Background/Aims: Advanced Care planning is becoming a major public health concern. The ambulatory care setting is a new frontier for delivery of palliative care services. Understanding patients' preferences and documenting them in an accessible location can facilitate honoring patients' wishes. However, physicians document Advanced Health Care Directives (AHCD) in various locations within EpicCare EHR, including progress notes, scanned documents, and the problem list. The aim of the study is to identify the locations of AHCD decision documentations in the EHR. Methods: Extensive search of AHCD terms in EPIC EHR, e.g., Physician Orders for Life-Sustaining Treatments (POLST), living will, and power of attorney, using 10 years of EHR data (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) (45,240/76,887) were >= 65 at the time of their first AHCD documentation. About 57% (44,067/76,887) were female. About 90% (5,689/6,347) of patients who died had their first AHCD decision documented within 5 years of their death. Documentation was updated nearing death -90% (3,594/3,989) of patients who died and had more than one documented decision had their last decision documented within a year of death. Discussion: Most AHCD decisions are in progress notes in the EHR which can be difficult to access for busy physicians. Physicians' effort to elicit patient preferences for AHCD and subsequent decisions may be wasted if these decisions cannot be readily found in the EHR in actionable formats. Scanned documents containing signatures of the patient, surrogate, and if applicable, the physician, may be more actionable than text in progress notes without proper signatures and flagging. Standardizing the location of these important decisions needs to become a priority. , using an electronic medical record with an online patient access feature, which includes: appointment requests, results review, medication list, refill request, problem list, care instructions, and email communication with their healthcare providers. We collected administrative data for health plan utilization documented in the EMR for patients 12 months before and after the activation of their online access and for a matched cohort of patients without online access. The analytic data set included those with and without online access matched on propensity scores within a 5% range based on age, gender, and co-morbidity within baseline visit and year strata. Results: The propensity matched cohorts (N = 51,535; in each cohort) contained 54.2% females, an average age of 43.7 years, 6.9% were less than age 20, 36.2% ages 20-39, 43.3% ages 40-59, and 13.7% ages 60 and over. Eighty-six percent of the cohort had none of four chronic illnesses, 7.4% with asthma, 5.7% with diabetes, 1.5% with coronary artery disease, and 1% with
RESULTS:A total of 1185 established T2DM patients were assessed. The mean (SD) age was 55 (10) years and mean duration of diabetes (SD) of 10 (7) years. Metformin was the most commonly prescribed drug [827 (70%)], in general followed by insulin [627 (53%)], sulfonylureas [520 (44%)], and pioglitazone [329 (28%)]. A total of 348 (29%) patients received monotherapy and 837 (71%) received combination therapy. The most frequently prescribed monotherapy was insulin [214 (62%)], followed by metformin in 81 (23%), sulfonylurea in 49 (14%) and pioglitazone in 4 (1%) patients. Family history(OR 1.76, 95%CI 1.18, 2.64), diabetes duration (OR 2.62, 95% CI 2.05, 3.36), Hb A1c (OR 1.25, 95%CI 1.01, 1.50), neuropathy(OR 1.57, 95% CI, 1.14, 2.2), nephropathy(OR 1.77, 95% CI 1.40, 2.24), retinopathy (OR 1.97, 95% CI 1.63, 2.40), Coronary Artery Disease (CAD) (OR 1.57, 95% CI, 1.14, 2.2) and diabetic foot t (OR 1.62, 95% CI 1.12, 2.40) were all significantly associated with the insulin therapy. Obese and overweight patients were prescribed oral antidiabetic drugs. [metformin (OR 1.25, 95% CI 1.15, 1.35), sulfonylurea (OR 1.28, 95% CI 1.01, 1.61)]. CONCLUSIONS: This study finding indicates that medication use was consistent with evidence based practice guidelines in T2DM. There was, however, scope for improvement in prescribing, especially in the T2DM patients with complications. OBJECTIVES:There is a growing interest in the use of electronic medical records (EMRs) for clinical research. The study describes a collaborative research project that uses an EMR database to explore the level of diabetic care in patients with type 2 diabetes in a primary care setting. METHODS: A retrospective study was conducted using the GE Centricity electronic medical records (EMR) database of a primary care physicians group. Patients with type 2 diabetes were identified using ICD-9 codes of 250.xx (January 1, 2004 to March 31, 2009. Patients Ͼ 18 years of age, with two or more visits with their respective physicians, and having an active status in the database were selected. Demographic characteristics, clinical parameters (HbA1c, LDL, HDL) medication use, and number of office visits were identified. Data was extracted using Microsoft SQL and descriptive statistical analyses were conducted using SPSS version 18.0. RESULTS: The study identified 4,598 patients (mean age: 67ϩ 12.9 years and males: 51.8%) with type 2 diabetes. A total of 24,590 office visits were recorded with a mean of 14.1 visits and 127 days between visits. 3,100 (61.3%) patients had HbA1c levels Ͻ 7; 1,473 (29.1%) patients had levels between 7-9; and 484 (9.6%) patients had levels Ͼ 9. 3,970 (59.2%) patients had LDL below 100 mg/dL and 2,737 (40.8%) had LDL greater than 100 mg/dL. Mean number of active medications were 2.34 and diabetes medications were 1.94. Combination drugs were used the most compared with amino acid derivatives and amylin analogs. CONCLUSIONS: The collaborative research project has been established between clinicians and researchers, a baseline data extraction ha...
A105Univariate sensitivity analysis was done. RESULTS: Over the time horizon evaluated, prophylactic treatment avoids 681 cases of bleeding and 246 of joint damage. Total expected costs with prophylactic treatment were US$3.86M compared to on demand treatment US$2.09M. The incremental cost effectiveness ratio (ICER) for prophylactic treatment was US$2592/avoided bleeding and US$7172/avoided joint damage (cost-effectiveness threshold: 1 Colombian GDP per capita = US$7235). Sensitivity analyses showed the robustness of the model. CONCLUSIONS: Prophylactic treatment of severe hemophilia B, with recombinant factor IX would be a highly cost-effective intervention from the social perspective.
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