Antibiotic prescribing by telephone in primary care.

Objectives: Little is known about the contribution of telephone-based prescribing on overall antibiotic utilization. The objective of this study was to determine the extent and characteristics of telephone-based antibiotic prescribing in teaching and non-teaching primary care practices.

Methods: This retrospective cohort study included all patients (n = 114 610) cared for by teaching and non-teaching internal medicine, pediatrics, family practice, and obstetrics/gynecology practices (n = 19) affiliated with a large US healthcare system during 2006-2010 and using a common electronic medical record.

Using the AUDIT-PC to predict alcohol withdrawal in hospitalized patients.

Background: Alcohol withdrawal syndrome (AWS) occurs when alcohol-dependent individuals abruptly reduce or stop drinking. Hospitalized alcohol-dependent patients are at risk. Hospitals need a validated screening tool to assess withdrawal risk, but no validated tools are currently available.

Comparative effectiveness research using electronic health records: impacts of oral antidiabetic drugs on the development of chronic kidney disease.

Purpose: Little is known about the comparative effects of common oral antidiabetic drugs ([OADs] metformin, sulfonylureas, or thiazolidinediones [THZs]) on chronic kidney disease (CKD) outcomes in patients newly diagnosed with type 2 diabetes (T2DM) and followed in community primary care practices. Electronic health records (EHRs) were used to evaluate the relationships between OAD class use and incident proteinuria and prevention of glomerular filtration rate decline.

Methods: A retrospective cohort study on newly diagnosed T2D cases requiring OADs documented in the EHRs of two primary care networks between 1998 and 2009 was conducted.

Early data from Project Engage: a program to identify and transition medically hospitalized patients into addictions treatment.

Background: Patients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalizations. Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients at admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES).

Patterns of warfarin use and subsequent outcomes in atrial fibrillation in primary care practices.

Background: Warfarin is recommended for stroke prevention in high-risk patients with atrial fibrillation. However, it is often underutilized and inadequately managed in actual clinical practice.

Objectives: To examine the patterns of warfarin use and their relationship with stroke and bleeding in atrial fibrillation patients in community-based primary care practices.

Initial and subsequent therapy for newly diagnosed type 2 diabetes patients treated in primary care using data from a vendor-based electronic health record.

Background: Diabetes is a leading cause of death and disability, and its prevalence is increasing. When diet fails, patients with type 2 diabetes mellitus (T2DM) are prescribed oral hypoglycemics for glycemic control. Few studies have explored initial use or change from initial oral hypoglycemic therapy in the primary care setting.

Electronic health record use to classify patients with newly diagnosed versus preexisting type 2 diabetes: infrastructure for comparative effectiveness research and population health management.

Use of electronic health record (EHR) content for comparative effectiveness research (CER) and population health management requires significant data configuration. A retrospective cohort study was conducted using patients with diabetes followed longitudinally (N=36,353) in the EHR deployed at outpatient practice networks of 2 health care systems. A data extraction and classification algorithm targeting identification of patients with a new diagnosis of type 2 diabetes mellitus (T2DM) was applied, with the main criterion being a minimum 30-day window between the first visit documented in the EHR and the entry of T2DM on the EHR problem list.

Efficiency and economic benefits of a payer-based electronic health record in an emergency department.

Objectives: The objective was to evaluate the use of a payer-based electronic health record (P-EHR), which is a clinical summary of a patient's medical and pharmacy claims history, in an emergency department (ED) on length of stay (LOS) and plan payments.

Methods: A large urban ED partnered with the dominant health plan in the region and implemented P-EHR technology in September 2005 for widespread use for health plan members presenting to the ED. A retrospective observational study design was used to evaluate this previously implemented P-EHR.

Cost effectiveness of enoxaparin in acute ST-segment elevation myocardial infarction: the ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 25) study.

Objectives: We used a U.S. model of health care costs to examine the cost effectiveness of enoxaparin compared with unfractionated heparin (UFH) as adjunctive therapy for fibrinolysis in patients with ST-segment elevation myocardial infarction (STEMI).

The risk of cardiovascular events in primary care patients following an episode of severe hypertension.

This retrospective study of office and hospital electronic medical records from June 1991 to June 2007 examines the occurrence of severe blood pressure (BP) elevation (>180/110 mm Hg) and the subsequent risk of cardiovascular events in a diverse set of primary care practices. A total of 18,747 patients were categorized according to BP using 3 methodologies based on the highest historical value, the first recorded value, and time-averaged antecedent values. During the follow-up period (median 3.

Determining the in-hospital cost of bleeding in patients undergoing percutaneous coronary intervention.

Background: The economic impact of bleeding in the setting of nonemergent percutaneous coronary intervention (PCI) is poorly understood and complicated by the variety of bleeding definitions currently employed. This retrospective analysis examines and contrasts the in-hospital cost of bleeding associated with this procedure using six bleeding definitions employed in recent clinical trials.

Methods: All nonemergent PCI cases at Christiana Care Health System not requiring a subsequent coronary artery bypass were identified between January 2003 and March 2006.

The impact of ethnicity and gender on agreement of severe allergy history between inpatient and outpatient electronic medical records.

Objective: To evaluate the rate of allergy documentation during inpatient admissions and determine if discrepancies exist between ethnicities and English proficiency, genders, and by medication classes.

Methods: Patients at an outpatient clinic with severe medication allergies documented in their electronic medical record were identified. Inpatient hospital admissions following the date this allergy was documented were reviewed and the presence or absence of this documentation in the inpatient electronic medical record was noted.

Appropriate admissions to the appropriate unit: a decision tree approach.

An intermediate care decision tree tool was developed to meet the demand for intermediate care beds. Concurrently, a charging process was developed to support the acuity adaptable model of care, allowing the patient to remain in the same bed from admission to discharge, regardless of level of care required, adjusting nurse-to-patient ratios as acuity changes. Since beginning this pilot, 96% to 100% of the patients admitted to intermediate care from the emergency department met the criteria.