Underserved populations with missing race ethnicity data differ significantly from those with structured race/ethnicity documentation

Sholle, Evan; Pinheiro, Laura C.; Adekkanattu, Prakash; Davila, Marcos A; Johnson, Stephen B.; Pathak, Jyotishman; Sinha, Sanjai; Li, Cassidie; Lubansky, Stasi A; Safford, Monika M.; Campion, Thomas R.

doi:10.1093/jamia/ocz040

Cited by 53 publications

(44 citation statements)

References 12 publications

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“…Our NLP pipeline, built using the Apache Unstructured Information Management Architecture-based Leo system, was validated by a manual review of 400 notes and achieved precision of 0.885, recall of 0.939, and F score of 0.911 for classifying black patients. 10 We have described details of the rule-based approach to extract race and ethnicity entities 10 and made the code available at https://github.com/ wcmc-research-informatics/CIREX.…”

Section: Race Data Supplementation Methodsmentioning

confidence: 99%

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A Method to Improve Availability and Quality of Patient Race Data in an Electronic Health Record System

et al. 2020

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Background Although federal regulations mandate documentation of structured race data according to Office of Management and Budget (OMB) categories in electronic health record (EHR) systems, many institutions have reported gaps in EHR race data that hinder secondary use for population-level research focused on underserved populations. When evaluating race data available for research purposes, we found our institution's enterprise EHR contained structured race data for only 51% (1.6 million) of patients. Objectives We seek to improve the availability and quality of structured race data available to researchers by integrating values from multiple local sources. Methods To address the deficiency in race data availability, we implemented a method to supplement OMB race values from four local sources—inpatient EHR, inpatient billing, natural language processing, and coded clinical observations. We evaluated this method by measuring race data availability and data quality with respect to completeness, concordance, and plausibility. Results The supplementation method improved race data availability in the enterprise EHR up to 10% for some minority groups and 4% overall. We identified structured OMB race values for more than 142,000 patients, nearly a third of whom were from racial minority groups. Our data quality evaluation indicated that the supplemented race values improved completeness in the enterprise EHR, originated from sources in agreement with the enterprise EHR, and were unbiased to the enterprise EHR. Conclusion Implementation of this method can successfully increase OMB race data availability, potentially enhancing accrual of patients from underserved populations to research studies.

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Section: Race Data Supplementation Methodsmentioning

confidence: 99%

“…9 This has a concrete impact on the conduct of observational research or patient cohort discovery reliant on EHR data, given that patients missing structured race data may more likely be from underserved racial groups. 10…”

Section: Background and Significancementioning

confidence: 99%

A Method to Improve Availability and Quality of Patient Race Data in an Electronic Health Record System

et al. 2020

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“…There was a potential for bias in recording of patient characteristics, for example, older patients are more likely to be missing ethnicity. 25 Nonetheless, apart from ethnicity, the proportions of missing data are low. Lastly, our ndings on e-consultations may not be as transferable as the other ndings.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study

Murphy

Scott

Salisbury

et al. 2020

Preprint

123

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Background: To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video or online consultation platforms.Aim: To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic.Design and Setting: Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire.Methods: Quantitative: Longitudinal observational analysis comparing volume and type of consultations in April-July 2020 with April-July 2019. Negative binomial models were used to identify if changes differed amongst different groups of patients. Qualitative: 87 practice staff longitudinal interviews in four rounds investigated practices experience of the move to remote consulting, challenges faced and solutions. A thematic analysis utilised Normalisation Process Theory.Results: There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April-July 2020 compared to 2019; GPs/nurses maintained a focus on older patients, shielding patients and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased.Conclusions: The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model may need adjustment.

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“…WCIMA is a large, academic, hospital-based primary care practice of Weill Cornell Medicine and NewYork-Presbyterian Hospital (https://weillcornell.org/ wcima). As a high-volume tertiary-care clinic, it averages 53,000 office visits per year and serves a diverse patient population (13). At WCIMA, 31 attending physicians, 11 nurse practitioners, and six registered nurses provide care, alongside 129 residents and interns.…”

Section: Setting and Patient Populationmentioning

confidence: 99%

Implementation of Video Visits During COVID-19: Lessons Learned From a Primary Care Practice in New York City

Sinha

Kern

Gingras

et al. 2020

Front. Public Health

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Background: During the height of the coronavirus (COVID-19) pandemic, there was an unprecedented demand for "virtual visits," or ambulatory visits conducted via video interface, in order to decrease the risk of transmission. Objective: To describe the implementation and evaluation of a video visit program at a large, academic primary care practice in New York, NY, the epicenter of the COVID-19 pandemic. Design and participants: We included consecutive adults (age > 18) scheduled for video visits from March 16, 2020 to April 17, 2020 for COVID-19 and non-COVID-19 related complaints. Intervention: New processes were established to prepare the practice and patients for video visits. Video visits were conducted by attendings, residents, and nurse practitioners. Main measures: Guided by the RE-AIM Framework, we evaluated the Reach, Effectiveness, Adoption, and Implementation of video visits. Key results: In the 4 weeks prior to the study period, 12 video visits were completed. During the 5-weeks study period, we completed a total of 1,030 video visits for 817 unique patients. Of the video visits completed, 42% were for COVID-19 related symptoms, and the remainder were for other acute or chronic conditions. Video visits were completed more often among younger adults, women, and those with commercial insurance, compared to those who completed in-person visits pre-COVID (all p < 0.0001). Patients who completed video visits reported high satisfaction (mean 4.6 on a 5-point scale [SD: 0.97]); 13.3% reported technical challenges during video visits. Conclusions: Video visits are feasible for the delivery of primary care for patients during the COVID-19 pandemic.

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Underserved populations with missing race ethnicity data differ significantly from those with structured race/ethnicity documentation

Cited by 53 publications

References 12 publications

A Method to Improve Availability and Quality of Patient Race Data in an Electronic Health Record System

A Method to Improve Availability and Quality of Patient Race Data in an Electronic Health Record System

The implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study

Implementation of Video Visits During COVID-19: Lessons Learned From a Primary Care Practice in New York City

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