ObjectiveTo assess the utility of inpatient and ambulatory clinical data compiled by public and commercial sources to enhance the Centers for Disease Control and Prevention's surveillance activities. IntroductionMedical claims and EHR data sources offer the potential to ascertain disease and health risk behavior prevalence and incidence, evaluate the use of clinical services, and monitor changes related to public health interventions. Passage of the HITECH Act of 2009 supports the availability of standardized EHR data for use by public health officials to obtain actionable information. While full adoption of EHRs is still years away, there are presently publicly-and commerciallyavailable EHR and medical claims data sets that could enhance public health surveillance at a national, regional and state level. The purposes of this evaluation were to i.) demonstrate the feasibility of gaining access to such data, ii.) evaluate their ability to augment current surveillance activities by developing measures for twenty separate healthcare indicators (e.g., HIV screening), iii.) evaluate each data source across a set of criteria needed for an effective surveillance system, and iv.) assess the ability of the data sources to evaluate changes in healthcare utilization and preventive services that may be a result of the 2009 Health Reform legislation. MethodsTen separate data sources were selected for inclusion in the study based on a number of criteria, including availability, representativeness, population, data structure and content, cost, and longitudinality. In collaboration with staff from seven Divisions across the CDC, detailed specifications were developed for twenty separate indicators of healthcare utilization or preventive services using best practices in healthcare quality measurement. Specifications were developed separately for EHR and medical claims data due to their differing structure, content and use of medical code sets and terminologies. Specifications for EHR data sources relied on the National Quality Forum (NQF) Meaningful Use (MUse) clinical quality measure specifications. The use of NQF MUse specification guidelines allowed us to gauge the current ability of each data source to measure healthcare utilization and preventive services as recommended by NQF, the national leader in healthcare measurement. Each of the data sources was also evaluated across established public health surveillance criteria, including data quality, representativeness, and flexibility, among others. Data analysis was performed using SAS 9.3 (SAS Institute, Cary, NC). ResultsAll twenty of the healthcare indicators were developed for at least one data source; however, many of the indicator specifications had to be modified due to the low frequency of certain code sets (e.g., CPT-4 II, LOINC). The observed strengths of medical claims data were the relatively low cost, ability to track patients longitudinally, and the standardized representation of procedures and diagnoses through use of medical codes, such as ICD-9-CM, CPT-4 and H...
The COVID-19 pandemic required social and physical distancing to reduce the spread of disease. The reduction in meeting sizes made it difficult to offer traditional in-person EHR training to new and transferring employees. This paper aims to share how one nurse educator team used an innovative approach to transition traditional EHR onboarding education to synchronous remote learning during the global pandemic. Participants in the remote learning course (n = 94) were compared with those who had previously completed the traditional course (n = 110). Postcourse evaluations for each group were comparable. Remote learning participants found the technology conducive to training and reported higher scores for locating and reviewing patient information than those in the traditional course. Providing remote EHR education is comparable with traditional classroom education. Remote learning provided a safe, effective way to onboard new staff during the pandemic.
Introduction: Sickle cell disease (SCD) CNS vasculopathy (SCNSV) is a frequent indication for hematopoietic stem cell transplantation (HSCT). Untreated, SCNSV can be progressive and impair quality of life (QoL) and cognitive functioning. By clinical MRI/MRA assessment, HSCT is thought to halt progression of SCNSV. Quantitative analysis of T2-weighted FLAIR MRI for white matter hyperintensity (WMH) can provide a meaningful estimate of small vessel cerebrovascular burden. Adding WMH assessment, we asked whether HSCT for SCD halted long-term progression of SCNSV, including small vessel involvement, despite transplant-associated CNS risks. QoL assessment can track school functioning and physical, emotional and social functioning. Methods: This retrospective single site study compared MRI analyses pre-transplant to 1-7-years post-HSCT. Subject eligibility required availability of clinical MRI scans from within 2 months pre-HSCT and at 1-year intervals for at least one year post-HSCT. Interim scans performed for acute clinical indications were not included in the analysis. MRI scans were evaluated independent to the initial clinical read by one neuroradiologist, and via in-house developed software to quantitate WMH burden. QoL was completed by parent- and child-report pre-HSCT and annually thereafter using the Peds QL 4.0TM with scores 0-100; higher numbers reflected higher QoL. Results: 25 patients who received HSCT for SCD between 2003-2014 were evaluated. Median age at HSCT was 9.9 years (1.4-21.9); male:female 18:7; HbSS (17), HbSC (3), HbS-Bthalassemia (5). Donors were related (14) or unrelated (11). Stem cell sources were: related bone marrow (BM) (10), unrelated BM (5), related cord blood (CB) (3), unrelated CB (6), or related peripheral blood stem cells (1). Eight patients had CNS pathology as the indication for HSCT. Transplant complications were: PRES (2), stroke (1), graft failure (2), death (1). Duration of follow-up was: 1 yr (9), 2 yrs (10), >2 yrs (6). Only a minority of patients had normal pre-HSCT MRI (5) and normal MRA (11; 6 had 1-2 stenoses <2mm and were rated as ambiguous). At 1 to 7 yrs post-HSCT, 5 originally normal MRIs were unchanged, 15 MRIs were stable and 4 were improved at 1 year post-HSCT, without subsequent changes by clinical assessment. One MRI worsened due to peri-HSCT hemorrhagic stroke. MRAs were unchanged following HSCT. Preliminary analysis of 18 patients at pre-HSCT revealed that 5 did not have elevated WMH, while elevated WMH was detected in 13 patients. WMH remained stable in 16 of 18 patients over subsequent annual assessments. In the 2 patients with markedly elevated WMH pre-HSCT, values decreased at follow-up, corresponding to the resolution of acute or recent infarction. Overall pre-HSCT QoL by parent-report (N=19) was 65.3 (SD16.3); while child self-report (N=14) was 67.6, (SD13.1). After mean follow-up of 3 years, parent-report QoL improved to 78.8 (SD15.8), and self-report to 78.7 (SD15.2). Conclusions: Most children in this retrospective cohort had MRI abnormalities pre-HSCT, and all but 1 were stable or improved post-HSCT, despite PRES and other potential CNS complications. Pre-HSCT WMH appeared to be unchanged for most of these patients, while stroke-induced WMH appears to decrease over time, suggesting stable small vessel SCNSV following transplantation. Overall, by MRI/MRA and by preliminary WMH, HSCT appears to have stabilized large and small vessel SCNSV in all but 1 of 25 children. While only a modest number of patients were assessed, WMH was reproducible at multiple annual time points. Long-term parent and self-reported QoL indicated improvement from HSCT. Chronically transfused SCD patients could not be compared due to lack of annualized assessment. Future transplant protocols will include enhanced MRI-based tracking, in conjunction with QoL and neuropsychological assessments. These data could be useful for decision-making about SCD transplantation. Disclosures No relevant conflicts of interest to declare.
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