21.2%), and sporadic use only (69.7%). Persistent daily use was more common among older participants who had higher Week 1 self-monitoring of BP frequency and was associated with lower BP levels than the persistent weekly use or sporadic use groups throughout the year.ConclusionWe identified three distinct self-monitoring of BP groups, with nearly 10% sustaining a daily use pattern associated with lower BP levels.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/04j3k0f4Test

المؤلفون: Lim, Justin, Ji, Christina X, Oberst, Michael, Blecker, Saul, Horwitz, Leora, Sontag, David

مصطلحات موضوعية: Computer Science - Machine Learning, Computer Science - Artificial Intelligence

الوصف: Individuals often make different decisions when faced with the same context, due to personal preferences and background. For instance, judges may vary in their leniency towards certain drug-related offenses, and doctors may vary in their preference for how to start treatment for certain types of patients. With these examples in mind, we present an algorithm for identifying types of contexts (e.g., types of cases or patients) with high inter-decision-maker disagreement. We formalize this as a causal inference problem, seeking a region where the assignment of decision-maker has a large causal effect on the decision. Our algorithm finds such a region by maximizing an empirical objective, and we give a generalization bound for its performance. In a semi-synthetic experiment, we show that our algorithm recovers the correct region of heterogeneity accurately compared to baselines. Finally, we apply our algorithm to real-world healthcare datasets, recovering variation that aligns with existing clinical knowledge.
Comment: To appear in NeurIPS 2021

الوصول الحر: http://arxiv.org/abs/2110.14508Test

المؤلفون: Durstenfeld, Matthew S, Katz, Stuart D, Park, Hannah, Blecker, Saul

المصدر: BMC Cardiovascular Disorders. 19(1)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Heart Disease, Cardiovascular, Clinical Research, Good Health and Well Being, Aged, Aged, 80 and over, Drug Prescriptions, Drug Utilization, Female, Heart Failure, Humans, Male, Middle Aged, Mineralocorticoid Receptor Antagonists, New York City, Patient Admission, Patient Discharge, Patient Readmission, Practice Patterns, Physicians', Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Mineralocorticoid, Aldosterone, Hospitalization, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology

الوصف: BackgroundMineralocorticoid receptor antagonists (MRA) are an underutilized therapy for heart failure with a reduced ejection fraction (HFrEF), but the current impact of hospitalization on MRA use is not well characterized. The objective of this study was to describe contemporary MRA prescription for heart failure patients before and after the full scope of hospitalizations and the association between MRA discharge prescription and post-hospitalization outcomes.MethodsWe conducted a retrospective cohort study at an academic hospital system in 2013-2016. Among 1500 included hospitalizations of 1009 unique patients with HFrEF and without MRA contraindication, the mean age was 71.9 ± 13.6 years and 443 (29.5%) were female. We compared MRA prescription before and after hospitalizations with McNemar's test and between patients with principal and secondary diagnoses of HFrEF with the chi-square test, and association of MRA discharge prescription with 30-day and 180-day mortality and readmissions using generalized estimating equations.ResultsMRA prescriptions increased from 303 (20.2%) to 375 (25.0%) at discharge (+4.8%, p

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/00g1t65nTest

المؤلفون: Adhikari, Samrachana, Mukhyopadhyay, Amrita, Kolzoff, Samuel, Li, Xiyue, Nadel, Talia, Fitchett, Cassidy, Chunara, Rumi, Dodson, John, Kronish, Ian, Blecker, Saul B

مصطلحات موضوعية: Cardiovascular medicine

الوصف: Purpose Clinic-based or community-based interventions can improve adherence to guideline-directed medication therapies (GDMTs) among patients with heart failure (HF). However, opportunities for such interventions are frequently missed, as providers may be unable to recognise risk patterns for medication non-adherence. Machine learning algorithms can help in identifying patients with high likelihood of non-adherence. While a number of multilevel factors influence adherence, prior models predicting non-adherence have been limited by data availability. We have established an electronic health record (EHR)-based cohort with comprehensive data elements from multiple sources to improve on existing models. We linked EHR data with pharmacy refill data for real-time incorporation of prescription fills and with social determinants data to incorporate neighbourhood factors. Participants Patients seen at a large health system in New York City (NYC), who were >18 years old with diagnosis of HF or reduced ejection fraction (<40%) since 2017, had at least one clinical encounter between 1 April 2021 and 31 October 2022 and active prescriptions for any of the four GDMTs (beta-blocker, ACEi/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i)) during the study period. Patients with non-geocodable address or outside the continental USA were excluded. Findings to date Among 39 963 patients in the cohort, the average age was 73±14 years old, 44% were female and 48% were current/former smokers. The common comorbid conditions were hypertension (77%), cardiac arrhythmias (56%), obesity (33%) and valvular disease (33%). During the study period, 33 606 (84%) patients had an active prescription of beta blocker, 32 626 (82%) had ACEi/ARB/ARNI, 11 611 (29%) MRA and 7472 (19%) SGLT2i. Ninety-nine per cent were from urban metropolitan areas. Future plans We will use the established cohort to develop a machine ...

وصف الملف: text/html

العلاقة: http://bmjopen.bmj.com/cgi/content/short/13/12/e076812Test; http://dx.doi.org/10.1136/bmjopen-2023-076812Test

الإتاحة: https://doi.org/10.1136/bmjopen-2023-076812Test
http://bmjopen.bmj.com/cgi/content/short/13/12/e076812Test

المؤلفون: Samal, Lipika, Wu, Edward, Aaron, Skye, Kilgallon, John L., Gannon, Michael, McCoy, Allison, Blecker, Saul, Dykes, Patricia C., Bates, David W., Lipsitz, Stuart, Wright, Adam

المساهمون: National Institutes of Health NIDDK

المصدر: Applied Clinical Informatics ; volume 14, issue 03, page 528-537 ; ISSN 1869-0327

الوصف: Background Chronic kidney disease (CKD) is common and associated with adverse clinical outcomes. Most care for early CKD is provided in primary care, including hypertension (HTN) management. Computerized clinical decision support (CDS) can improve the quality of care for CKD but can also cause alert fatigue for primary care physicians (PCPs). Computable phenotypes (CPs) are algorithms to identify disease populations using, for example, specific laboratory data criteria. Objectives Our objective was to determine the feasibility of implementation of CDS alerts by developing CPs and estimating potential alert burden. Methods We utilized clinical guidelines to develop a set of five CPs for patients with stage 3 to 4 CKD, uncontrolled HTN, and indications for initiation or titration of guideline-recommended antihypertensive agents. We then conducted an iterative data analytic process consisting of database queries, data validation, and subject matter expert discussion, to make iterative changes to the CPs. We estimated the potential alert burden to make final decisions about the scope of the CDS alerts. Specifically, the number of times that each alert could fire was limited to once per patient. Results In our primary care network, there were 239,339 encounters for 105,992 primary care patients between April 1, 2018 and April 1, 2019. Of these patients, 9,081 (8.6%) had stage 3 and 4 CKD. Almost half of the CKD patients, 4,191 patients, also had uncontrolled HTN. The majority of CKD patients were female, elderly, white, and English-speaking. We estimated that 5,369 alerts would fire if alerts were triggered multiple times per patient, with a mean number of alerts shown to each PCP ranging from 0.07–to 0.17 alerts per week. Conclusion Development of CPs and estimation of alert burden allows researchers to iteratively fine-tune CDS prior to implementation. This method of assessment can help organizations balance the tradeoff between standardization of care and alert fatigue.

الإتاحة: https://doi.org/10.1055/s-0043-1768994Test

المؤلفون: Mukhopadhyay, Amrita, Reynolds, Harmony R., Xia, Yuhe, Phillips, Lawrence M., Aminian, Rod, Diah, Ruth-Ann, Nagler, Arielle R., Szerencsy, Adam, Saxena, Archana, Horwitz, Leora I., Katz, Stuart D., Blecker, Saul

المساهمون: NCATS

المصدر: American Heart Journal ; volume 258, page 38-48 ; ISSN 0002-8703

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الإتاحة: https://doi.org/10.1016/j.ahj.2022.12.016Test
https://api.elsevier.com/content/article/PII:S0002870322003374?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0002870322003374?httpAccept=text/plainTest

المؤلفون: Mukhopadhyay, Amrita, Blecker, Saul, Li, Xiyue, Kronish, Ian Matthew, Dodson, John A., Lawrence, Steven, Zheng, Yaugang, Kozloff, Sam, Chunara, Rumi, Adhikari, Samrachana

المصدر: Journal of the American College of Cardiology ; volume 81, issue 8, page 275 ; ISSN 0735-1097

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الإتاحة: https://doi.org/10.1016/s0735-1097Test(23)00719-2
https://api.elsevier.com/content/article/PII:S0735109723007192?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0735109723007192?httpAccept=text/plainTest

المؤلفون: Berry, Carolyn A., Kwok, Lorraine, Paul, Margaret, Albert, Stephanie L., Blecker, Saul, Shelley, Donna

المصدر: Journal of Clinical and Translational Science ; volume 7, issue s1, page 20-20 ; ISSN 2059-8661

مصطلحات موضوعية: General Medicine

الوصف: OBJECTIVES/GOALS: Primary care practices struggle to identify which combination of care structures and processes need to be implemented to improve practice performance and subsequently, patient outcomes. The goal of this study is to develop and validate a tool to assess care structures and processes that are associated with better quality and patient outcomes. METHODS/STUDY POPULATION: Data from a scoping review, Delphi study, and qualitative interviews with high-performing primary care practices contributed to the development and content validation of the Tool for Advancing Practice Performance (TAPP). From these sources we identified 314 items representing care structures (e.g., care team makeup, use of electronic health records) and processes (e.g., care coordination, panel management). We developed criteria for deleting and rescuing items and received input from our expert panel to refine the pool of items. We eliminated items that were redundant and lacked clarity/specificity. The tool was further modified based on feedback from cognitive interviewing and pilot testing with practice managers, quality improvement leaders, and physicians from primary care practices. RESULTS/ANTICIPATED RESULTS: The pool of 314 items was winnowed to 188 after applying criteria for deleting and rescuing items. During the expert review, 70 items were eliminated and 8 new items were added, resulting in a working tool of 126 items. We conducted eight cognitive interviews with the 126-item tool and received feedback on the content, item structure, and language, which led to the elimination of 13 items that were poorly or incorrectly understood by respondents. We also modified the language of 23 items for clarity. After cognitive interviewing, the resulting tool comprised 113 items. Fifteen practices piloted the tool and no additional items were eliminated. We modified the instructions for completing the tool and resolved technical issues related to online administration. DISCUSSION/SIGNIFICANCE: TAPP is a novel tool for assessing ...

الإتاحة: https://doi.org/10.1017/cts.2023.158Test
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S2059866123001589Test

المؤلفون: Dapkins, Isaac, Blecker, Saul B.

المصدر: Ethnicity & Disease, 2021 Jan 01. 31(1), 89-96.

الوصول الحر: https://www.jstor.org/stable/48667881Test

المؤلفون: Hamo, Carine E., Mukhopadhyay, Amrita, Li, Xiyue, Zheng, Yaguang, Kronish, Ian M., Chunara, Rumi, Dodson, John, Adhikari, Samrachana, Blecker, Saul

المصدر: American Heart Journal; Jul2024, Vol. 273, p53-60, 8p

مستخلص: Despite advances in medical therapy for heart failure with reduced ejection fraction (HFrEF), major gaps in medication adherence to guideline-directed medical therapies (GDMT) remain. Greater continuity of care may impact medication adherence and reduced hospitalizations. We conducted a cross-sectional study of adults with a diagnosis of HF and EF ≤ 40% with ≥2 outpatient encounters between January 1, 2017 and January 10, 2021, prescribed ≥1 of the following GDMT: 1) Beta Blocker, 2) Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker/Angiotensin Receptor Neprilysin Inhibitor, 3) Mineralocorticoid Receptor Antagonist, 4) Sodium Glucose Cotransporter-2 Inhibitor. Continuity of care was calculated using the Bice-Boxerman Continuity of Care Index (COC) and the Usual Provider of Care (UPC) index, categorized by quantile. The primary outcome was adherence to GDMT, defined as average proportion of days covered ≥80% over 1 year. Secondary outcomes included all-cause and HF hospitalization at 1-year. We performed multivariable logistic regression analyses adjusted for demographics, insurance status, comorbidity index, number of visits and neighborhood SES index. Overall, 3,971 individuals were included (mean age 72 years (SD 14), 71% male, 66% White race). In adjusted analyses, compared to individuals in the highest COC quartile, individuals in the third COC quartile had higher odds of GDMT adherence (OR 1.26, 95% CI 1.03-1.53, P =.024). UPC tertile was not associated with adherence (all P >.05). Compared to the highest quantiles, the lowest UPC and COC quantiles had higher odds of all-cause (UPC: OR 1.53, 95%CI 1.23-1.91; COC: OR 2.54, 95%CI 1.94-3.34) and HF (UPC: OR 1.81, 95%CI 1.23-2.67; COC: OR 1.77, 95%CI 1.09-2.95) hospitalizations. Continuity of care was not associated with GDMT adherence among patients with HFrEF but lower continuity of care was associated with increased all-cause and HF-hospitalizations. [Display omitted] [ABSTRACT FROM AUTHOR]

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