Methodologic issues in health informatics trials: the complexities of complex interventions.

OBJECTIVE All electronic health (e-health) interventions require validation as health information technologies, ideally in randomized controlled trial settings. However, as with other types of complex interventions involving various active components and multiple targets, health informatics trials often experience problems of design, methodology, or analysis that can influence the results and acceptance of the research. Our objective was to review selected key methodologic issues in conducting and reporting randomized controlled trials in health informatics, provide examples from a recent study, and present practical recommendations.

A comprehensive appropriateness of prescribing questionnaire was validated by nominal consensus group.

Objective: To develop and validate a comprehensive Appropriateness of Prescribing Evaluation Questionnaire (APEQ) suitable for human and computer use.

Study Design And Setting: This study was part of an ongoing research program examining the effectiveness and cost-effectiveness of computerized prescribing decision support for providers, patients, and drug policy. A nominal group consensus process involved physicians, both primary care physicians and specialists, pharmacists, drug plan managers, patients, patient advocates, and pharmaceutical industry.

The role of metals in the etiology of Alzheimer's disease.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder and the most common cause of dementia, affecting millions of men and women worldwide. It is characterized by the accumulation of extracellular amyloid-beta (A beta) plaques and neurofibrillary tangles inside neurons and dystrophic neurons. Several risk factors are associated with the early onset and progression of the disease.

E-health interventions as complex interventions: improving the quality of methods of assessment.

E-health interventions require rigorous evaluation, preferably within a randomized trial. Health technology assessment and complex intervention methodologies exist, but are often not used in health informatics research. We propose a framework of methodologic issues which should be considered for every e-health intervention.

Racial disparity in hypertensive disorders of pregnancy in New York State: a 10-year longitudinal population-based study.

Objectives: We studied trends of hypertensive disorders of pregnancy by residential socioeconomic status (SES) and racial/ethnic subgroups in New York State over a 10-year period.

Methods: We merged New York State discharge data for 2.5 million women hospitalized with delivery from 1993 through 2002 with 2000 US Census data.

Hazardous waste sites and stroke in New York State.

Background: Environmental exposure to persistent organic pollutants (POPs) may lead to elevation of serum lipids, increasing risk of atherosclerosis with thromboembolism, a recognized cause of stroke. We tested the hypothesis that exposure to contaminants from residence near hazardous waste sites in New York State influences the occurrence of stroke.

Methods: The rates of stroke hospital discharges were compared among residents of zip codes containing hazardous waste sites with POPs, other pollutants or without any waste sites using information for 1993-2000 from the New York Statewide Planning and Research Cooperative System (SPARCS) database, containing the records of all discharge diagnoses for patients admitted to state-regulated hospitals.