Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant

Butler, Catherine R.; Wightman, Aaron; Richards, Claire; Laundry, Ryan S.; Taylor, Janelle S.; Hebert, Paul L.; Liu, Chuan‐Fen; O’Hare, Ann M.

doi:10.1001/jamainternmed.2020.6388

Cited by 20 publications

(20 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Complexity and Challenges of the Clinical Diagnosis and Management of Long COVID build consensus around the content and organization of thematic descriptions, and establish trustworthiness. [26][27][28][29] Data were analyzed from February 5 to May 31, 2022.…”

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 99%

“…However, to our knowledge, no prior studies have offered a detailed description of the clinical diagnosis and management of long COVID within health care systems. To address this knowledge gap, we conducted a qualitative analysis of the electronic health records (EHRs) 26 , 27 , 28 , 29 of a national random sample of patients with a long COVID diagnostic code 6 receiving care in the Department of Veterans Affairs (VA). Our specific research goal was to understand how clinicians approached the diagnosis of long COVID and the challenges they faced in making this diagnosis and caring for patients who had or were suspected to have long COVID.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Complexity and Challenges of the Clinical Diagnosis and Management of Long COVID

et al. 2022

Self Cite

View full text Add to dashboard Cite

ImportanceThere is increasing recognition of the long-term health effects of SARS-CoV-2 infection (sometimes called long COVID). However, little is yet known about the clinical diagnosis and management of long COVID within health systems.ObjectiveTo describe dominant themes pertaining to the clinical diagnosis and management of long COVID in the electronic health records (EHRs) of patients with a diagnostic code for this condition (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code U09.9).Design, Setting, and ParticipantsThis qualitative analysis used data from EHRs of a national random sample of 200 patients receiving care in the Department of Veterans Affairs (VA) with documentation of a positive result on a polymerase chain reaction (PCR) test for SARS-CoV-2 between February 27, 2020, and December 31, 2021, and an ICD-10 diagnostic code for long COVID between October 1, 2021, when the code was implemented, and March 1, 2022. Data were analyzed from February 5 to May 31, 2022.Main Outcomes and MeasuresA text word search and qualitative analysis of patients’ VA-wide EHRs was performed to identify dominant themes pertaining to the clinical diagnosis and management of long COVID.ResultsIn this qualitative analysis of documentation in the VA-wide EHR, the mean (SD) age of the 200 sampled patients at the time of their first positive PCR test result for SARS-CoV-2 in VA records was 60 (14.5) years. The sample included 173 (86.5%) men; 45 individuals (22.5%) were identified as Black and 136 individuals (68.0%) were identified as White. In qualitative analysis of documentation pertaining to long COVID in patients’ EHRs 2 dominant themes were identified: (1) clinical uncertainty, in that it was often unclear whether particular symptoms could be attributed to long COVID, given the medical complexity and functional limitations of many patients and absence of specific markers for this condition, which could lead to ongoing monitoring, diagnostic testing, and specialist referral; and (2) care fragmentation, describing how post–COVID-19 care processes were often siloed from and poorly coordinated with other aspects of care and could be burdensome to patients.Conclusions and RelevanceThis qualitative study of documentation in the VA EHR highlights the complexity of diagnosing long COVID in clinical settings and the challenges of caring for patients who have or are suspected of having this condition.

show abstract

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complexity and Challenges of the Clinical Diagnosis and Management of Long COVID

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…This process has been previously applied to medical record review [13][14][15][16][17] and was conducted in three steps as described below.…”

Section: Approach To Qualitative Analysis and Taxonomy Developmentmentioning

confidence: 99%

Use of electronic health records to develop an actionable taxonomy of persistent hypertension

Khidir

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: The digital transformation of medical data presents opportunities for novel approaches to manage patients with persistent hypertension (defined as multiple measurements of elevated BP over 6 months). We sought to develop an actionable taxonomy of patients with persistent hypertension based on clinical data from the electronic health records (EHR). Methods: This qualitative study was a content analysis of clinician notes in the EHR of patients in the Yale New Haven Health System. Eligible patients were 18 to 85 years and had blood pressure ≥160/100 mmHg at five or more consecutive outpatient visits between January 1st 2013 to October 31st 2018. A total of 4,828 patients met criteria, of which 200 records were randomly selected for chart review. Through a systematic, inductive approach, we developed a rubric to abstract data from the EHR and then analyzed the abstracted data qualitatively using conventional content analysis until saturation was reached. Results: We reached saturation with 115 patients, who had a mean age of 68.1 (SD, 11.6) years; 54.8% were female; 52.2%, 30.4%, and 13.9% were White, Black, and Hispanic people. We identified three content domains related to persistence of hypertension: (1) non-intensification of pharmacological treatment (defined as absence of antihypertensive treatment intensification in response to persistent severely elevated blood pressure) with four subcategories, including provider purview, competing medical priorities, patient preference, and de-emphasis of the office measurement; (2) non-implementation of prescribed treatment (defined as a documentation of provider recommending a specified treatment plan to address hypertension but treatment plan not being implemented) with four subcategories, including obstacles to obtaining medications, psychosocial barriers, patient misunderstanding, and negative medication experience; and (3) non-response to prescribed treatment (defined as clinician-acknowledged persistent hypertension despite documented effort to escalate existing pharmacologic agents and addition of additional pharmacologic agents with presumption of adherence) with two subcategories, including resistant hypertension and secondary hypertension. Conclusions: This study presents a novel actionable taxonomy for classifying patients with persistent hypertension by their contributing causes based on EHR data. These categories can be automated and linked to specific types of actions to address them.

show abstract

“…9,12,19 Waitlisted patients are increasingly willing to accept transplants from HCV-viremic donors. 1,20 Consequently, investigators have called for patient-centered research promoting rigorous informed consent and patient education, 5,[21][22][23][24] including evaluation of transplant candidates' informational needs and decision-making processes surrounding HCV-viremic donor organs. 19,21,25 To date, only one study 26 assessed the experiences of HCV-negative recipients transplanted with HCV-viremic organs.…”

mentioning

confidence: 99%

Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection

Saine

Schnellinger

Liu

et al. 2022

Transplantation Direct

View full text Add to dashboard Cite

Background. Historically, many organs from deceased donors with hepatitis C virus (HCV) were discarded. The advent of highly curative direct-acting antiviral (DAA) therapies motivated transplant centers to conduct trials of transplanting HCV-viremic organs (nucleic acid amplification test positive) into HCV-negative recipients, followed by DAA treatment. However, the factors that influence candidates’ decisions regarding acceptance of transplant with HCV-viremic organs are not well understood. Methods. To explore patient-level perceptions, influences, and experiences that inform candidate decision-making regarding transplant with organs from HCV-viremic donors, we conducted a qualitative semistructured interview study embedded within 3 clinical trials investigating the safety and efficacy of transplanting lungs and kidneys from HCV-viremic donors into HCV-negative recipients. The study was conducted from June 2019 to March 2021. Results. Among 44 HCV-negative patients listed for organ transplant who were approached for enrollment in the applicable clinical trial, 3 approaches to decision-making emerged: positivist, risk analyses, and instinctual response. Perceptions of risk contributed to conceptualizations of factors influencing decisions. Moreover, most participants relied on multiple decision-making approaches, either simultaneously or sequentially. Conclusions. Understanding how different decisional models influence patients’ choices regarding transplant with organs from HCV-viremic donors may promote shared decision-making among transplant patients and providers.

show abstract

Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant

Cited by 20 publications

References 46 publications

Complexity and Challenges of the Clinical Diagnosis and Management of Long COVID

Complexity and Challenges of the Clinical Diagnosis and Management of Long COVID

Use of electronic health records to develop an actionable taxonomy of persistent hypertension

Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection

Contact Info

Product

Resources

About