A Comparison of Veterans with Problematic Opioid Use Identified through Natural Language Processing of Clinical Notes versus Using Diagnostic Codes.

Opioid use disorder is known to be under-coded as a diagnosis, yet problematic opioid use can be documented in clinical notes, which are included in electronic health records. We sought to identify problematic opioid use from a full range of clinical notes and compare the demographic and clinical characteristics of patients identified as having problematic opioid use exclusively in clinical notes to patients documented through ICD opioid use disorder diagnostic codes. We developed and applied a natural language processing (NLP) tool that combines rule-based pattern analysis and a trained support vector machine to the clinical notes of a patient cohort (n = 222,371) from two Veteran Affairs service regions to identify patients with problematic opioid use.

Multicenter Tract-Based Analysis of Microstructural Lesions within the Alzheimer's Disease Spectrum: Association with Amyloid Pathology and Diagnostic Usefulness.

Diffusion changes as determined by diffusion tensor imaging are potential indicators of microstructural lesions in people with mild cognitive impairment (MCI), prodromal Alzheimer's disease (AD), and AD dementia. Here we extended the scope of analysis toward subjective cognitive complaints as a pre-MCI at risk stage of AD. In a cohort of 271 participants of the prospective DELCODE study, including 93 healthy controls and 98 subjective cognitive decline (SCD), 45 MCI, and 35 AD dementia cases, we found reductions of fiber tract integrity in limbic and association fiber tracts in MCI and AD dementia compared with controls in a tract-based analysis (p < 0.

Using comparative effectiveness research to remedy health disparities.

Health disparities are an important and continuing problem of considerable research importance. Comparative effectiveness research (CER) is an excellent vehicle to evaluate interventions to remedy disparities. We classify CER for disparities at three levels of science: basic biology, care and systems, and social and cultural context.

Commentary: building human capital: discovery, learning, and professional satisfaction.

Physician satisfaction is an important contributor to a well-functioning health system. Mohr and Burgess report that physicians in the Veterans Health Administration (VA) who spend time in research have greater overall job satisfaction, that satisfaction tracks with aggregate facility research funding, and that satisfaction is higher among physicians working in VA facilities located on the same campus or within walking distance of an affiliated medical school. An environment conducive to research therefore not only advances science but also seems to be a key element of physician satisfaction.

Implementation research: a critical component of realizing the benefits of comparative effectiveness research.

Comparative effectiveness research (CER) holds the promise of improving patient-centered care and increasing value in the healthcare system. Achieving these goals, however, depends on effectively implementing the findings of CER. In this article, we draw on lessons from implementation research and our experience in the Veterans Administration (VA) healthcare system to offer recommendations about what is needed to support implementation of CER.

The past, present, and future of comparative effectiveness research in the US Department of Veterans Affairs.

A particular challenge for the healthcare provider and the patient is to choose among competing therapeutic approaches for a particular condition. Often, the relative benefits and risks of potential therapies are not uniformly available from the existing scientific information. Many have pointed to the need for more comparative effectiveness research (CER) to aide in these decisions.

The Veterans Affairs experience: comparative effectiveness research in a large health system.

Comparative effectiveness research is a tool to use in achieving patient-centered, high-value health care. However, applying the results to individual patients and health systems raises unique issues. Here, we review lessons learned by the Veterans Health Administration (VHA) in developing and implementing the research in a large integrated health system.

Comparative effectiveness research: what kind of studies do we need?

Comparative effectiveness research (CER) is increasingly popular, yet discussions of its conduct and consequences often overlook the extensive history of comparing different therapeutic options in patient-oriented research. In particular, research in the Department of Veterans Affairs (VA) has included a decades-long focus on generating information that can enhance medical decision making and improve health outcomes. Categories of such research include multisite randomized controlled trials (conducted by the Cooperative Studies Program) and observational studies involving either primary or secondary data collection.

Information technology and the inferential gap.

In medical practice, an "inferential gap" exists in two contexts: the nonapplication of relevant existing evidence, and the absence of evidence germane to a particular clinical situation. Randomized controlled trials are the current gold standard of evidence development; however, they suffer limits of generalization to the "real world." Conversely, observational studies might be more generalizable but are prone to bias, data inconsistency, and measurement error.

Advancing evidence-based care for diabetes: lessons from the Veterans Health Administration.

The Veterans Health Administration (VHA) is a unique laboratory for using the electronic health record (EHR) to transform health care and accelerate discovery. This is particularly evident in the care of veterans with diabetes, who constitute a quarter of those served by the VHA. Although EHRs have enabled rapid learning, additional factors were necessary, including the lead participation of clinician-investigators, accountability through performance measurement, a delivery system focused on population health, and favorable economic externalities.