A GPT-based EHR modeling system for unsupervised novel disease detection.

Objective: To develop an Artificial Intelligence (AI)-based anomaly detection model as a complement of an "astute physician" in detecting novel disease cases in a hospital and preventing emerging outbreaks.

Methods: Data included hospitalized patients (n = 120,714) at a safety-net hospital in Massachusetts. A novel Generative Pre-trained Transformer (GPT)-based clinical anomaly detection system was designed and further trained using Empirical Risk Minimization (ERM), which can model a hospitalized patient's Electronic Health Records (EHR) and detect atypical patients.

Metabolic Disease and The Risk of Post-COVID Conditions: A Retrospective Cohort Study.

Objective: To examine the influence of having a baseline metabolic disorder (diabetes, hypertension, and/or obesity) on the risk of developing new clinical sequelae potentially related to SARS-CoV-2 in a large sample of commercially insured adults in the US.

Design Setting And Participants: Deidentified data were collected from the IBM/Watson MarketScan Commercial Claims and Encounters (CCAE) Databases and Medicare Supplemental and Coordination of Benefits (MDCR) Databases from 2019 to 2021. A total of 839,344 adults aged 18 and above with continuous enrollment in the health plan were included in the analyses.

Development and Assessment of a New Framework for Disease Surveillance, Prediction, and Risk Adjustment: The Diagnostic Items Classification System.

Importance: Current disease risk-adjustment formulas in the US rely on diagnostic classification frameworks that predate the .

Objective: To develop an -based classification framework for predicting diverse health care payment, quality, and performance outcomes.

Design Setting And Participants: Physician teams mapped all diagnoses into 3 types of diagnostic items (DXIs): main effect DXIs that specify diseases; modifiers, such as laterality, timing, and acuity; and scaled variables, such as body mass index, gestational age, and birth weight.

Risk Factors for Admission Within a Hospital-Based COVID-19 Home Monitoring Program.

Background: Despite increasing vaccination rates, coronavirus disease 2019 (COVID-19) continues to overwhelm heath systems worldwide. Few studies follow outpatients diagnosed with COVID-19 to understand risks for subsequent admissions. We sought to identify hospital admission risk factors in individuals with COVID-19 to guide outpatient follow-up and prioritization for novel therapeutics.

Pediatric surgical site infections in 287 hospitals in the United States, 2015-2018.

Among 287 US hospitals reporting data between 2015 and 2018, annual pediatric surgical site infection (SSI) rates ranged from 0% for gallbladder to 10.4% for colon surgeries. Colon, spinal fusion, and small-bowel SSI rates did not decrease with greater surgical volumes in contrast to appendix and ventricular-shunt SSI rates.

Projected Long-Term Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Hepatitis C Outcomes in the United States: A Modeling Study.

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted access to and uptake of hepatitis C virus (HCV) care services in the United States. It is unknown how substantially the pandemic will impact long-term HCV-related outcomes.

Methods: We used a microsimulation to estimate the 10-year impact of COVID-19 disruptions in healthcare delivery on HCV outcomes including identified infections, linkage to care, treatment initiation and completion, cirrhosis, and liver-related death.

Time to SARS-CoV-2 PCR Clearance in Immunocompromising Conditions: Is Test-Based Removal From Isolation Necessary in Severely Immunocompromised Individuals?

To determine the association between immunosuppression and time to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) clearance, we studied 3758 adults retested following initial SARS-CoV-2 infection. Cox proportional hazards models demonstrated delayed PCR clearance with older age, multiple comorbidities, and solid organ transplant but not by degree of immunocompromise. These findings challenge current retesting practices.

Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before and After the Affordable Care Act.

This cross-sectional study uses national claims data to assess trends in well-child care visits with out-of-pocket costs before and after passage of the Affordable Care Act.

Health Care-Associated Infections Among Critically Ill Children in the US, 2013-2018.

Importance: Central catheter-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) increase morbidity, mortality, and health care costs in pediatric patients.

Objective: To examine changes over time in CLABSI and CAUTI rates between 2013 and 2018 in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) using prospective surveillance data from community hospitals, children's hospitals, and pediatric units within general hospitals.

Design, Setting, And Participants: This time series study included 176 US hospitals reporting pediatric health care-associated infection surveillance data to the National Healthcare Safety Network from January 1, 2013, to June 30, 2018.

Association Between Federal Value-Based Incentive Programs and Health Care-Associated Infection Rates in Safety-Net and Non-Safety-Net Hospitals.

Importance: In the US, federal value-based incentive programs are more likely to penalize safety-net institutions than non-safety-net institutions. Whether these programs differentially change the rates of targeted health care-associated infections in safety-net vs non-safety-net hospitals is unknown.

Objective: To assess the association of Hospital-Acquired Condition Reduction Program (HACRP) and Hospital Value-Based Purchasing (HVBP) implementation with changes in rates of targeted health care-associated infections and disparities in rates among safety-net and non-safety-net hospitals.

Diagnostic Category Prevalence in 3 Classification Systems Across the Transition to the International Classification of Diseases, Tenth Revision, Clinical Modification.

Importance: On October 1, 2015, the US transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for recording diagnoses, symptoms, and procedures. It is unknown whether this transition was associated with changes in diagnostic category prevalence based on diagnosis classification systems commonly used for payment and quality reporting.

Objective: To assess changes in diagnostic category prevalence associated with the ICD-10-CM transition.

Provision of Utility Shut-off Protection Letters at an Urban Safety-Net Hospital, 2009-2018.

Most states prohibit utility companies from terminating service to low-income households when occupants present a medical letter confirming a household member has a chronic serious illness. It is unclear how many patients receive these letters and whether screening for health-related social needs (HRSN) identifies these patients. We analyzed characteristics of adult patients at a safety-net hospital with a utility shut-off protection letter 2009-2018.

A National Approach to Pediatric Sepsis Surveillance.

Pediatric sepsis is a major public health concern, and robust surveillance tools are needed to characterize its incidence, outcomes, and trends. The increasing use of electronic health records (EHRs) in the United States creates an opportunity to conduct reliable, pragmatic, and generalizable population-level surveillance using routinely collected clinical data rather than administrative claims or resource-intensive chart review. In 2015, the US Centers for Disease Control and Prevention recruited sepsis investigators and representatives of key professional societies to develop an approach to adult sepsis surveillance using clinical data recorded in EHRs.