A Retrospective Comparison of Creatinine Changes Among Patients Receiving, Not Receiving, and Not Yet Receiving Contrast Administration.

Objective: We sought to compare variability in serum creatinine among inpatients in our institution receiving contrast imaging studies and among inpatients not receiving such studies.

Materials And Methods: This retrospective, single-site, multiple-cohort study in a 550-bed academic medical center in October 2016 used the electronic medical record data to analyze the greatest absolute and relative changes in serum creatinine over periods no longer than 48 hours (1) during the admission for 1,134 patients who did not receive a contrast imaging study, (2) before the earliest contrast study for 155 patients who had not yet had a scheduled contrast examination, and (3) straddling the time when 266 patients received their earliest contrast study. We compared creatinine changes in the first cohort with those in the second and the third using histograms and t tests.

Evaluating Report Text Variation and Informativeness: Natural Language Processing of CT Chest Imaging for Pulmonary Embolism.

Objective: The aim of this study was to quantify the variability of language in free text reports of pulmonary embolus (PE) studies and to gauge the informativeness of free text to predict PE diagnosis using machine learning as proxy for human understanding.

Materials And Methods: All 1,133 consecutive chest CTs with contrast studies performed under a PE protocol and ordered in the emergency department in 2016 were selected from our departmental electronic workflow system. We used commercial text-mining and predictive analytics software to parse and describe all report text and to generate a suite of machine learning rules that sought to predict the "gold standard" radiological diagnosis of PE.

Association of Baseline Statin Use Among Older Adults Without Clinical Cardiovascular Disease in the SPRINT Trial.

This secondary analysis of the Systolic Blood Pressure Intervention trial examines whether a treatment program aimed at reducing systolic blood pressure to a lower goal than currently recommended would reduce cardiovascular disease risk among patients without diabetes.

Survival Outcomes Following the Use of Extracorporeal Membrane Oxygenation as a Rescue Technology in Critically Ill Patients: Results From Pennsylvania 2007-2015.

Objective: To examine real-world outcomes of survival, length of stay, and discharge destination, among all adult extracorporeal membrane oxygenation admissions in one state over nearly a decade.

Design: Retrospective analysis of administrative discharge data.

Setting: State-wide administrative discharge data from Pennsylvania between 2007 and 2015.

Volume-Outcome Relationships in Extracorporeal Membrane Oxygenation: Retrospective Analysis of Administrative Data From Pennsylvania, 2007-2015.

This article seeks to understand whether a volume-outcome relationship exists in adult extracorporeal membrane oxygenation (ECMO). We examined primary administrative discharge data from the Pennsylvanian Health Care Cost Containment Council for all 2,948 consecutive adults treated with ECMO in Pennsylvania between January 1, 2007, and December 31, 2015. We used a well-fitting backwards stepwise logistic regression to obtain patient-level predicted mortality.

Serious Adverse Events Among SPRINT Trial Participants Taking Statins at Baseline.

Background: Real-world evidence of statin side effects is potentially biased because statin use is neither randomized nor unblinded. An innovative study design can mitigate these biases. For example, in the recent ASCOT-LLA trial, patient-reported adverse events such as muscle pain and weakness were higher in the non-randomized and non-blinded setting than in the randomized, blinded setting.

Commercial Online Social Network Data and Statin Side-Effect Surveillance: A Pilot Observational Study of Aggregate Mentions on Facebook.

Introduction: Surveillance of the safety of prescribed drugs after marketing approval has been secured remains fraught with complications. Formal ascertainment by providers and reporting to adverse-event registries, formal surveys by manufacturers, and mining of electronic medical records are all well-known approaches with varying degrees of difficulty, cost, and success. Novel approaches may be a useful adjunct, especially approaches that mine or sample internet-based methods such as online social networks.

Evaluation of the "Angelina Jolie Effect" on Screening Mammography Utilization in an Academic Center.

Purpose: The aim of this study was to understand the impact on screening mammography at our institution, comparing weekly utilization in the 2 years before and the 2 years after Ms Angelina Jolie disclosed in the New York Times on May 13, 2013, that she had had a prophylactic double mastectomy.

Methods: All 48,110 consecutive screening mammograms conducted at our institution between May 16, 2011, and May 16, 2015, were selected from our electronic medical record system. We used interrupted time series statistical models and graphical methods on utilization data to understand utilization changes before and after Ms Jolie's news.

Frequencies of Private Mentions and Sharing of Mammography and Breast Cancer Terms on Facebook: A Pilot Study.

Background: The most popular social networking site in the United States is Facebook, an online forum where circles of friends create, share, and interact with each other's content in a nonpublic way.

Objective: Our objectives were to understand (1) the most commonly used terms and phrases relating to breast cancer screening, (2) the most commonly shared website links that other women interacted with, and (3) the most commonly shared website links, by age groups.

Methods: We used a novel proprietary tool from Facebook to analyze all of the more than 1.

The Challenges in Predicting ECMO Survival, and a Path Forward.

Extracorporeal membrane oxygenation (ECMO) support is a life-saving but complex technique for patients suffering from severe cardiac or pulmonary dysfunction. Increasingly greater utilization in the last 15 years means that a suite of mortality risk analytics is both feasible for researchers and required by clinicians, patients, administrators, and insurers. We argue that to date, research into such risk analytics has been insufficient and does not adequately reflect the various indications and configurations of extracorporeal life support (ECLS).

Lung Cancer Care Before and After Medicare Eligibility.

Uninsured and underinsured near-elderly may not have timely investigation, diagnosis, or care of cancer. Prior studies suggest Medicare eligibility confers significant and substantial reductions in mortality and increases in health service utilization. We compared 2245 patients diagnosed with lung cancer at ages 64.

Prostate Cancer Care Before and After Medicare Eligibility.

Prior studies suggest Medicare eligibility confers significant and substantial reductions in mortality and beneficial increases in health service utilization. We compared 13,882 patients diagnosed with prostate cancer at ages 63 to 64 years with 14,774 patients diagnosed at ages 65 to 66 (controls) in 2004 to 2007. Compared with controls, patients diagnosed with prostate cancer before Medicare eligibility had no statistically significant or meaningful differences in cancer stage, time to treatment, or type of treatment.

Using Social Media, Online Social Networks, and Internet Search as Platforms for Public Health Interventions: A Pilot Study.

Objective: To pilot public health interventions at women potentially interested in maternity care via campaigns on social media (Twitter), social networks (Facebook), and online search engines (Google Search).

Data Sources/study Setting: Primary data from Twitter, Facebook, and Google Search on users of these platforms in Los Angeles between March and July 2014.

Study Design: Observational study measuring the responses of targeted users of Twitter, Facebook, and Google Search exposed to our sponsored messages soliciting them to start an engagement process by clicking through to a study website containing information on maternity care quality information for the Los Angeles market.

Electronic medical record-based multicondition models to predict the risk of 30 day readmission or death among adult medicine patients: validation and comparison to existing models.

Background: There is increasing interest in using prediction models to identify patients at risk of readmission or death after hospital discharge, but existing models have significant limitations. Electronic medical record (EMR) based models that can be used to predict risk on multiple disease conditions among a wide range of patient demographics early in the hospitalization are needed. The objective of this study was to evaluate the degree to which EMR-based risk models for 30-day readmission or mortality accurately identify high risk patients and to compare these models with published claims-based models.

Clinical evidence inputs to comparative effectiveness research could impact the development of novel treatments.

Aim: This study aims to analyze the impacts of a range of clinical evidence generation scenarios associated with comparative effectiveness research (CER) on pharmaceutical innovation.

Materials & Methods: We used the Global Pharmaceutical Policy Model to project the effect of changes in pharmaceutical producer costs, revenues and timings on drug innovation and health for the age 55+ populations in the USA and Europe through year 2060 using three clinical scenarios.

Results: Changes in producer incentives from widespread CER evidence generation and use had varied but often large predicted impacts on simulated outcomes in 2060.

Factors associated with increased cesarean risk among African American women: evidence from California, 2010.

Objectives: We studied if both observed and unobserved maternal health in African American women in hospitals or communities were associated with cesarean delivery of infants.

Methods: We examined the relationship between African American race and cesarean delivery among 493 433 women discharged from 255 Californian hospitals in 2010 using administrative data; we adjusted for patient comorbidities and maternal, fetal, and placental risk factors, as well as clustering of patients within hospitals.

Results: Cesarean rates were significantly higher overall for African American women than other women (unadjusted rate 36.

Implementing electronic health care predictive analytics: considerations and challenges.

The use of predictive modeling for real-time clinical decision making is increasingly recognized as a way to achieve the Triple Aim of improving outcomes, enhancing patients' experiences, and reducing health care costs. The development and validation of predictive models for clinical practice is only the initial step in the journey toward mainstream implementation of real-time point-of-care predictions. Integrating electronic health care predictive analytics (e-HPA) into the clinical work flow, testing e-HPA in a patient population, and subsequently disseminating e-HPA across US health care systems on a broad scale require thoughtful planning.

Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012.

Objectives: Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information.

Setting And Design: A leading Internet search engine (Google) was the main focus of the study.