Optum Labs: Building A Novel Node In The Learning Health Care System

Wallace, Paul; Shah, Nilay D.; Dennen, T; Bleicher, Paul A.; Crown, William H.

doi:10.1377/hlthaff.2014.0038

Cited by 359 publications

(275 citation statements)

References 14 publications

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“…The database contains longitudinal health information on over 100 million privately insured and Medicare Advantage enrollees over the last 20 years, from geographically diverse regions across the United States, with greatest representation from the South and Midwest 10. The OLDW provides claims data for professional (eg, physician), facility (eg, hospital), and outpatient prescription medication services.…”

Section: Methodsmentioning

confidence: 99%

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

Madhavan

Yao

Sangaralingham

et al. 2016

JAHA

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BackgroundIncidental mobile thrombi are commonly found on endovascular leads of cardiac implantable electronic devices (CIEDs). Transseptal puncture for catheter ablation of arrhythmia poses a risk for paradoxical embolism. We examined risk of ischemic stroke, transient ischemic attack (TIA), or systemic embolism after transseptal ablation in patients with and without CIEDs.Methods and ResultsUsing a national administrative claims database, 31 720 patients who underwent a transseptal catheter ablation between January 2004 and September 2014 were identified. Two propensity‐matched cohorts were created by matching demographic variables, administrative variables, Charlson Comorbidity Index, CHA 2 DS 2‐Vasc score, and year and indication for ablation (5533 and 11 300 patients with and without CIEDs). Incidence rates and Cox proportional hazards models were used to estimate risk of ischemic stroke, TIA, or systemic embolism for patients with and without CIEDs. Impact of oral anticoagulation (OAC) use on the endpoint was examined. Over a mean follow‐up of 2.1 years, the incidence of the combined endpoint was 1.9 per 100 person‐years in patients with CIEDs and 1.5 per 100 person‐years in patients without CIEDs (P=0.03). Among patients not on OAC, presence of a cardiac device was associated with an increased risk (hazard ratio [HR], 1.71 [1.24–2.35]; P<0.01), whereas there was no association noted among patients treated with OAC (HR, 0.98 [0.75–1.28]).Conclusion CIEDs are associated with an increased risk of stroke, TIA, or systemic embolism after transseptal ablation, but this risk is attenuated with postablation OAC use. Role of anticoagulation post‐transseptal ablation in patients with CIED warrants further investigation.

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Section: Methodsmentioning

confidence: 99%

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

Madhavan

Yao

Sangaralingham

et al. 2016

JAHA

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“…[18][19][20] Finally, EHR data can be used in multicenter, national, or international clinical research studies. [21][22][23] Several examples exist of cardiology programs that use EHR data to optimize clinical care. The Veterans Affairs (VA) healthcare system uses EHR data in its Clinical Assessment Reporting and Tracking (CART) cardiac quality program to support clinical care in VA cardiac catheterization laboratories.…”

Section: Ehr Datamentioning

confidence: 99%

“…21,23,29,30 Use of EHR data for this purpose provides a unique opportunity to address important questions that enhance the value of healthcare delivery for all of its key stakeholders. 31,32 Research infrastructures using EHR data include large, publicly funded initiatives such as the National PatientCentered Clinical Research Network, public-private partnerships such as the High Value Healthcare Collaborative, and private initiatives such as Optum Labs.…”

Section: Ehr Datamentioning

confidence: 99%

“…31,32 Research infrastructures using EHR data include large, publicly funded initiatives such as the National PatientCentered Clinical Research Network, public-private partnerships such as the High Value Healthcare Collaborative, and private initiatives such as Optum Labs. 21,23,33 An example of an EHR-based cardiovascular research initiative focused on generating new research insights is the Cardiovascular Research Network. 21 With support from the National Institutes of Health, this research consortium combines EHR data from 15 geographically diverse healthcare delivery systems that care for ≈11 million patients.…”

Section: Ehr Datamentioning

confidence: 99%

See 1 more Smart Citation

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

Maddox¹,

Albert²,

Borden³

et al. 2017

Circulation

Self Cite

118

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ABSTRACT:The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented.H ealth care has never been more complex. Clinicians and patients must make decisions that integrate the continually evolving scientific evidence base with hundreds of individual data points such as patients' vital signs, symptoms, comorbidities, medications, test results, and preferences. Furthermore, once these decisions are made, little information is available about their impact, limiting the ability to learn from and ultimately improve care delivery. This inability of the healthcare system to learn from its operation results in significant inefficiencies, substantial costs, and suboptimal health outcomes.The creation of a learning healthcare system (LHS) can potentially address these issues. The LHS uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery 1,2 (Figure 1). Thus, the LHS enables rapid, iterative learning in which "evidence informs practice, and practice informs evidence." 2 The authors argued that recent advances in information processing and connectivity, healthcare organizational design, and reimbursement policies centered on quality rather than quantity of care provided the necessary tools for the creation of the LHS. Accordingly, they called for systematic redesign of the healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture.

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“…Briefly, the OLDW is a health care database containing deidentified claims from Ͼ100 million individuals enrolled in either commercial insurance or Medicare Advantage plans over a 20-year period (13). For our analysis, we identified first-time tests performed between January 2010 and December 2012 using Current Procedural Terminology, version 4 (CPT-4) codes for H. pylori serology (86677: antibody, H. pylori; the code does not differentiate among IgA, IgM, or IgG serology), SAT (87338: H. pylori, stool), and UBT (83013: H. pylori; breath test analysis for urease activity, nonradioactive isotope).…”

mentioning

confidence: 99%

Use of the Optum Labs Data Warehouse To Assess Test Ordering Patterns for Diagnosis of Helicobacter pylori Infection in the United States

et al. 2015

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eWe surveyed national Helicobacter pylori diagnostic testing practices and diagnoses using commercial and Medicare medical claims data from Optum Labs (Cambridge, MA). Serologic testing for antibodies to H. pylori remains the most commonly ordered diagnostic test despite recent expert recommendations. Changes in reimbursement for serologic testing will likely drive future provider ordering practices. Helicobacter pylori remains among the most common bacterial infections worldwide. It is estimated that globally one in every two individuals is infected. Local prevalence rates vary, however, with approximately 20 to 40% of individuals in the United States exposed to H. pylori by adulthood (1-5). Despite these infection rates, most individuals remain asymptomatic. A number of welldefined clinical syndromes have been associated with infection, however, including dyspepsia, peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue (MALT) lymphoma, with the latter two collectively occurring in Ͻ1% of individuals (3). Eradication of H. pylori through appropriate antibiotic regimens leads to a significant reduction of ulcer recurrence and long-term remission of MALT lymphoma for the majority of afflicted patients (6-8). Therefore, accurate and prompt diagnosis of H. pylori infection is essential.Three noninvasive testing methods are available to detect H. pylori, including serologic assays to measure anti-H. pylori IgM, IgA, and IgG antibodies, H. pylori stool antigen tests (SATs), and urea breath test (UBTs) (9-11). Choosing among these methods requires a thorough understanding of each assay's clinical utility. Serologic testing shows poor sensitivity (74% to 85%) and specificity (79% to 90%) for active infection, although such testing is not affected by prior intake of protein pump inhibitors (PPIs), bismuth compounds, or antibiotics. Additionally, serologic testing should not be used to document H. pylori eradication due to demonstrable antibody levels for years following the initial exposure (10). Finally, most serologic assays, aside from certain IgG tests, lack Food and Drug Administration (FDA) clearance. Conversely, detection of H. pylori antigen by the SAT or urease activity by the UBT is indicative of active H. pylori infection, and either assay can be applied to confirm H. pylori clearance following completion of antibiotic therapy (9-11). Both methods also have commercially available, FDA-cleared assays that offer high sensitivities and specificities for H. pylori infection (both Ͼ95% in pretreatment conditions). Certain drawbacks exist for these two assays, including the generally higher cost compared to that of serologic testing, although this cost is offset by the improved diagnostic accuracy and typically higher reimbursement rates for UBTs and SATs (11, 12). Additionally, due to the specimen collection requirements and assay complexity, UBT availability may be limited to larger hospitals and reference laboratories. Finally, PPIs, bismuth compounds, and antibiotics need to be dis...

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Optum Labs: Building A Novel Node In The Learning Health Care System

Cited by 359 publications

References 14 publications

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

Use of the Optum Labs Data Warehouse To Assess Test Ordering Patterns for Diagnosis of Helicobacter pylori Infection in the United States

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