“There is an urgent need to improve diagnostic excellence in sepsis1. One potential solution is the development of a flexible, scalable, and interoperable data infrastructure to screen and identify sepsis patients across health systems using real-time, granular clinical data available within electronic health records (EHRs). Despite clinical data for millions of sepsis or pre-sepsis patients routinely collected in EHRs, the healthcare enterprise has accessed only a small fraction of these data to improve the clinical understanding of sepsis. The development of a sepsis data backbone could be extended to meet diverse needs, including sepsis translational research, clinical care delivery, machine … Read More
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“[..] artificial intelligence (AI) is well suited to the detection and reporting of follow-up recommendations because of the large volume of imaging studies requiring screening and the relatively standardized language employed by radiologists in preparing reports. Natural language processing (NLP) methods, including text pattern-matching and traditional machine-learning techniques, have been developed for this task. In this article, we use the term traditional machine learning to refer to all machine-learning methods that are not deep learning, and these terms will be defined in detail in the sections that follow. More recently, novel deep-learning methods for NLP have shown great promise for … Read More
“Before the pandemic, most health centers did not offer telehealth visits for primary care or behavioral health, in large part because of reimbursement policy. In spring 2020, dramatic policy changes removed many of the restrictions on telehealth delivery, and health centers responded by standing up large telehealth programs. This sudden and dramatic change in health care delivery posed numerous challenges. Health centers had to quickly make changes to technology, workflows, and staffing to accommodate telehealth visits. To support health centers in these efforts, the California Health Care Foundation established the Connected Care Accelerator (CCA) program, a quality improvement initiative that … Read More
“Routine use of home-based symptom monitoring and management using electronic patient-reported outcomes (ePRO) to improve care delivery is on the horizon. Randomized clinical trials demonstrate that use of patient-reported symptoms can have marked impact on patient outcomes, including minimizing symptom burden, enhancing quality of life, reducing hospitalizations, increasing time receiving cancer treatments, and, in some studies, improving survival. [..] few health systems have successfully, fully integrated ePRO. [..] In the study by Daly and colleagues, the authors begin to tackle an important question of frequency of assessment administration in ePRO. This study used daily symptom assessment in contrast to the … Read More
“β-Blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARBs) are beneficial after AMI [acute myocardial infarction], and adjustment of these medications to moderate to high doses is recommended in the setting of reduced LV ejection fraction (LVEF) or heart failure. Initiation and adjustment of these medications can be challenging during hospitalization, particularly among patients with borderline or low systemic blood pressure because of an emphasis on shortening length of stay and the challenges in organizing frequent face-to-face visits early after discharge. Telemedicine has enabled the transition from face-to-face care and is set to play a key role in the post–coronavirus disease-19 … Read More
“Digital health is a broad spectrum of measurement technologies that include personal wearable devices and internal devices as well as sensors in people, homes, cars, and communities. Digital health can help identify health risks and assist with diagnosis, treatment, and monitoring of health and disease conditions and offers novel ways to capture continuous data on individuals and populations that complement the episodic data on individuals that are captured by current health care approaches. [..] Digital health technologies may enhance capabilities for improving health through 3 modalities: improved data communications, miniaturization, and decentralization of devices. Electronic medical records, mobile health apps, … Read More
“[Introduction] In this study, we aim to build on the existing research by analyzing the association of the adoption of EPCS [electronic prescribing of controlled substances] with opioid prescribing across the United States. We specifically examine trends in the adoption and use of EPCS and 2 measures of opioid prescribing across the United States from 2010 to 2018. In doing so, we aim to provide policy makers, prescribers, and patients with evidence of the association of the use of EPCS with the opioid epidemic. [..] [Methods] [..] We used data from annual reports published by Surescripts, a near-monopoly supplier of … Read More
“[Introduction] Hip and knee replacements are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial cost and variability in care during the hospitalization and through postacute care. Most hospitals are participating in a bundled payment program for hip or knee replacement surgery, such as the comprehensive care for joint replacement model, with the goal of reducing unnecessary postacute care and rehospitalizations. Patients discharged from hospitals to facilities have higher costs and not necessarily improved outcomes, and payment policies have not resulted in substantially reduced rehospitalizations. [..] Behavioral science has revealed that humans have predictable biases … Read More
“In the USA, virtual care in its current form, like conventional outpatient care, is still episodic and transactional via a fee-for-service model. This transactional nature occurs despite the knowledge that disease, or even wellness, is a continuous state and flare ups do not coincide with periodic, predetermined follow up clinic visits. In the peri-pandemic period, medical professionals must develop an economic model that would encourage the delivery of continuous care. Maybe there is something to learn here from the role of remote monitoring with pacemakers, loop recorders, and defibrillators. In the not-so-distant past, patients with implanted devices were evaluated in-person … Read More
“We previously described an automated early warning system that identifies patients at high risk for clinical deterioration. Detection is achieved with the use of a predictive model (the Advance Alert Monitor [AAM] program) that identifies such patients. Beginning in November 2013, we conducted a pilot test of this program in 2 hospitals in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system that owns 21 hospitals. The system generates AAM scores that predict the risk of unplanned transfer to the ICU or death in a hospital ward among patients who have “full code” orders (i.e., patients who wish … Read More